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So You're Addicted to Opiates, And Just Became Pregnant - how to deal

Discussion in 'Opiate addiction' started by Rainbowzz, Jun 25, 2010.

  1. Rainbowzz

    Rainbowzz Iridium Member Palladium Member

    Reputation Points:
    Apr 27, 2008
    35 y/o from Canada
    Hello everyone. I am just creating this thread as a placeholder. I Will be adding to it regularly. I endeavor to post as much information, ideas, and opinions on the subject - much like a wiki - however i chose here so that the available information would be veiwable right away. Anyone who wishes to add to t his thread is VERY welcome.

    I decided to do this after veiwing a recent thread on the subject, and realizing this is a subject most never want to touch. So, here I am, Touching it.


    Addiction to Opiates and Pregnancy: An Overveiw



    So you are addicted to opiates. That in and of itself is a huge problem for someone to tackle. Now you have found yourself pregnant, and you are a little lost as to what is the healthiest, most responsible, safest thing for you PERSONALLY to do.

    This thread will endeavor to provide you with as much information as possible for you. Though it is imperative that you seek medical advice IMMEDIATELY if you find yourself in this situation, while you do so, this information will provide you with both the facts and opinions, so that you and your child can be as safe as possible and you can make the most informed decision you can.


    Feelings - You Will Have Many!

    Feelings. Everyone has them, some have difficulty with them, and others love them. Say what you will about feelings, but when it comes to difficult situations, of ANY kind,you are likely to have many mixed feelings. You may find yourself feeling things that surprise or even scare you. Alternatively, you may surprise yourself by being excited when you thought you would be horrified, or even horrified when you thought you would be excited.

    The most important thing about your feelings is that they are FINE to feel - no matter what they are.(of course, any suicidal, or homicidal feelings, or any other feelings which press you to harm yourself or others, should be reported to a doctor immediately)

    The best thing you can do is recognize that you may have some strange or odd feelings about your situation. And also realize that that is ok. Right now is not the time to be fighting with feelings - rather it is the time to sort out what you will do about your situation.


    Pregnancy and Opiates - The Basic Facts

    Pregnancy is inherently hard on a woman's body. Though it is true that women are built for having babies, it does not mean we go through the process with no stress on ourselves both physically and mentally. You can expect many different things to happen to you physically during your pregnancy. I wont cover those - as I wish to focus solely on the addiction side of pregnancy - but if you wish to read more about general pregnancy issues, please visit the following website:


    The Long Term and Short Term Effects of Opiate Addiction

    Opiates are often referred to as narcotics and have been used medically to relieve pain for centuries. In the early 19th century, pure morphine extract was suitable for solution, and with the advent of the hypodermic needle in the mid-19th century, injection of morphine became a common method of pain relief. In 1898, heroin was introduced into the medical community as a remedy for addiction to morphine. However, it was soon revealed that heroin was even more likely to produce addiction than morphine. While opiates began their start in the medical community, they have quickly become one of the most commonly abused drug groups. Today, only codeine and morphine are still used in the clinical setting for pain management. The opiates drug group includes opium, morphine, codeine and heroin, among other synthetic opiates such as Demerol.

    Short-term and Long-term Effects of Opiates

    Opiates can cause serious health complications, such as fatal overdose, spontaneous abortion, and infectious diseases such as HIV/AIDS and hepatitis, particularly in users who inject opiates.

    Opiates have short-term effects that appear quite soon after a dose and last a few hours. After injection of opiates, the user typically reports feeling a rush of euphoria, an increase in body temperature, dry mouth, and a heavy feeling in their limbs. The user then spends the next few hours alternating from a wakeful to a drowsy state until the drug wears off.

    Regular use of opiates leads to a buildup of a user's tolerance. This means that the user must increase their subsequent dose of opiates to achieve the same effect as before. As the user increases their dose over time, they develop physical dependency and addiction. Their body has acclimated to the drug use, and has grown to depend on the presence of drugs in order to function properly. If an opiate user stops the intake of that drug, uncomfortable and even dangerous withdrawal symptoms may occur. Death from a opiate overdoese often occurs when a user who has been off opiates for some time resumes taking the same amount of drug they are used to. Because the body's tolerance has decreased during this time off period, the resulting effect is a drug overdose.

    After repeated opiate use over a long peroid of time, long term side effects will begin to appear. Addicts who have been using for a long peroid of time often ignore their health because the only thing that matters is getting more of that drug. This self neglect can take the form of not eating and ignoring personal hygiene, which makes the user more susceptible to disease. Longtime users may develop collapsed veins, infections in their heart and valves, and liver disease. Because opiates depress respiration, pulmonary complications, such as pneumonia, may occur in longtime users due to respiratory depression and the poor health of the drug user.

    Opiate Withdrawal

    Opiate withdrawal can be incredibly painful, and in some case very dangerous.(Note: in a normal, healthy individual, withdrawal is for the most part painful, but not fatal) Withdrawal symptoms may occur as soon as a few hours after the last dose in users who have been regularly abusing opiates. Withdrawal symptoms can include intense cravings for opiates, restlessness, body pain, insomnia, diarrhea, vomiting, and cold flashes among other symptoms. In longtime, heavy users who are in poor health, withdrawal can occasionally be fatal. Withdrawal symptoms for most users typically subside within two weeks(physical - mental can continue for some time after that - it is debatable exactly how long).

    Following is Med-line's article on Opiate Withdrawal.

    Last edited by a moderator: Apr 30, 2017
  2. southern girl

    southern girl Newbie

    Reputation Points:
    Apr 12, 2010
    32 y/o from U.K.
    Re: So Your Addicted to Opiates, And Just Became Pregnant - how to deal

    Well first thing you would want to do is see your Dr, obviously, and be completely honest. You are now not the most important thing. Your baby is. In my opinion anyway. And you need to keep yourself as healthy as possible to keep the baby as healthy as possible.

    By "YOU", I mean a hypothetical "YOU".

    This is my friend Peaches experience.
    When my friend Peaches was pregnant and her back and nerve pain issues became increasingly worse she went to her Dr and was put on 8mg codeine tabs. She was told that a low dose of codeine was safe at the stage in her pregnancy, she was around 20wks, as long as she didnt use constantly and become addicted. He said not to use more than 3 days at a time, take atleast 1-3days break to avoid dependence. Peaches never used them that much though, she was not opiate dependent then, her pain problems were just beginning to worsen. However she has a serious codeine addiction now.

    Peaches is not sure if this is qualifies for the thread or not.
    She thinks it does. Though she was not addicted at the time she was permitted to take opiates while pregnant.

    Peaches does not in anyway want to suggest to someone that its safe to take opiates while pregnant without consulting a Dr first.

    Peaches is just stating her experience and what her Dr told her at the time. She was also permitted to take opiates while breastfeeding. She was told that very little medication gets into the breast milk so it would be safe at the dose she was taking, 16mg or 2-8mg codeine tablets a time. Which is a very low dose.

    Peaches is just putting her experience with opiates while pregnant and breastfeeding out there and hopes it helps someone, but ultimately suggests consulting a Dr. Please be safe, better safe than sorry.

    Peaches just wants to clarify she is in NO way saying that is safe to take opiates at any dose while pregnant or breastfeeding without consulting a Dr first.

  3. msmogadon

    msmogadon Silver Member

    Reputation Points:
    Jul 23, 2008
    from scotland
    Re: So Your Addicted to Opiates, And Just Became Pregnant - how to deal

    I got pregnant during the last months on her nursing course. I was addicted to smoking heroin at the time and the pressure from Mr SWIM to get SWIM to stop was unbelievable.
    Of course SWIM also wanted to stop too but its not just as easy as that. At the start I was afraid to speak to the midwife as she has worried about what other people were gonna think of her.
    Mr SWIM works away and had gone off in the agreement that I would have this abortion (I think it was scheduled for about 2 days before he was due to come home).
    Throughout all this time in between I was not really stop. A. because she knew it was bad to cold turkey for the baby and B. She just couldn't do it (no one else in the world except SWIM knew about it).
    As the days got closer. She was at her work in a ward for people who have dementia when she started to bleed lightly. After her shift took herself up to A & E. SWIM though she was coming on for about 12 weeks gestation.
    The nurse and doc searched over again and again but the nurse told her that there was no 12 week foetus there. They figured out that it had stopped growing around 4 weeks.
    All these weeks I had been excited and felt different (and oh the sickness) and had went over it with Mr SWIM time and time again. "You've got to get off the gear" again and again, all this time and it was already dead.
    Maybe it was a blessing maybe it would have transformed SWIM's life.

    The biggest regret was listening so much to other people and worrying about what people would say and not going to see that midwife a bit sooner. Even though it may not have matter. Funnily enough I remember having to wait over 24hrs to get her heroin around that 4 week times. but no one ever knows what is the cause of miscarriage.

    Sorry for prattling on Rainbowzz
  4. Rainbowzz

    Rainbowzz Iridium Member Palladium Member

    Reputation Points:
    Apr 27, 2008
    35 y/o from Canada
    Re: So Your Addicted to Opiates, And Just Became Pregnant - how to deal

    Prattle away. Thats what this thread is for - to express as much information on the subject(including opinion - since this is a VERY personal decision).
  5. nowilltolive

    nowilltolive Silver Member

    Reputation Points:
    Jan 19, 2010
    from U.S.A.
    Re: So Your Addicted to Opiates, And Just Became Pregnant - how to deal

    I have wondered this very same thing many times since her opiate addiction began. When it was just pills, SWIM always thought "I can quit if I get pregnant.." and SWIM always thought that, if anything, becoming pregnant would be one of the major reasons for SWIM to cease her use of opiates.

    ^^I agree.

    Now, as a small-time heroin addict, SWIM wonders if it would be so easy to just quit the opiates if she were to find herself pregnant. She wants children, very much so, and is in a relationship with a wonderful man whom she would love to have children with.. so this issue is very relevant to her, and she would love to see more opinions/advice on this subject.

    I would try to taper off the opiates as soon as she found she was pregnant, and try to refrain from further use until done breast feeding (if You intends to breast feed). Of course, we all know this is easier said than done.

    I don't know if You is actually pregnant or just posting as a hypothetical, but either way SWIM wishes You the best of luck!
  6. Rainbowzz

    Rainbowzz Iridium Member Palladium Member

    Reputation Points:
    Apr 27, 2008
    35 y/o from Canada
    Re: So Your Addicted to Opiates, And Just Became Pregnant - how to deal

    No, I am not personally pregnant. She just thought this might be helpful for someone in that situation. And, perhaps helpful to someone wishing to help their loved one.:vibes:
  7. Spucky

    Spucky Palladium Member

    Reputation Points:
    Feb 9, 2009
    from japan
    AW: So Your Addicted to Opiates, And Just Became Pregnant - how to deal

    Methadone & Pregnancy
    “Is methadone safe for my baby?” is usually the first question we hear from women.
    Pregnant women have been treated with methadone for more than 25 years and neither methadone or other opiates have not been shown to directly cause birth defects. However, your baby may experience some side effects from methadone. The most common are smaller-than-normal head size, low birth weight, and withdrawal symptoms. As babies born dependent on methadone grow, they usually will fall in the normal range for size and development.

    Methadone is not the only thing that can cause these symptoms. Smoking cigarettes, drug use, your biological makeup, nutrition, and how well you take care of yourself are just a few examples of things that can affect the health of your baby.
    Whether or not you are pregnant, you only get the benefits of methadone if you are stable on your dose. There is no ‘magic number’ of milligrams to stay below. If you feel any withdrawals or cravings to use, make sure you talk to your counselor about adjusting your dose. When you feel withdrawals, so does your baby and that can lead to complications and even miscarriage.

    Research does not necessarily show any connection between a mother’s dose and withdrawal symptoms in the baby.
    It might seem that the more milligrams a mother is taking, the worse the withdrawal symptom s will be, however this is not the case.
    That’s why we encourage you to focus on finding a dose that works for you and not to worry about the amount of milligrams. If you are tapering, most clinics will stop your taper and keep you at your current dose.
    Some women ask about tapering off methadone while they are pregnant. The Government’s Center for Substance Abuse Treatment says this: “Medical withdrawal of the pregnant women from methadone is not indicated or recommended.” and here at methadoneandpregnancy.com agree with them.

    Remember- If you were not ready to taper before you were pregnant, you are not ready to taper because you are pregnant.
    Medically, pregnant women have been safely tapered off of methadone, but it’s only been done on an inpatient basis where they can monitor the fetus for any distress. You should never try to detox yourself. This can be very dangerous to you and your baby. This can also put your recovery in jeopardy.

    Usually when women learn more about methadone use during pregnancy and see other healthy babies at the clinic with their moms, they decide to continue methadone treatment.

    It’s not uncommon to need a dose increase during your pregnancy. By the third trimester the amount of blood in your body just about doubles! Because of this your dose of methadone may need to be increased to help keep you and your baby free from withdrawal symptoms. In fact, an increase in methadone (if you need it) during this time can help improve growth and reduce risk of premature delivery. We cannot stress it enough; make sure you are stable on your dose!
    If for some reason you aren’t able to make it to the clinic for one day make sure you call the clinic and let them know you aren’t able to make it in. Do your best to get there the next day as early as possible. If you’re having problems with transportation, talk to your counselor. They will help you to figure out how you can get to the clinic every day.

    Many people wonder: does methadone use during pregnancy increase the chance of my child becoming an addict?
    There are not many studies that have looked at long-term effects of babies born depended on methadone. The other problem is that there are so many factors influencing drug use, it would be difficult to pinpoint methadone as the ‘cause’ if a child did start using drugs. We do know that there is a genetic component to addiction, so regardless if you are in methadone treatment or not, if you or the baby’s father has had substance abuse problems, the child may be at an increased risk of being an addict or having problems with drug use.

    While you are pregnant some clinics require that you meet with the Nurse Practitioner (NP) or other medical staff at least once per month. The medical staff wants to check in with you to make sure your pregnancy is going smoothly and ask about your prenatal visits. This is an excellent time to ask any medical questions. If you have any questions at anytime feel free to talk to your counselor or medical staff at the clinic. Your questions are important and deserve to be answered! Clinic staff may ask you to sign a release so we can speak with your prenatal providers. The release is needed so we can talk with your prenatal provider about your treatment at the clinic. It’s also important to have a release in place so if there are any medical concerns the clinic will be able to assist you.

    Medications such as Suboxone, Nubain, and Stadol could cause you to have severe withdrawal symptoms if you are taking methadone.
    Be cautious of medications that you are prescribed or given. You should always check with your medical providers before taking any medication.
    You should never take anyone else’s prescription medication. And be careful about taking any medications, even if it’s offered to you from a friend or family member. Some people store more than one type of medication in a bottle and you might be given something that could harm you, your pregnancy, or cause you to have a positive drug screen.
    All of your providers are here to support you and want to help you to have a healthy and safe pregnancy! Let us know what you need and how we can help.

    1. Methadone maintenance treatment
    Methadone maintenance treatment (MMT) is the treatment of choice for opioid dependant pregnant women 2. Methadone is a long-acting opioid that enables women to cease or reduce their heroin use and related behaviours, in accordance with a harm minimization philosophy.

    MMT throughout pregnancy is associated with improved fetal development, infant birth weight, and reduces the risk of perinatal and infant mortality in heroin dependant women (level III 2, 1).

    The aims of methadone maintenance treatment are to:

    • Reduce or eliminate illicit heroin and other drug use
    • Improve the health and wellbeing of those in treatment
    • Facilitate social rehabilitation
    • Reduce the spread of blood borne diseases
    • Reduce the risk of death associated with opioid use
    • Reduce the level of crime associated with opioid use 2
    • Withdrawal from heroin, without MMT is associated with risks to the fetus and a high risk of relapse2. Women should be informed of these risks, and if it is to be attempted it should ideally be done in the 2nd trimester, supervised in a specialist unit (Consensus,1). While inpatient supervision of withdrawal is not available at the Women's, WADS clinicians are able to provide outreach services to pregnant women undergoing withdrawal in specialist detoxification units.

    2. Methadone stabilisation program

    Heroin dependant women should have priority access to methadone treatment, which includes admission to an inpatient obstetric unit for stabilization and rapid dose titration, with respite from the external environment (Consensus,1). This service is offered at the Women's, under the supervision of WADS care coordination team inpatient stabilisation brochure, at any gestation. Admission is for 5 days (Monday to Friday). Inpatient admission is necessary as rapid induction onto methadone is required. Legislative requirements must be met, including obtaining a permit for prescribing methadone from DHS before commencing, as per the Women's CPG: Methadone and Buprenorphine Dosing Procedures.

    Care in pregnancy should be provided as per CPG: Care of Women with Alcohol and Drug Issues in Pregnancy.

    2.1 Criteria for methadone stabilisation program
    Women will be assessed as being

    • dependent on opioids
    • motivated to undertake induction onto MMT
    • willing to comply with the whole program and methadone regime.

    Women not suitable for treatment with methadone3:

    • Severe hepatic impairment
    • Hypersensitivity to methadone
    • Unable to give informed consent (eg. Major psychiatric illness) or age under 18, consider jurisdictional requirements for obtaining legal consent
    Specialist advice should be sought for clients with severe respiratory depression, acute asthma, acute alcoholism, head injury and raised intracranial pressure, ulcerative colitis, biliary and renal tract spasm, patients receiving monoamine oxidase inhibitors.

    3. Methadone induction procedure

    Women should commence on a dose of methadone that should be titrated to the woman's symptoms with rapid increases.

    The starting dose should be 20mg, and is reviewed at 4 hourly intervals or earlier if required.

    At each review, if the woman has objective signs of withdrawal (eg. Pupils dilated, restless, see short opiate withdrawal scale in appendix of National clinical guidelines for the management of drug use during pregnancy, birth and the early development years of the newborn), then give an additional 5-10mg.

    If there are no signs of withdrawal no extra dose is given until the next scheduled review.
    The maximum dose in the first 24 hours should not exceed 50mg.

    Extreme caution should be exercised when assessing the woman's requirements on subsequent days if a dose of over 30mg is used on day 1, in order to prevent accumulation and possible toxicity from methadone.

    The same process should be repeated on day 2 (when the woman will almost certainly require less methadone), commencing again with 20mg and giving additional doses of 2.5 to 10mg as required, with a maximum dose increase of 50mg.

    If at any time the woman becomes sedated (small pupils, drowsiness), increase frequency of observation and ensure no further methadone is administered until sedation is reversed.

    Women should be encouraged to remain on the ward for 30-60 minutes post dose, for observation.

    Women should be cautioned regarding the use of other drugs whilst on methadone.

    Urine drug screening is not routine, but may sometimes be requested if there are concerns about harmful concurrent drug use.

    3.1 Vomiting

    Vomiting is a serious concern in pregnant women on methadone. Vomiting of a methadone dose may lead to withdrawal in both mother and fetus (consensus,1).

    If a methadone dose is vomited (consensus,1):

    • Within 10 minutes of dosing - consider giving a repeat dose
    • Within 10-60 minutes of dosing - consider giving half a repeat dose
    • More than 60 minutes after dosing - consider half a repeat dose if withdrawal occurs

    Prevention of vomiting (consensus,1):

    • Women should be discouraged from ingesting methadone on an empty stomach
    • Women should be encouraged to sip their dose slowly
    • If the dose consistently causes vomiting, consider splitting the dose or giving rectal prochlorperazine 30-60 minutes before dosing
    • If woman vomits constantly not in relation to dose, assess and treat according to the Women's CPG: Hyperemesis Gravidarum.
    sources: http://www.thewomens.org.au/MethadoneStabilisationinPregnancy

    I uploaded the "Pregnancy Files+ Buprenorphin aka Subutex/Suboxone" a while ago:

    Spucky added 16 Minutes and 13 Seconds later...

    Health Conditions of Drug-exposed Infants
    Birth weight
    Birth weight is an important factor associated with children’s overall health and development. Children who weigh under five-and-one-half pounds at birth are more likely to have serious medical problems and to exhibit developmental delays. Drug-exposed infants often do not exhibit normal development.

    The risk of prematurity (birth at less than thirty-seven weeks) is higher in drug-exposed infants. Other complications can include an increase in acute medical problems following birth, and extended periods of hospitalization. Birth weight under three pounds has been associated with poor physical growth and poor general health status at school age. Low Birth weight infants also have an increased risk of neurosensory deficits, behavioral and attention deficits, psychiatric problems, and poor school performance. Premature infants may have experienced bleeding of the brain tissue, hydrocephalus, bronchial problems, eye disease, and interferences with the normal ability to feed.

    Small for Gestational Age (SGA)
    This term is used to describe infants whose Birth weight is below the third percentile for their gestational age (i.e., 97% of infants the same age are heavier than the SGA infant). It is common for women who abuse cocaine to experience decreased appetite and provide inadequate nutrition for themselves and their baby.

    Failure to Thrive (FTT)
    Infants who were exposed to alcohol and/or drugs may exhibit this disorder, which is characterized by a loss of weight, or slowing of weight gain, and a failure to reach developmental milestones. This can be due to medical and/or environmental factors. The infant’s behavior includes poor sucking, difficulty in swallowing, and distractibility. Many of these children live in chronically dysfunctional families which places them at greater risk of parental neglect.

    Neurobehavioral symptoms
    Within seventy-two hours after birth, many infants who were exposed prenatally to drugs experience withdrawal symptoms, including tremors and irritability. Their skin may be red and dry; they may have a fever, sweating, diarrhea, excessive vomiting, and even seizures. Such infants may require medication for calming. Other infants exposed to stimulants show a pattern of lethargy during the first few days after birth, are easily overstimulated, and may go from sleep to loud crying within seconds. These behaviors usually decrease over time and subside in toddlerhood.

    Infectious diseases
    Infants with prenatal drug exposure may be exposed prenatally or postnatally to infectious and/or sexually transmitted diseases contracted by their mothers. The most common infectious diseases seen in infants are chlamydia, syphilis, gonorrhea, hepatitis B, HIV, and AIDS.

    Sudden Infant Death Syndrome (SIDS)
    Children who have been exposed prenatally to alcohol and/or drugs have an increased risk of dying from sudden infant death syndrome. The causes of SIDS are unknown and its occurrence is almost impossible to predict. Apnea/cardiac monitoring is recommended for these infants.

    Fetal Alcohol Syndrome
    Mothers who consume large quantities of alcohol during pregnancy may have babies who are born with Fetal Alcohol Syndrome (or FAS). A diagnosis of FAS is based on three factors: 1) prenatal and postnatal growth retardation; 2) central nervous system abnormalities, and, 3) abnormalities of the face. Many of these children display significant disabilities, learning disorders, and emotional problems as they mature.
    Each of the above conditions associated with prematurity or drug exposure has programmatic implications for caregivers; the children who exhibit these conditions are often referred to as "medically fragile".

    Developmental Outcomes
    There are many unknowns involved in trying to predict the outcomes of infants and children exposed to drugs. While we know that there are certain physical problems that may remain with the child, in a structured and nurturing environment, many of these children are able to grow and develop quite normally. A small percentage of children have been found to have moderate to severe developmental problems.
    But regardless of their health status, all children who have a history of prenatal substance exposure should receive developmental evaluations on a regular basis: at least once during the first six months; at twelve months; and at least every year thereafter until school age. Early identification of social, language, cognitive, and motor development problems is essential.

    Developmental Patterns in Children
    Exposed Prenatally to Drugs

    Birth to fifteen months

    • Unpredictable sleeping patterns
    • Feeding difficulties
    • Irritability
    • Atypical social interactions
    • Delayed language development
    • Poor fine motor development
    Toddlers from sixteen months to thirty-six months

    • Atypical social interactions
    • Minimal play strategies
    Preschool children from age three to five
    While average preschoolers are beginning to share and take turns, demonstrate language skills, and increase their attention spans in a group setting, the drug-exposed toddler may be hyperactive, have a short attention span, lose control easily, have mood swings and problems moving from one activity to another. These children may also experience difficulties processing auditory or visual information/instructions.

    School and teenage years
    There has not been sufficient research into the long-term biological effects of drug exposure on older children and teenagers, however, we do know that children with the behaviors described above are at greater risk of abuse and neglect, learning disabilities, and behavioral problems. Obviously, it becomes imperative to identify these problems at a very early age, access the necessary resources for the child, and build a team of professionals who regularly monitor the progress of each child.
    Supporting a drug-exposed child in the course of his life may require advocating vigorously for specialized educational services; providing recreational and employment opportunities that allow a measure of success; educating parents; and providing counseling.

    Techniques in Working with
    Drug-exposed Infants and Young Children

    Respite and crisis care programs working with drug-exposed infants and children may not know the exact drugs to which each child was exposed. A combination of substances, including alcohol and tobacco, may be involved. There are a few techniques, however, which can be used in a general plan of care that may be individualized to meet the specific problems of each child:

    1. Provide a calm environment: low lighting; soft voices; slow transition from one activity to another.
    2. Be aware of signs of escalated behavior and frantic distress states before they occur, e.g., increased yawns, hiccoughs, sneezes, increased muscle tone and flailing, irritability, disorganized sucking, and crying.
    3. Use calming and special care techniques on a regular basis, such as
      • swaddling blankets tightly around the infant
      • using a pacifier even when the infant is not organized enough to maintain a regular suck
      • rocking, holding, or placing the infant in a swing, or Snuggly™ carrier
      • massaging the child
      • bathing in a warm bath, followed by a soothing application of lotion
      • rubbing ointment on diaper area to prevent skin breakdown
    4. Encourage developmental abilities when the infant is calm and receptive using only one stimulus at a time. Look for signs of infant distress and discontinue the activity if this occurs.
    5. Gradually increase the amount and time of daily developmental activities; encourage the child to develop self-calming behaviors and self control of his own body movements.
    Behavior Descriptions and Suggested Strategies
    Feeding problems
    Feed the baby more often; feed smaller amounts at one time; allow the infant to rest frequently during feeding. Place the infant upright for feeding; after feeding, place the child on his side or stomach to prevent choking; if vomiting occurs, clean the skin immediately to prevent irritation.

    Irritability/unresponsive to caregiver
    Reduce noise in the environment; turn down lights; swaddle the infant: wrap snugly in a blanket with arms bound close to the body. Hold the infant closely; put the infant in a bunting-type wrapper and carry it close to your body. Rock the infant slowly and rhythmically, either horizontally or with its head supported vertically, whichever soothes. Place the child in a front-pack carrier; walk with the infant; offer the infant a pacifier or place it in an infant swing.

    Goes from one adult to another, showing no preference for a particular adult
    Respond to specific needs of child with predictability and regularity.

    May have poor inner controls/frequent temper tantrums
    Use books, pictures, doll play, and conversation to help the child explore and express a range of feelings.

    Ignores verbal/gestural limit setting
    Talk the child through to the consequence of the action.

    Shows decreased compliance with simple, routine commands
    Provide the child with explicitly consistent limits of behavior.

    Exhibits tremors when stacking or reaching
    Observe the child and note the onset of tremors, their duration, and how the child compensates for them; provide a variety of materials to enhance development and refinement of small motor skills, e.g., blocks, stacking toys, large Leggos™, and puzzles with large pieces. Sand and water play are soothing and appropriate.

    Unable to end or let go of preferred object or activity
    Provide attention and time to children who are behaving appropriately; provide child with an opportunity to take turns with peers and adults.

    Delayed receptive and expressive language
    Create a stable environment where the child feels safe to express feelings, wants, and needs; use stories/records/songs; use hands-on activities to reinforce the child’s language abilities.

    Expresses wants, needs, and fears by having frequent temper tantrums
    Remove and help calm the child; redirect the child’s attention; verbalize the expected behavior; reflect the child’s feelings. Praise attempts toward adaptive behavior. Set consistent limits.

    Difficulty with gross motor skills (e.g. swinging, climbing, throwing, catching, jumping, running, and balancing)
    Provide appropriate motor activities through play, songs, and equipment. Offer guidance, modeling, and verbal cues as needed.

    Over-reacts to separation of primary caregiver
    Offer verbal reassurance; be consistent, and help the child learn to trust adults.

    Withdraws and seems to daydream or not be there
    Provide opportunities for contact; move close to the child, make eye contact, use verbal reassurance; allow, identify, and react to the child’s expressions of emotions.

    Frequent temper tantrums
    Understand that a tantrum is usually a healthy release of rage and frustration; protect the child from harm; remove objects from the child’s path if he is rolling on floor. Some children do not want to be held during a tantrum and doing so can cause more frustration. Remain calm, using a soothing voice; anger will only escalate the child’s frustration. Do not shout or threaten to spank the child–the adult needs to be in control. Help the child to use words to describe emotions. Read stories about feelings. Help the child gain control by making eye contact, sitting next to the child, giving verbal reassurance, and offering physical comfort (rubbing back, etc.). Note the circumstances that provoked the tantrum, and try to avoid such confrontations when possible. Provide a neutral area for the child to work through the tantrum, (e.g., a large cushion or bean bag chair). Some children want to work through a tantrum alone; keep the child in sight, but do not interact until he is calm.

    Parent Involvement
    It is critical to the success of the drug-exposed infant that the eventual caregiver (parent, relative, foster parent, respite provider, adoptive parent) learn the care routine, control techniques, and background of the children for whom they will be providing care. Understanding the etiology of drug-exposure, the types of medical problems that arise, the developmental patterns, and the techniques for handling drug-exposed infants and toddlers is imperative.

    Program social workers, case managers, child care staff, and nursing staff must all work together with the caregiver to offer parent education ("hands-on" opportunities to provide care under the guidance of professionals), and encouragement for families who undertake the care of a drug-exposed infant. The caregiver’s understanding of the child’s behavior, physical "cues," and developmental problems, goes a long way in helping the drug-exposed infant, toddler, and teen succeed. It also assists the caregiver in setting realistic expectations for children who enter the world battling the the effects of their parent’s addiction.

    Many children who were prenatally exposed to drugs will grow and develop without unusual problems. However, for those infants who have physical indicators, the respite and crisis care provider can make a difference by providing, perhaps, the first stable, nurturing environment. Here, the child can be observed, positive routines for care can be established, and parents can receive the critically necessary education and support to enable them to care for an alcohol or drug-exposed child.

    Staff training, caregiver training, and parent education are all critical elements of any program that will be successful with these children. Physical elements of the environment (lighting, noise, and space) may need to be adjusted to accommodate their care. The inclusion of medical support, i.e., nurses and physicians who are familiar with the problems of these children, is essential. In summary, the care of alcohol and drug-exposed children is a team effort that requires coordination, case management, special care techniques, and education to be successful in any respite or crisis care situation. With these components in place, agencies and families can witness the positive growth and development of children who have been greatly at risk.

    About the Author: Jeanne Landdeck-Sisco, MSW, is the Executive Director of Casa de los Niños in Tucson, Arizona, which was the first crisis nursery in the U.S., established in 1973. Ms. Landdeck-Sisco served as the first President of the ARCH National Advisory Committee for Respite and Crisis Care Programs from 1991-93 and remained on the committee until 1996.
    Center for Substance Abuse Prevention National Resource Center for the Prevention of Perinatal Abuse of Alcohol and Other Drugs, 9302 Lee Highway, Fairfax, VA 22031, (800) 354-8824.
    National Organization on Fetal Alcohol Syndrome, 1815 H Street, N.W., Suite 710, Washington, DC 20006, (202) 785-4585.
    Besharov, Douglas J. When Drug Addicts Have Children. Washington, DC: Child Welfare League of America, 1994.
    Hargrove, Elisabeth, et al. Resources Related to Children and Their Families Affected by Alcohol and Other Drugs. Chapel Hill, NC: NEC*TAS, 1995.

    Special acknowledgment is given to Rosemarie Dyer, R.N., Nursing Supervisor at Casa de los Niños, who has developed the agency’s program for drug- and alcohol-exposed infants and from whose training material many of the techniques and caregiver responses have been drawn; and to Anna Binkiewicz, M.D., Casa de los Niños Board Member and Medical Director, who has provided on-site medical treatment of Casa’s medically fragile children.
    Last edited by a moderator: Sep 10, 2017
  8. Suboxer

    Suboxer Silver Member

    Reputation Points:
    Feb 20, 2010
    from U.K.
    Re: So Your Addicted to Opiates, And Just Became Pregnant - how to deal

    Methadone is safe to take during pregnancy. Buprenorphine is still being studied, and nothing is assumed to be safe to take during pregnancy until it is proven, but all current research says it, also, is safe to take.

    The list of what is safe, by class, now includes open-chain opioids (methadone, ketobemidone, etc.) and phenanthrene opioids (all of the common ones - codones, morphones, morphine, heroin - and most of the rare ones). The only three common opioids outside of these classes are pethidine, fentanil, and propoxyphene. There do exist opioids that aren't safe to take during pregnancy and aren't listed above, like lefetamine, but you're not going to find them anywhere unless you synthesize them yourself.

    Opioids are perfectly safe for the foetus, just as safe as they are for the user. They are, as a whole, with some few exceptions (pethidine and propoxyphene, namely) extremely non-toxic substances with a large therapeutic index. In a pure form, they cause stress on no organs, and cause no damage to the body or brain with long-term use.

    The only harm that comes of opioid addiction, as long as it is stable, as in maintenance, is addiction of the foetus/neonate. This is easily handled, with an extremely small rate of complications, with a quick morphine taper while your child is kept in the hospital for a few days, and has no lasting impact on your neonate's development, unlike cocaine, nicotine, or ethanol. The child is weaned, and that is it. There is no lasting change in the development of the neonate/child.

    However, this does not mean (illicit) opioid use is safe during pregnancy. The dangers of injection can also damage the foetus, damaging circulation, etc., and the foetus can overdose fatally even if you experience only a sub-lethal overdose due to your respiratory depression. Infections are dangerous. The cuts in the dope you're using, if you use heroin, can be dangerous, and can not be assumed safe for the foetus.

    Withdrawal can, and will, kill a foetus. If you are pregnant and addicted to opioids, under no circumstances should you ever withdraw from them.

    When using short-acting opioids, one can not prevent withdrawal. One is dopesick every morning, so on and so forth. The daily stress of withdrawal - what the opioid user experiences as highs and lows, ups and downs - is extremely hard on the foetus, and this is what causes spontaneous abortion. The foetus is not as hardy and hale as the mother when it is in the womb, and can not survive many things the mother can, such as opioid withdrawal. If you are pregnant and can't score, and will be dopesick, go to the A&E/emergency room. This is one of the few circumstances where the A&E doctor will give you a shot of morphine or hydromorphone to relieve withdrawal instead of the usual clonidine. However, they are compelled by law to alert the authorities in most jurisdictions, and this will often result in haven your foetus taken, when born, by the local Child Protection Agency. However, a foster child that you may yet be able to regain is better than a dead foetus.

    If you are an opioid addict and become pregnant, the course of action is plain and thus:

    Quit injecting drugs immediately, quit smoking cigarettes, and quit drinking ethanol. Abstain from all drugs, especially amphetamines, including MDMA, and above all else, abstain from LSD, which has a proclivity to cause spontaneous abortion - LSD is derived from ergotamine, an abortifacient, and has abortifacient activity. Quit drinking caffeine. If you're a heavy weed smoker, quit that too in order to be safe, but - as much as I rail against weed - three tokes during a pregnancy is not likely to harm the foetus. It is likely the least harmful illicit drug (maintenance opioids are safer, but they are not illicit) to take during pregnancy - safer than caffeine - but one should abstain from all.

    Go to your doctor or OB/GYN as soon as humanly possible. If you don't have one, go to a doctor. "Come clean" and tell him you are addicted to opioids: if you "come clean" early, as soon as you find out you are pregnant, and show a desire to do what is best for your child, you will almost always retain custody of it - it will not become a ward of the state - with the possibility of a few visits from the Child Protection Agency to your residence. The doctor will refer you to a maintenance program, such as methadone maintenance, which is safe for the foetus and does not harm or hinder its development in any way. If a spot in maintenance is not immediately available - there often is, as preference is shown for the pregnant - the doctor will write you a script to maintain on safely, taking opioids by mouth, until a spot opens up in a maintenance program.

    Above all else, do not attempt to withdraw from opioids without a doctor's close supervision and co-ordination with all other treatment providers (OB/GYN, etc.) while pregnant - it is the most dangerous option of all, arguably more so than continuing to take street opioids.

    d/b/a Suboxer M.A. (Neuropsychology) Ph.D. Ph.D. Ph.D. (Analytical, Organic Chemistries, Psychopharmacology) D.Pharm.Sci. (Pharmaceutical Sciences)

    However educated I might be, my knowledge is in the fields of (medicinal) chemistry, and I am not a medical doctor, nor am I qualified to dispense medical advice. My medical advice is as follows: go see a medical doctor as soon as you find out that you have been impregnated, doubly so if you are addicted to any drug, including opioids. None of the above is medical advice, only observation, a parsing of the results of research studies, and chemical knowledge - all pilfered from Wikipedia - tempered by the advice I do give, which is, "See a medical doctor immediately."
    Last edited: Jun 27, 2010
  9. Suboxer

    Suboxer Silver Member

    Reputation Points:
    Feb 20, 2010
    from U.K.
    Re: So Your Addicted to Opiates, And Just Became Pregnant - how to deal

    UPDATE: The first long-term trial of buprenorphine in impregnated women concluded in May 2010 and was presented at a gathering of the American College of Gynecologists at the end of June 2010, though not yet published. It concluded that buprenorphine was even safer, with nearly 1/3 lower occurrence of neonatal abstinence syndrome (neonatal withdrawal) than methadone, and a lesser severity of NAS when it did occur.

    The doses of either maintenance drug the impregnated woman was taking before delivery of the neonate had absolutely no correlation with the chance of experiencing or the severity of NAS.
    That is to say, some neonates delivered to impregnates dosing 150mg methadone q24h had lesser or no withdrawal symptoms compared to those delivered to those dosing 2mg buprenorphine q24h, and vice verse. No correlation at all: there is no reason to attempt to lower one's dose while impregnated. If anything, there is a reason to never decrease the dose - which is dangerously close to withdrawal for the infant; dose reductions can be just as harmful - and stabilize your dose at worst, and possibly increase it.

    "'It has been shown that patients on methadone are more stable in terms of their physical and mental health and are more likely to receive standard prenatal care, but methadone has clear effects on the child,” noted lead author Michael Czerkes, MD, Maine Medical Center, Portland, Maine. “Buprenorphine is an attractive alternative, but there are few data on the effects on neonatal outcomes. Since our patient population uses both agents, we decided to find out.'

    The key objection to methadone from the infant’s perspective is the appearance of neonatal abstinence syndrome (NAS), a combination of symptoms that include dysfunction of the autonomic nervous system, gastrointestinal tract, and respiratory system. NAS has a number of short-term consequences, including prolonged hospital stays, prolonged monitoring, and an increased need for intravenous medications. Methadone is also inconvenient for the mother, requiring daily clinic visits, and it is subject to diversion because it is a euphoric agent.

    Limited data on buprenorphine suggest that it may carry less risk for perinatal morbidity, but trials have been small and somewhat contradictory. Buprenorphine can be dispensed in 30-day packaging, which eases the burden on the mother, and is less subject to diversion because it significantly less euphoric than methadone.

    Researchers at the Maine Medical Center conducted a retrospective chart review of women addicted to opioids who were using either buprenorphine or methadone and who delivered their babies at the institution between 2004 and 2008. There were 101 methadone patients and 68 buprenorphine patients available for analysis. There were no significant maternal differences between the 2 groups.

    The differences between offspring of mothers in the 2 groups were dramatic, said Dr. Czerkes. The mean NAS score for buprenorphine infants was 10.69 compared with 12.5 for methadone infants (P = .0012). While the difference was statistically significant, Dr. Czerkes cautioned that it might not be clinically significant.

    Other outcomes were both statistically and clinically significant. Buprenorphine infants spent a mean of 8.4 days in the hospital compared with 15.7 days for methadone infants (P < .0001) and only 48.5% of buprenorphine infants required treatment compared with 73.3% of methadone infants (P < .001).

    Among buprenorphine infants who needed treatment, withdrawal symptoms appeared by day 3 or did not appear at all. Withdrawal symptoms in methadone infants appeared anywhere between days 2 and 6. “That may be a clinically significant finding,” said Dr. Czerkes. “If you don’t see withdrawal in these babies by day 3, they may not have withdrawal at all.”
    Overall, he concluded, buprenorphine appears to be safer for neonates than methadone. Researchers are recruiting patients for a larger randomized controlled trial."

    Presentation title: Buprenorphine Versus Methadone Treatment for Opiate Addiction in Pregnancy: An Evaluation of Neonatal Outcomes
    Last edited: Jul 9, 2010
  10. paisleypomegranates

    paisleypomegranates Newbie

    Reputation Points:
    Nov 13, 2009
    28 y/o from U.S.A.
    I have been addicted to heroin/methadone for about 2 years when she got pregnant. She knew she was pregnant, but was in denial and continued using throughout the first trimester. It wasn’t until swim actually saw the fetus on the ultrasound screen that she realized that she was in fact pregnant, and that she was putting harm, intentionally, onto her own child. At the time I got pregnant, she wasn’t on the methadone clinic, which she had been before. She was only buying methadone on the street, as well as heroin, just to keep her well, sometimes loaded. When she talked to her doctor, he said, as long as you stay off of everything, no methadone, no heroin, no nothing, your baby should be fine. At this time, a few weeks prior, I have been staying clean for a few days, then using once or twice to limit the withdrawals, so when it came time for her to actually stop, there was not really an initial kick. Swim’s baby girl, autumn, was born 1 week overdue, 6lbs,13oz, completely healthy, beautiful baby girl. She is the love of her life. I have recently become addicted again, thanks to her husband who continued using methadone without her knowing. And everyone knows that an addict cant live with another who is using for too long before they start using again too. So I was strung out on methadone again, then recently switched to heroin to have less of a kick, and is now heading into a heroin kick to save her life, and to save her daughter, and to give her a life and a mother that she deserves. HEROIN DOES NOTHING BUT DESTROY AND CHANGE YOU AS A PERSON. IT IS, SWIM BELIEVES, ONE OF THE DEVILS BIGGEST TOOLS HE USES AGAINST US TO TURN US AWAY FROM WHO WE ONCE WERE. IF YOU ARE ADDICTED, SAVE YOURSELF AND YOUR SOUL BEFORE IT IS TOO LATE. NOTHING GOOD CAN COME OF A HEROIN ADDICTION, TAKE IT FROM A JUNKIE…
    Last edited by a moderator: Apr 30, 2017
  11. RoriElizabeth

    RoriElizabeth Silver Member

    Reputation Points:
    Apr 16, 2009
    36 y/o from U.S.A.
    Such a very touchy subject. One that I have been though first hand....on two occasions. Once swim (who was already addicted to opiates) found out she was pregnant....she was faced with the conflict of what to do. It's just not as 'black and white' as some (usually non-addicts) believe. And there is next-to-nothing, when it comes to available information on the options for opiate-addicted mothers.

    An obvious thought might be that one should speak with their doctor about which route to take. The thing is, using/abusing opiates in the way that I was, is illegal. And the thought of having Child- Protective-Services hovering around during pregnancy and right after giving birth is an enormous cause of anxiety. The addicted mother wants nothing more than to bring the child into the world as smoothly and as healthy as possible--but at what cost? If said mother seeks treatment for her addiction, is she giving up the right to make decisions for her baby? Will C.P.S intervene at the mere mention of her problem to her doctor?

    Pregnant mothers worry constantly. About the health and well being of their baby, their ability to provide, even about obscure genetic diseases that the baby has almost no chance of getting. PREGNANT MOMs WORRY. Just imagine if that pregnant Mom had an addiction to worry about, too.

    So, say that Pregnant Mom decided not to inform her OB/GYN of her addiction, because of (the very rational) fear of intervention of child protective services. Then what? She goes online and learns as much as she can about trying to safely "wean" herself off of opiates. She learns that when her body goes through withdrawal, the fetus's endures the same withdrawal. Anything she goes through, the fetus goes through.
    Not only that, but opiate withdrawal can also cause miscarriage. Wow. Check-self tapering off the list.

    The stressors and fears that a woman goes through while pregnant and addicted are endless. In Swim's personal story, she had finally decided on enrolling with the Methadone clinic. But not without reservation. She lived in constant anxiety. Filled with worry about the baby's health, about the chance of the baby being born with methadone withdrawal. About the slim chance that Child Protective Services would still get involved.; at the mere mention of methadone.

    Luckily for Swim, everything turned out better then well. The baby had shown no signs of withdrawal, and everyone lived happily ever after. But whose to say that in the next pregnancy, things will be so good?

    One of the worst parts of being addicted during pregnancy is that every little thing is a chance. A "maybe". Maybe the fetus will survive in the womb while Mom self-tapers. Maybe Mom's Ob/Gyn will be more than understanding and provide information and support while offering non-biased treatment. Maybe Mom will choose Methadone clinic and things will turn out ok. Or Maybe baby will have awful withdrawal symptoms and need to stay in the hospital for treatment for weeks on end.

    One thing is for sure though. Mothers in this horrid situation are almost alone. There are not enough places to go that offer help, advice, or even the most basic of information on the options she has. It is an increasingly common occurrence, yet still, there is little information available.

    Swim thinks this is a great topic, and hopes that other swimmers will continue to post their personal trials and tribulations, as well as any information they have to offer. And Swim hopes that many will benefit from it.
    Last edited by a moderator: Sep 10, 2017
  12. ash24

    ash24 Newbie

    Reputation Points:
    Sep 15, 2012
    from U.K.

    I know someone who is also pregnant in the same boat.. this person is willing to quit with some use of Suboxen off the streets so I don't get addicted to a new substance. But, the fact is the placenta is still dirty and I am clean, so is the baby me is scared they will take her baby. How does one keep a baby if they used in the beginning of pregnancy
    Last edited by a moderator: Apr 30, 2017
  13. goldengirl21

    goldengirl21 Newbie

    Reputation Points:
    Jun 29, 2013
    from U.S.A.
    Honestly, as someone who does use opiates often for pain, I think I would probably just do everything I could to stop cold turkey. I wouldn't want to hurt the child. It's a tough situation :/
  14. Iezegrim

    Iezegrim Silver Member

    Reputation Points:
    Dec 8, 2013
    from earth
    As a 47 yo woman who has spent hundreds of thousands of dollars on IVF, egg donation and surrogacy and gotten nowhere, I would have to say that it depends on your age. I had a baby at 26, no worries, but in my second marriage when I was over 40, it wasn't happening. Therefore, if you're under 35, IMO, get an abortion but if you're over 40, this could be your only chance so you go on methadone or subutex, cross your fingers, and hope for the best. One comprehensive study has shown, however, that methadone babies have small heads. You can find this paper on PubMed. Subutex would be better as it has a longer half-life. less is known about it, however.
  15. MHSCheeto118

    MHSCheeto118 Newbie

    Reputation Points:
    May 13, 2016
    from U.S.A.
    I just found out that I am pregnant. I am a recovering addict, Lortab mostly. I also suffer from Lupus. Right now I am on Morphine DR 15mg. I am wondering how to handle this with my pregnancy. Any input is welcome.
  16. Beenthere2Hippie

    Beenthere2Hippie The Constant Optimist Palladium Member

    Reputation Points:
    May 20, 2013
    from U.S.A.
    Welcome to DF, MHSCheeto - And congratulations on your pregnancy! I do hope you're feeling well, other than worrying currently about the health and well-being of your baby.

    Of course being on morphine while you're pregnant is not ideal, quitting cold turkey is not suggested either. But don't worry too much. If you're use is limited to 15 mg of long-acting morphine daily, the problem you're facing is far from insurmountable.

    Here on DF, quite a few women over the years have successfully gotten off whatever form of opiates they were on and gone on to have healthy babies, so I'm fully sure the same is true for you. But of course, it's hard to give further advice until we understand a few more of the particulars surrounding your personal story.

    May I ask if your opiates are prescribed? Also, have you seen an obstetrician as of yet?
  17. MHSCheeto118

    MHSCheeto118 Newbie

    Reputation Points:
    May 13, 2016
    from U.S.A.
    My opiates are prescribed and being monitored by a pain management clinic. I haven't seen the OB yet, that is next on my list, as I have a bad.case of the cold /flu right now and can barely get out of bed.
    I was also prescribed Norco 7.5mg three times a day but I feel I can quit those without consequence as I still have the Morphine. Thoughts?
  18. Beenthere2Hippie

    Beenthere2Hippie The Constant Optimist Palladium Member

    Reputation Points:
    May 20, 2013
    from U.S.A.
    My best advice is to stay stable on the dose you're currently on (the 15 mg long-acting daily) and get to a quality OB/GYN very soon. Your doctor will help get you off the remainder of the dose you're on, without putting your baby in danger. Or the OB will refer you back to your pain doctor for a change up in medication.

    And stop worrying. It's going to be alright, as long as you follow through. :)
  19. mycatkeepsmesane

    mycatkeepsmesane Newbie

    Reputation Points:
    May 8, 2013
    36 y/o from U.S.A.
    I just found out I'm pregnant today and I'm scared because I take around 60-70mg of hydrocodone a day. I want to quit but I keep reading that it's bad to go cold turkey and it could cause a miscarriage. I quit for four days last week with the help of Kratom before knowing I was pregnant and I'm still pregnant so maybe I won't miscarry if I detox again with Kratom? Thoughts? I really want to put this all behind me and I'd really like to do that and still be pregnant. I just don't know what will happen when I detox from the Kratom. Any help and opinions are welcome! Thank you :)