A report that begins with the following line, “A professional organization does not recommend opioid detoxification in pregnancy.” but starts its Conclusion with this statement, “Detoxifying from opioids in pregnancy does not appear to harm the fetus,” may leave one scratching their head.

Let’s break it down into plain English…

Title: Medication-assisted treatment vs. detoxification for women who misuse opioids in pregnancy: Associations with dropout, relapse, neonatal opioid withdrawal syndrome (NOWS), and childhood sexual abuse.

Published in Addict Behav Rep. Nov 12, 2020

Summary in plain English :

The American College of Obstetricians and Gynecologists advises using medication-assisted treatment (MAT) for pregnant women who misuse opioids instead of detoxification due to the risks of relapse and treatment dropout. In a study of 55 pregnant women with opioid use disorder, those who chose MAT had a lower dropout rate, but higher rates of neonatal opioid withdrawal syndrome (NOWS) in their infants compared to those who chose detoxification. Relapse was more common among women on MAT (26%) than those who detoxified (0%).

What happens when the infant experiences NOWS?

• The average cost of delivery increases from $3,500 to $93,400

• Baby’s first experience outside of the womb is the frightening stress of detoxification

• Significant effects on cognitive and motor development are likely

• Inhibitory control and working memory abilities are damaged

• Head circumference at birth is smaller (30% are below or equal to the 10th percentile, and 8% are below or equal to the 3rd percentile)

Full detoxification from opioids during pregnancy offers the potential to eliminate NOWS and the lifelong effects of prenatal opioid exposure. This is not the first study showing that detoxifying from opioids during pregnancy doesn’t appear to harm the fetus. In this study, no participants dropped out and there was minimal relapse (all within the MAT cohort). Lowering MAT doses reduced neonatal opioid withdrawal syndrome (NOWS), and detoxification eliminated it. Women with a history of sexual abuse were more successful in tapering or detoxifying than those on MAT. Different causes of opioid misuse might affect treatment outcomes. More research is needed to confirm these findings and to identify which pregnant women are most likely to benefit from detoxification, along with postpartum follow-up for relapse vulnerability.

Many thanks to the authors of this article: Macfie J, Towers CV, Fortner KB, Stuart GL, Zvara BJ, Kurdziel-Adams G, Kors SB, Noose SK, Gorrondona AM, Cohen CT

The full report is accessible here: https://doi.org/10.1016/j.abrep.2020.100315