[I’m sticking my neck out on this one. Take it in the spirit in which it’s written—an attempt to unpack the issues involved rather than any kind of declaration of truth. Please, set me straight in the comments if I’ve missed big chunks of research.]
This post in Time rightly chides those who invoke “crack babies” to stoke fear about “Oxycontin babies”.
I have a few other thoughts beyond this agreement.
The post references the “angriest letters to the editor that [the author has] ever seen from an academic” about the NY times failing to convey the unanimity about the use of methadone or buprenorphine to opioid-dependent women during pregnancy. (It was snippy, but not THAT angry. Maybe a 6 or 7 out of ten.) His most scathing line follows: “That there are physicians who are ambivalent on this issue says more about the state of medical education in the field of addiction medicine than about the state of the science.”
It has been my impression that there is very little disagreement about this. I assumed that the reason was that miscarriage rates were too high for detox. Quick searches of PubMed and Google Scholar with several combinations of the search terms opioid, opiate, pregnant, pregnancy, miscarriage, preterm, withdrawal, detoxification & methadone found shockingly little research on the risks of withdrawal for fetuses. (This was really the point of the NY Times article—that we know very little and we’ve made very little progress in this area.) Two (here and here) found no increased risk of miscarriage for methadone detox and one found MMT patients have a preterm delivery rate 3 times that of non-addicted women. (Which may be lower than opioid addicted pregnant women not in MMT. I don’t know.)
Rather, most of the research on pregnant opioid addicts seem to focus on the risk of relapse by the mother and newborn withdrawal.
If I haven’t completely blown the lit search and the emphasis on opioid maintenance is primarily driven by concerns about relapse, maybe we should be troubled by the unanimity rather than any ambivalent physicians.
Even if there is solid evidence to lay to rest any questions about opioid maintenance for pregnant addicts, what bothers me about the letter is that the focus of his indignation is the suggestion that some people are uncomfortable with opioid maintenance for pregnant addict rather than pregnant women’s lack of access to the kind of treatment that an opioid addicted doctor might receive—long-term, recovery-oriented treatment with long-term monitoring and support. If relapse is the primary concern, this model works very, very well.
On another note, I was also bothered by the Time blogger slipping in the addiction-as-secondary-to-social-ills meme that seems to inform a lot of reporting about addiction in spite of evidence that continues to accumulate, and a strong and long-standing consensus that addiction is a primary disease:
…we need to recognize that addiction is not primarily a cause, but a result, of community problems — and one that can exacerbate them. We need to treat the emotional and economic pain that drives addiction…