Things to consider

Because MAT uses prescribed medications, it is not right for everyone. Some medications work better for some people than for others. Some are unsafe during pregnancy or for people who have certain health conditions. The more you talk with your providers about your concerns with MAT, the more help they can offer.

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Pregnancy

Many women who become pregnant while using opioids make immediate plans to quit. This is a good instinct. Studies find that women who use substances during pregnancy have more early births, deliver babies with lower birth rates, and have more problems during labor and delivery.

Yet, going off opioids too quickly during pregnancy is risky. When a pregnant woman uses opioids, they cross over into the bloodstream of the developing fetus and affect the baby’s system. If the mother quits cold turkey, the baby also experiences withdrawal symptoms. This can result in sudden abortion, early birth, and other dangerous complications.

Methadone has been used for a number of years to safely treat opioid use disorder during pregnancy, and has been widely researched. There is no known permanent harm to babies born to mothers treated with methadone during pregnancy. It controls withdrawal symptoms and helps stabilize heart rate, blood pressure, and other maternal and fetal functions. Pregnant women treated with methadone are three times more likely to remain in treatment (CSAT, 2009).

However, methadone also gets into the baby’s system. Shortly after birth, most babies born to mothers treated with methadone, experience temporary withdrawal symptoms such as fussiness or shaking. This is called neonatal abstinence syndrome (NAS). These symptoms are monitored in the hospital. About 50 percent of the time, NAS symptoms require special treatment that may include medications and longer stays in the hospital before infants can be discharged.

Buprenorphine is another treatment option for pregnant women. Although there are fewer long-term studies available on buprenorphine treatment during pregnancy, research has shown it is safe. It also effectively controls withdrawal symptoms and stabilizes maternal and fetal functions. A number of studies on buprenorphine and pregnancy have consistently shown that withdrawal symptoms are milder for infants born to mothers treated with buprenorphine. They are less likely to require treatment with medications and more likely to have shorter hospital stays than infants born to mothers treated with methadone.

Decisions about the right course of treatment are best made by each woman, with the help of a doctor experienced in treating pregnant women, who can explain the risks and benefits of each medication.

  • Some women have strong feelings about treatment with medications during pregnancy and may wish to withdraw from opioids. It is important they find a doctor or program that specializes in working with recovering women during pregnancy. Experienced providers can supervise a safe withdrawal and make recommendations that are best for the health of mom and baby.
  • Pregnant women treated with buprenorphine are prescribed the single drug formula that contains buprenorphine only. Compounds that contain both buprenorphine and naloxone are not recommended for use during pregnancy or while breastfeeding, since naloxone has not been tested on pregnant women, and its effects on the developing fetus are unknown.

More on pregancy

HIV, hepatitis, and MAT

Human immunodeficiency virus (HIV) is the virus that causes AIDS (acquired immunodeficiency syndrome). In the United States, more than a million people are infected with HIV—and many of them do not know they have it. Getting tested for HIV is the best way to know whether you are infected. Treatment providers offer confidential HIV testing. It is a good idea to get tested since there have been many advances in HIV treatment. People, who know their status, start treatment, and take medications as advised, are having favorable results.

Drug users are at high risk for HIV infection from sharing syringes, spoons, water, or cotton. Many people get HIV by having sex with others who are infected. You can significantly reduce the risk of HIV infection by stopping injection drug use and practicing safe sex.

For people living with HIV, treatment for opioid dependence reduces the chance of giving the virus to others. It also leads to better outcomes for medical treatment of HIV. Medications for opioid use disorder do not protect people from HIV infection, but they can help reduce behaviors that put people at risk.

Medications used to treat HIV may interact with medications used in MAT such as methadone and buprenorphine. If you are living with HIV, talk to your doctor about your HIV treatment and your safest options.

Hepatitis

Viral hepatitis is a leading cause of liver disease and is very common among people who have injected drugs. Because many symptoms of hepatitis are “silent,” most people living with viral hepatitis do not know they are infected. Doctors often screen for hepatitis and take liver function tests before starting MAT.

Always talk with your doctors about all your health conditions before starting MAT. Some MAT options are safer than others for people with liver problems. Most studies find that interferon (a medication commonly used to treat viral hepatitis) and methadone can be used together safely.

People with any liver disease should check with their doctors before deciding to use naltrexone or buprenorphine. Very large doses of naltrexone can cause liver damage, but studies show it can be used safely at the recommended dose, even with people being treated for viral hepatitis.

Liver function tests are recommended before beginning buprenorphine, since there is a possibility it could contribute to liver damage, especially in people with liver disease. Studies so far show it may be used safely by most people with viral hepatitis, unless the liver is functioning very poorly.

Detoxification

Detoxification or “detox” is often a first step for people when they make a decision to stop using. When people addicted to opioids stop using, they have withdrawal symptoms and intense drug cravings. Withdrawal from opioids can be both physically and emotionally painful. Symptoms include anxiety, leg cramps, muscle pain, irritability, diarrhea, and vomiting.

With medically managed detoxification from opioids, a variety of prescription and over-the-counter medications may be used on a short-term basis to help ease the physical symptoms of acute withdrawal. Medically supervised detoxification may take place during a short-term inpatient stay or in an outpatient clinic.

Medication-assisted detoxification is available through federally regulated programs and treatment centers where methadone can be used to help with withdrawal from opioids. During methadone detoxification, the dose is gradually lowered until it is stopped, normally over about 21 days. Because methadone detoxification is short-term, many people relapse if they do not have long-term follow-up treatment and support. Detoxification alone is not considered treatment.

Female

I'm feeling very overwhelmed. I have been using for years and I just don't want this lifestyle anymore.