Prescription opioids during pregnancy

The March of Dimes has prepared this overview regarding the use of prescription opioids for women who may become pregnant, are pregnant or are still breastfeeding.

KEY POINTS

• Prescription opioids are painkillers often used for pain after an injury, surgery or dental work. They include codeine, morphine and oxycodone.
• If you take opioids during pregnancy, they can cause serious problems for your baby, like premature birth and drug withdrawal called NAS.
• Even if you use an opioid exactly like your health care provider says to, it still may cause NAS in your baby.
• Don’t stop taking an opioid without talking to your provider first. Quitting suddenly can cause severe problems for your baby.
• If you’re not pregnant and taking an opioid, use effective birth control until you’re no longer taking the medicine.

What are prescription opioids?

Prescription opioids are painkillers (medicine used to relieve pain) your health care provider may prescribe if you’ve been injured or had surgery or dental work. They’re sometimes used to treat a cough or diarrhea. A prescription medicine is one your provider says you can take to treat a health condition. You need a prescription (order for medicine) from your health care provider to get the medicine.

These are prescription opioids and some of their common brand names. A brand name is the name given to a product by the company that makes it.

• Buprenorphine (Belbuca^®, Buprenex^®, Butrans^®, Probuphine^®)
• Codeine
• Fentanyl (Actiq^®, Duragesic^®, Sublimaze^®)
• Hydrocodone (Lorcet^®, Lortab^®, Norco^®, Vicodin^®)
• Hydromophone (Dalaudid^®, Exalgo^®)
• Meperidine (Demerol^®)
• Methadone (Dolophine^®, Methadose^®)
• Morphine (Astramorph^®, Avinza^®, Duramorph^®, Roxanol^®)
• Oxycodone (OxyContin^®, Percodan^®, Percocet^®)
• Oxymorphone (Opana^®)
• Tramadol (ConZip^®, Ryzolt^®, Ultram^®)

There are many other brands of opioids, so if you’re taking any medicine you think may be an opioid or combined with an opioid, tell your provider. For example, some cough medicines contain the opioid codeine.

The illegal drug heroin is an opioid. Fentanyl and other prescription opioids are being made and sold illegally. When used illegally, fentanyl sold on the street often is mixed with heroin or cocaine, which makes it extremely dangerous.

Why are opioids dangerous?

Opioids are highly addictive (easy to get addicted to) most likely because along with relieving pain, they release chemicals in the brain that can make you feel calm and intensely happy (also called euphoria). Drug addiction is a brain condition that makes you use drugs, even if they’re harmful to you. Addiction affects your self-control and your ability to stop taking a drug. People who are addicted to prescription opioids may try to buy them illegally, and they may start using heroin or mixing opioids with drugs like heroin and cocaine.

When your health care provider gives you a prescription for medicine, he tells you exactly how much to take, how often to take it and how long to take it. If you’re pregnant and using prescription opioids, take them exactly as your provider tells you to. Tell your provider about any opioid or other drug you take, even if it’s prescribed by another provider. If you go to a provider who prescribes you an opioid, make sure she knows you’re pregnant. When you take any prescription medicine:

• Don’t take more than your provider says you can take.
• Don’t take it with alcohol or other drugs.
• Don’t use someone else’s prescription drugs.

Can opioids cause problems for your baby during pregnancy and after birth?

Yes. Using opioids during pregnancy may cause problems for your baby, including:

• Miscarriage. This is when a baby dies in the womb before 20 weeks of pregnancy.
• Preterm labor and premature birth. Preterm labor is labor that starts too early, before 37 weeks of pregnancy. Preterm labor can lead to premature birth. This is when your baby is born before 37 weeks of pregnancy. Babies born early may have more health problems at birth and later in life than babies born full term.
• Birth defects, including heart defects and spina bifida. Birth defects are health conditions that are present at birth. Birth defects change the shape or function of one or more parts of the body. They can cause problems in overall health, how the body develops, or in how the body works. Spina bifida is the most common neural tube defect (also called NTD). Neural tube defects are birth defects of the brain and spinal cord.
• Fetal growth restriction (also called growth-restricted, small for gestational age and small for date). This means a baby doesn’t gain the weight she should before birth.
• Low birthweight (also called LBW). This is when a baby is born weighing less than 5 pounds, 8 ounces.
• Neonatal abstinence syndrome (also called NAS). NAS is when a baby is exposed to a drug in the womb before birth and goes through withdrawal from the drug after birth. NAS is most often caused when a woman takes opioids during pregnancy. NAS can cause serious problems for a baby, like being born too small and having breathing problems. Even if you use an opioid exactly as your health care provider tells you to, it may cause NAS in your baby. So tell your prenatal care provider about any opioid you take, even if it’s prescribed to you by another health care provider. If another health care provider prescribes you an opioid, make sure she knows you’re pregnant.

If you’re not pregnant and you’re using opioids, use effective birth control until you’re ready to get pregnant. This can help prevent complications when you do get pregnant.

Is it safe to suddenly quit taking opioids during pregnancy?

No. Quitting suddenly (also called going cold turkey) during pregnancy can cause severe problems for you and your baby. If you’re pregnant and taking opioids, don’t go cold turkey without talking to your health care provider. Quitting opioids suddenly may increase your risk of:

• Placental abruption. This is serious condition in which the placenta separates from the wall of the uterus (womb) before birth. It can separate partially or completely. Placental abruption can cause heavy bleeding that can be life-threatening to mom and can lead to premature birth. The placenta grows in your uterus and supplies your baby with food and oxygen through the umbilical cord.
• Preterm labor and premature birth
• Growth problems in your baby
• Stillbirth. This is the death of a baby in the womb after 20 weeks of pregnancy.

What is opioid use disorder?

Addiction to opioids is called an opioid use disorder. You may have an opioid use disorder if:

• You take more opioids than your provider says you can take.
• You have cravings (a strong desire) for an opioid.
• You have problems at home, work or school caused by taking opioids.

Most people who take prescription opioids don’t become addicted to them. We don’t know why some people become addicted to drugs and others can stop using them without problems. We do know that some things make you more likely than others to become addicted. These are called risk factors. Having a risk factor doesn’t mean for sure that you’ll have an addiction. But it may increase your chances. Risk factors for addiction include:

• A family history of addiction. Drug addiction is more common in some families. Tell your provider if you have a parent, brother or sister who’s had a drug addiction or problems with alcohol. Fill out the March of Dimes family health history form to record health information about your family and share the form with your provider.
• A mental health condition. Pregnant women with opioid use disorder often have a mental health condition, like anxiety, depression or post-traumatic stress disorder (also called PTSD). Anxiety is strong feelings of worry or fear, and depression is strong feelings of sadness. These feelings last for a long time and interfere with your daily life. PTSD can happen if you’ve experienced a shocking, scary or dangerous event, like a disaster, rape, abuse or the sudden death of a loved one. People with PTSD may have serious anxiety, flashbacks, nightmares or physical responses (like sweating or a racing heartbeat) when reminded of the event. Tell your provider if you have or think you have a mental health condition, like anxiety, depression or PTSD.
• Peer pressure. If your friends or people around you use drugs, you’re more likely to use drugs and get addicted to them.
• Taking a drug that’s highly addictive, like opioids.

If you have opioid use disorder, you’re at risk for overdose. This is when you take too much of a drug. Overdose can slow or stop your breathing. It can cause you to pass out and even die. If you’re using opioids and have any of these signs and symptoms of overdose, call your provider or 911:

• Blurred vision
• Cold, clammy skin
• Feeling dizzy, faint or very sleepy
• Feeling sick to your stomach
• Loose, floppy muscles
• Slowed or trouble breathing or a slow heartbeat

If you have opioid use disorder and you share needles with other drug users, you’re at risk for infections like hepatitis and HIV. Hepatitis is a virus that attacks the liver. HIV stands for human immunodeficiency virus. HIV attacks the body’s immune system that usually helps protect you from infections. You can pass infections like these to your baby during pregnancy.

Treatment for opioid use disorder during pregnancy may include:

• Medication-assisted therapy (also called MAT) or opioid-assisted therapy (also called OAT). For these treatments, your provider prescribes you long-acting opioids, like methadone or buprenorphine, that you take during pregnancy and after your baby is born. Long-acting means the opioids stay in your body for a long time. Methadone and buprenorphine help reduce your need for opioids in a way that’s safe for you and your baby. They don’t make you feel happy or calm the way some opioids do. If you’re in MAT, talk to your provider about a medicine called naloxone (brand name Narcan®). Naloxone helps stop the harmful effects of opioids, and it can save your life if you have an opioid overdose. With your provider’s OK, it’s safe to use during pregnancy in small doses. Your provider may prescribe it as a nasal spray or a shot. If you’re using naloxone, keep it with you at all times. Your provider can show you and your family how to use it if you have signs or symptoms of an overdose.
• Drug counseling. Your provider may recommend that you meet with a drug counselor by yourself, with a group or both. Counseling can help you change your feelings about drugs and help you develop healthy life skills. It also helps you learn how to avoid or manage situations that may make you likely to relapse. Relapse is when you go back to using a drug after trying to quit using it. People who get drug counseling are less likely to relapse than people who don’t get counseling.

If you’re breastfeeding, is it safe to take opioids?

Breastfeeding is good for both you and your baby. It helps you bond with your baby, and your breast milk helps build your baby’s immunity to protect her from infections. If you baby has NAS, breastfeeding may help make her withdrawal less severe so she needs less medicine and can leave the hospital sooner.

If you’re using prescription opioids for pain relief with your provider’s supervision, you can breastfeed depending on the medicine you take. Some opioids can cause life-threatening problems for your baby. Make sure the provider who prescribes you the opioid knows you’re breastfeeding, and take the medicine exactly as our provider tells you to. Talk to your provider about switching to a safer pain reliever if you take:

• Codeine or medicines that contain codeine
• Hydrocodone
• Meperidine
• Oxycodone
• Tramadol

Pain relievers like ibuprofen (Advil^®) or acetaminophen (Tylenol^®) are safe to use when breastfeeding.

If you’re in MAT or OAT, you can breastfeed your baby if:

• Your health is stable and you’re no longer abusing opioids or using street drugs, like cocaine or marijuana.
• You don’t have HIV.
• Your MAT or OAT program is supervised and your treatment is closely monitored.
• You have social support from friends and family throughout your treatment.
• Your baby continues to gain weight as you breastfeed.

Where can you get help to stop abusing prescription drugs, including opioids?

If you need help to stop abusing prescription drugs, talk to your health care provider. Or contact:

• National Council on Alcoholism and Drug Dependence, (800) 622-2255
• Substance Abuse Treatment Services Facility Locator, (800) 662-4357