Introduction
According to Lowe (2017), “…across the United States, a woman presents every 3 minutes to an emergency department for opioid misuse or abuse” (p.657). With the significant increase in the misuse of opioids over the last thirty years in the US, it has become a serious public health concern. With the most dramatic rise in opioid use being of childbearing age women, it is a very important issue in maternal health care (Keough & Fantasia, 2017). It is imperative that nurses are informed and have efficient knowledge of the potential risks, effects, treatment, and prevention of opioid dependence during pregnancy.
Opioid Use in Women
All opioids, including illegal substances like heroin and legal prescription pain reducers such as
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It can cause substantial teratogenic effects early in gestation, during the embryonic stage. During the fetal period, abnormal growth and maturation, alterations in neurotransmitters and their receptors, and brain organization are direct effects caused by opioid abuse (Behnke & Smith, 2017). Continuous use of opioids throughout pregnancy increases the risk of prematurity and growth retardation, deficits in attention, cognition, and behavior, neonatal morbidity and mortality, and neonatal abstinence syndrome (NAS) (McQueen, Murphy-Oikonen, & Desaulniers, 2015).
An abrupt cessation of opioids during pregnancy can lead to many severe complications, affecting both mother and fetus. Poor fetal outcomes may be seen due to this discontinuation of opioids such as an increased risk of intrauterine passage of meconium and neonatal aspiration, preterm labor and birth, fetal growth restriction, as well as fetal distress or demise (Keough & Fantasia, 2017). There is also an increased risk of placenta previa, placental abruption, premature rupture of membranes, and postpartum hemorrhage, all maternal high-risk factors (Shaw et al., 2016). Therefore, it is detrimental to educate woman of the child-bearing age of these dangers prior to their attempt to conceive.
Due to the high risks associated with an untreated opioid addiction during pregnancy, medication-assisted treatment is the standard of care, which is a combination of behavioral
Methadone maintenance therapy is the primary go to source for addicts looking to quit the street drug, heroin. Methadone on it's own has its own number of controversies within society. However add on the fact that a number of patients that attend the meth clinic that is pregnant, well this can add additional controversy and raise ethical implications as well. Ultimately the child is better off when not being subjected to harmful substances such as drugs an alcohol. However when given the choice of heroin or methadone, we will examine what the benefits of methadone maintenance therapy can provide the mother, and the fetus. Methadone clinics provide a safe form of the drug with clean needles which helps cut the spread of HIV/AIDS among the population. While the client is at the clinic it is a good time to reach out and provide the future mother with resources that may help her once her child is born. Clinicians can also take advantage of this meeting time to reach out to the mother and inform her on the benefits of attending a treatment facility to help achieve sobriety.
Initially opioids are prescribed to relieve pain, however many patients get hooked and addicted to opioids. The risks for addicted patients with chronic pain is yet known, in addition opioids are also more accessible, thus overdose cases have increased, some leading to death. A woman who is addicted to opioids during her pregnancy, has the possibility of leading her child to addiction and causing birth defects. Additionally, the addiction is expensive, thus to get the money it will lead to criminal activity or withdrawal symptoms such as pain, diarrhea, nausea, vomiting, and other symptoms. Needles, and various methods are used to inject opioids, however this will lead to transmission of diseases. Opioids cause damages emotionally, physically, and economically, as an attempt to make others aware of this ordeal, National Institute on Drug Abuse (NIDA) is communicating with teens through an online education program. Overconsumption is hard to ignore, however the prevention message are hard to disregard as
(n.d.) also conducted a study focused on infants that were exposed to buprenorphine or methadone while in utero. Unlike MacMullen et al. (2014) their focus was on predicting how the symptoms of NAS might manifest in the exposed newborns. Since the 1970s (MacMullen et al., 2014) methadone has been the treatment of choice for mothers with opioid dependence during pregnancy, the use of this drug allows for a decrease in withdrawal symptoms for the child after birth. The main categories of symptoms include central nervous system hyperirritability, gastrointestinal dysfunction, respiratory distress and vague autonomic symptoms (MacMullen et al., 2014). Although methadone has been being used for many years buprenorphine has only been used since 2002 in the United States (MacMullen et al., 2014). Their research was consistent with Kaltenbach et al. (n.d.) in that infants born to buprenorphine-exposed mothers had lower scores for NAS than those born to methadone-exposed mothers, but still had varying severities of symptoms and scores across all infants. For at least 10 days after birth, an expert scored the newborns on a modified Finnegan scale every 4 hours. The results showed that high birth weight was often a predictor for high NAS scores, along with lower NAS scores for infants delivered by cesarean section. MacMullen et al. (2014) were unable to find any connection between the use of methadone and buprenorphine to indicators of symptoms of NAS. The main
There are three predominate forms of Medication Assisted Treatment (MAT) that have proven effective in combating opioid use disorder. Methadone, buprenorphine, and naltrexone have all shown to be effective in the treatment of substance use. When prescribed and monitored properly, MAT has been shown to reduce illicit drug use and reduce the rate of accidental overdose. However, while as many as 2.5 million people are suffering from substance use disorder, less than 40% have access to MAT
Through the years, substance misuse in the United States has turned into an industrious issue influencing numerous people. In 2008, it was assessed that 17.8 million Americans beyond 18 years old where substance subordinate. Women who use medications during pregnancy can have an enduring impact on fetal. Medications can have an impact of maternal and child wellbeing, yet there are a lot of different variables, which influence it, poor social environment, nourishment, cleanliness, and sexual abuse. Regenerative interruption connected with heroin utilization has been shown in both and women and even low dosages of opiates can impede ordinary ovarian capacity and ovulation. The harm that goes hand in hand with substance utilization comes either straightforwardly from the impact of the medication itself or from issues identified with development and/or unexpected labor. The entanglements of jumbling components clamorous way of life, poor nourishment, liquor utilization and cigarette smoking influence the appraisal of the impacts of cocaine in pregnancy. In obstetric practice, 100% of pregnant women utilizing cocaine or heroin are cigarette smokers. Cigarette smoking is presumably the most well known manifestation of substance utilizes and is noteworthy corresponding considering ladies who use unlawful medications. Babies whose moms smoked in pregnancy have a tendency to have lower conception weights and diminished length, cranial and thoracic
As of now what is known about Opiate drug usage is that pregnant women using this drug give birth to babies with neonatal abstinence syndrome. Babies being born going through withdrawal because the fetus is no longer receives the drug. It was found that neonatal abstinence syndrome is passed when the drug is in the mother's bloodstream which then passes through the placenta into the fetus. Symptoms of neonatal abstinence syndrome in babies vary depending on how much opiate was used during the pregnancy. It includes premature birth, seizures, birth defects, and developmental delays as they grow. Babies who are born full term suffer from tremors, irritability, sleep problems, high-pitched crying, tight muscle tone, poor feeding, dehydration,
“Every 25 minutes, 1 baby is born suffering from opiate withdrawal. Newborns with neonatal abstinence syndrome (NAS) are more likely than other babies to also have low birth weight and respiratory complications” (Dramatic Increases in Maternal Opioid Use and Neonatal Abstinence Syndrome, 2015, Paragraph 2). To insure a better life for these babies, people are trying to create an Act called the Plan of Safe Care Improvement or otherwise known as the Infant Plan of Safe Care Improvement. This Act is meant to protect future babies from not only being born drug dependent because of their mothers, but also ensuring them a drug-free environment after birth. It will also “get help for the mothers and any other guardians involved in drug addiction”
Social and familial effects. While NAS is a heartbreaking and disadvantageous outcome of maternal addiction, it is not the only outcome seen in children. Infants born to dependent mothers who evaded NAS are still at a higher risk of poorer childhood development and lifelong outcomes because of the unhealthy and damaging lifestyle of opioid addiction and familial stress. Through the use of psychiatric and family functioning evaluations, one study found children of opioid dependent mothers or parents showed a significantly higher rate of psychopathologies such as depression and anxiety as compared to those without familial substance abuse and children of alcoholics (Wilens et al., 2002). These children have a much more difficult time growing,
The United States currently faces an unprecedented epidemic of opioid addiction. This includes painkillers, heroin, and other drugs made from the same base chemical. In the couple of years, approximately one out of twenty Americans reported misuse or abuse of prescriptions painkillers. Heroin abuse and overdoses are on the rise and are the leading cause of injury deaths, surpassing car accidents and gun shots. The current problem differs from the opioid addiction outbreaks of the past in that it is also predominant in the middle and affluent classes. Ultimately, anyone can be fighting a battle with addiction and it is important for family members and loved ones to know the signs. The cause for this epidemic is that the current spike of opioid abuse can be traced to two decades of increased prescription rates for painkillers by well-meaning physicians.
The world as we know it is facing an uphill battle with the abuse of opioids. Overprescribed painkillers and heroin are the leading causes in this fight. Opioids are easily attainable in our world today, causing addiction to spread quickly. If no actions are taken soon to end this problem, several lives could be at stake. The negative impacts of the opioid epidemic can be resolved by implementing precautions and treatment plans worldwide.
Throughout my short time working at Crouse Hospital on the Antepartum/Postpartum unit, I have witnessed pregnant and postpartum mothers struggling with substance abuse on a recurring basis. While working on this unit, I have had the opportunity to experience some of the best moments in the newborn 's life, such as parents holding their baby for the first time. On the other hand, I have witnessed the heart breaking reality of what the newborn experiences as a result of maternal substance abuse during pregnancy. Sine I started working at Crouse Hospital, there has been a significant increase of infants being born addicted to opioids and therefore having to endure opioid withdrawal. Sadly, many of these infants are born to mothers who have previously delivered an opioid addicted baby; making this a recurring issue. In Onondaga Country, of every 1,000 babies born, 26 babies have drug-related problems and there is an infant born every hour in the U.S. with a drug related issue (NAS, 2016). This being said, the goal of this research project is to provide education to all mothers on the negative consequences of heroin and other opioid use during pregnancy and how this negatively affects the neonate. The purpose of this research project is to present the realities and the struggles that these helpless infants go through as a result of opioid addiction, hoping to decrease the incidence of this highly prevalent issue. Therefore, an increased education needs to be given to
Many women, including teens, abuse drugs while they are pregnant. This rate is especially high to those who are homeless, underprivileged, or live in a broken home. In order for drug abusers to even have a chance at beating their addiction they have to have support whether it’s family, friends, or boyfriend/spouse. They must also let the abuser now all the consequences to themselves and the unborn child. There are many consequences when using drugs during pregnancy such as miscarriage, health risks to baby, and health risks to the mother. And learning disabilities and brain damage to the fetus.
Opioid addiction is so prevalent in the healthcare system because of the countless number of hospital patients being treated for chronic pain. While opioid analgesics have beneficial painkilling properties, they also yield detrimental dependence and addiction. There is a legitimate need for the health care system to provide powerful medications because prolonged pain limits activities of daily living, work productivity, quality of life, etc. (Taylor, 2015). Patients need to receive appropriate pain treatment, however, opioids need to be prescribed after careful consideration of the benefits and risks.
The use of heroin, cocaine, and other illicit drugs has become a public health concern especially during pregnancy. Maternal substance abuse has become an issue during the crack epidemic in the 1980’s; however, there is an alarm rate of infants born addicted to heroin. More than 3.7% women have indicated the uses some form of illicit drugs during their pregnancy, as well as 1.9 % reports binge drinking (Bhuvaneswar el at., 2008; Grant el at., 2009). With this in mind, more than 375,000 infants are born to maternal substance abusers each year costing over $100,000 in medical expenses covered by the state (Reitman, 2002).
Substance abuse during pregnancy can have a negative force on the health and wellness of not only the fetus, but that of the mother. The harmful effects of medications, alcohol and illegal drugs on an unborn child can be devastating and can have significant consequences to its use. Sometimes the effects can be faced and treated, and other times the outcome is a lifelong challenge. During the prenatal period, it is important that new mothers are informed of the different types of abuse, how they may affect the fetus, and the adverse conditions their child may be faced with before and after birth.