I think you should speak to a doctor as soon as possible. There are ways of tapering during pregnancy that can reduce the possible harms to your baby, but definately don't go cold turkey. It's a pretty huge physical strain and I've known some women who've lost their babies doing this.
Sometimes it's better to switch to methadone during pregnancy, just so your habit can be stabilised. Those babies who do display some methadone withdrawl symptoms can be easily tapered with oral morphine.
I think that you need to find yourself a good doctor who is experienced in working with women who use opiates. These are complex decisions, and only you can decide which path is best. But, you've got to be fully informed, which is why I strongly recommend seeing a doctor.
You're not the first to go through this and it can be a difficult time. Try not to let the doctor push something that you really don't want. Doctors generally will prefer to use methadone, but this might not be what's best for you. You
have options and you deserve to know about all the pros and cons.
Opiates
Regular use of illicit opiates endangers the health of the woman and her foetus through continual change in blood heroin levels, exposure to a diverse range of drugs and contaminants, and infections consequent upon injecting drug use. Due to lifestyle factors associated with opiate dependency, pregnant women in this population do not usually have adequate nutrition, necessary rest or sufficient antenatal care.
Health risks of taking opiates during pregnancy
General medical risks associated with injecting drug use that may affect the health and development of the foetus:
* HIV
* hepatitis B and hepatitis C
* endocarditis
* malnutrition
* anaemia
* sexually transmitted diseases.
Obstetric complications
* Increased risk of miscarriage
* Increased risk of intrauterine growth retardation
* Increased risk of other obstetric complications – placental insufficiency, foetal distress, intrauterine death
* Risk of physical dependence in the foetus and subsequent withdrawal in the neonate (known as Neonatal Abstinence Syndrome)
* Opiate withdrawal or detoxification during pregnancy may induce abortion, or premature labour/foetal distress particularly before the 14th week or after the 32nd week respectively. If withdrawal is to be attempted it ideally should be undertaken between the 14th and 32nd weeks under close supervision.
Opiate management options for pregnant drug-dependent women
Opiate-dependent women generally have two management options:
* reduce opiate intake independently or attempt detoxification. Such a task is enormously difficult and results in many users returning to opiate use. Constantly changing states of intoxication and withdrawal can stress the foetus, particularly in the first and third trimesters
* enrol in a methadone maintenance program.
Advantages of methadone maintenance programs
* It provides the woman with a daily dose of methadone which eliminates the fluctuating heroin blood levels experienced by mother and foetus during illicit opiate use.
* Women in methadone maintenance programs tend to have longer pregnancies, fewer obstetrical complications and infants who are larger for their gestational age than similar populations not in treatment (Giles et al., 1989).
* Methadone maintenance programs dramatically reduce the possibility of foetal exposure to unknown drugs and contaminants.
* Enrolment in methadone maintenance programs may provide the woman with sufficient antenatal care and parenting education and support. This is important for a population who are often highly stigmatised and unsupported.
Neonatal Abstinence Syndrome (NAS)
* Many infants born to methadone-maintained women will experience some form of withdrawal, usually within 72 hours of birth.
* Such withdrawal is characterised by agitation, irritability, or by vomiting, diarrhoea or convulsions in extremely severe cases.
* This abstinence syndrome tends to respond well to morphine or phenobarbitone.
* Women who are stable on methadone maintenance programs should be encouraged to breastfeed. The amount of methadone in breast milk is minute and unlikely to harm the infant in the first three to six months of life. When breastfeeding is ceasing, the infant must be weaned slowly as there is a risk of withdrawal.
Handbook for Medical Practitioners and other Health Care Workers on Alcohol and other Drug Problems.
Good luck with all this.
