Pregnant Women May Face Barriers For Opioid Addiction Treatment

Prescription opioid use during pregnancy could lead to misuse, addiction, and even overdose. A 2020 report from the Centers for Disease Control and Prevention (CDC) found that around 6.6% of pregnant people used opioids during their pregnancy.

For women who struggle with opioid use disorder, accessing adequate treatment may be difficult in the United States. A new study published by Vanderbilt University Medical Center sheds light on the barriers that pregnant women may face when trying to get treatment from an addiction care provider in 10 states.

Researchers had trained nine women to schedule appointments over the phone for medication prescription and opioid treatment programs. For each call, the callers were randomly assigned to pretend to be pregnant or not. The callers placed more than 28,000 calls.

The "secret shopper" study revealed that pregnant women were about 20% less likely to be accepted for treatment than non-pregnant women. Those who claimed to be on Medicaid also had a hard time booking an appointment.

For callers who pretended they were pregnant, their pregnancy either hindered or helped them get treatment more quickly. Some providers said that they were uncomfortable treating someone who was pregnant, especially in prescribing buprenorphine, a medication for opioid use disorder.

Many actors encountered unwelcoming reaction from receptionists. Others were told that buprenorphine is not safe during pregnancy. According to the CDC, both buprenorphine and methadone are first-line treatment options for pregnant women with opioid use disorder.

The dismissal or hesitancy in treating pregnant patients reflects the need for better ways to address the opioid crisis. "The opioid crisis is moving much more quickly than the medical community can keep up," Sherry Ross, MD, OB/GYN, and women’s health expert at Providence Saint John’s Health Center, tells Verywell. "That's why we were doing a very poor job at handling the opioid epidemic, especially with pregnant patients."

Possible Effects of Opioid Use on Childbirth

The CDC reports that long-term opioid use during pregnancy could result in poor fetal growth, preterm birth, stillbirth, and specific birth defects.

Opioid use from a pregnant parent could result in a newborn experiencing neonatal abstinence syndrome (NAS), also known as neonatal opioid withdrawal syndrome.

"For a newborn baby, opioid withdrawals can be deadly and fatal, so they would need respiratory support," Medhat Mikhael, MD, pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center, tells Verywell.

Symptoms of NAS can include the following:

• Tremors (trembling)
• Irritability, including excessive or high-pitched crying
• Sleep problems
• Hyperactive reflexes
• Seizures
• Yawning, stuffy nose, or sneezing
• Poor feeding and sucking
• Vomiting
• Loose stools and dehydration
• Increased sweating

Why Doctors May Be Hesitant to Treat Opioid Use Disorder During Pregnancy

There is no treatment for opioid use disorder that would completely guarantee the safety of pregnant patients.

"Some of the physicians feel uncomfortable detoxing her, [and wonder if] putting her through an addiction treatment [during pregnancy] is the right time or we should wait until to deliver the baby," Mikhael says.

Some healthcare professionals, Ross explains, may be uncertain about the correct measures. "I don't think we have the skill set to know what to do properly," she says. "Plus it's a team effort to work with someone who uses opioids during their pregnancy."

Despite this uncertainty, research has indicated that treatment with buprenorphine and methadone can help improve the health of the fetus (and. later, the baby) of pregnant people who are trying to get off of opioids. The National Institute of Drug Abuse reports that this treatment stabilizes "fetal levels of opioids, reducing repeated prenatal withdrawal." In comparison with untreated pregnant people, people on treatment buprenorphine or methadone had a lower risk of NAS and less severe NAS.