Pregnancy and Bup

Buprenorphine Post
compchat57
Posts: 35

Postby compchat57 » Fri Aug 05, 2016 8:37 pm

Here's a link to a consensus opinion.
http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Opioid-Abuse-Dependence-and-Addiction-in-Pregnancy

fishdoc
Posts: 111

Postby fishdoc » Fri Aug 05, 2016 8:37 pm

I have prescribed the combination product, all 3 brands, to many many pregnant women in my private practice, and the Methadone Clinic in which I work has most pregnant women on generic buprenorphine. They watch all these women take the buprenorphine in the clinic so they are able to use the mono product without risk of diversion or abuse.

The Ohio State University Substance Abuse, Treatment, Education and Prevention Program uses Suboxone exclusively.

As a former OB-GYN, I know of no contraindication to naloxone. I, therefore, will only use the combination product for outpatient care.

Like the published data, I have found that the babies have shorter hospitalizations than those treated with methadone.

kcairns
Posts: 571

Postby kcairns » Fri Aug 05, 2016 8:37 pm

Heroin/pills same thing...huge problem out this way is efforts all around to prevent pregnant women getting on mat...ie pressures in other words to keep using instead..and the gov capping of mat care which in these parts will not be benefited by the new rules re limits...the pregnant young woman who know better than authority's what's best for their baby's forced to buy street bup...

Jeremy K
Posts: 109

Postby Jeremy K » Fri Aug 05, 2016 8:37 pm

I should add that I haven't Rx'd to a pregnant woman who was heroin-addicted, that I know of (altho' multi-substance use is very common here as I suppose it is elsewhere); I would suspect the outcomes would be similar however.

Jeremy K
Posts: 109

Postby Jeremy K » Fri Aug 05, 2016 8:37 pm

I have had a few pregnant women that I treated with Bup/Nal (Suboxone). I only did so if their OB knew they were on it and were OK with it. An OB in our eastern KY community actively Rx'd Bup/Nal to many pregnant women for 5-10 years, after encountering heavy %'ges of mostly Oxy-dependent pregnant women with many infants requiring transfer to NICU's. After he began Rx'ing such referrals dropped substantially. Nursery RN's averred that a Suboxone baby was much easier to handle than an Oxy baby. None of the FP's and the pediatrician in our community, who amongst us saw the majority of these babies as outpt, reported any significant problems (e.g. late withdrawal). I was in a position of oversight for this whole affair, having previously done OB as an FP at our hospital, and being the 'physician adviser' for the hospital, so I was the one the hospital looked to to do preliminary review of the OB. I know of no significant complications pre- or postnatally****ociated with the use of Bup/Nal for these patients.
This despite the fact that, AFAIK, the nationwide guidelines are to use Methadone, and, failing that, to use Bup only. However Bup only is, AFAIK, more susceptible to diversion. AFAIK there are NO studies that demonstrate a problem with Naloxone in pregnancy.
I no longer Rx Bup/Nal to pregnant women, only because KY now requires an OB who is certified to Rx Bup to 'sign off' on such, and I know of none that I can call on to do so. Sadly I've had to turn away patients due to this.

kcairns
Posts: 571

Postby kcairns » Fri Aug 05, 2016 8:37 pm

Bup simple safe and wonderful as are the super cute newborns that keep being carried in to see me..up to 3 per family so far...literature abounds.special programs not nec...what is NEC is to end the discrimination our clients face from majority of involved health professionals


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