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According to the National Institute on Drug Abuse, there can be devastating consequences for the unborn baby if a pregnant woman who is dependent on opioids is not properly treated. The function of the placenta can be comprised and the unborn baby can experience severe episodes of withdrawal.

A new study published in the Annals of Family Medicine looked at maternity care and buprenorphine prescribing in new family physicians.

“We were interested in exploring the family physician workforce that is providing care to pregnant women with opioid use disorder,” study author Dr. Joshua St. Louis told us. “In particular we were interested in looking at those physicians who are able to prescribe buprenorphine.”

Buprenorphine is one of the first line treatments for opioid use disorder. The Food and Drug Administration (FDA) approved it for clinical use in 2002. It’s the first opioid dependency drug that physicians can prescribe from their office. The drug is usually prescribed to patients along with therapy.

Pregnant women dependent on opioids who are not treated can also have damaging effects to the mother and baby including preterm labour, neonatal abstinence syndrome (when the infant becomes addicted to the drug and experiences withdrawal symptoms including tremors, fever, diarrhea, seizures, irritability and feeding difficulties), fetal convulsions, stunted growth, and fetal death. There is also an increased HIV risk of infection to the mother. The rate of neonatal abstinence syndrome increased five fold from 2000 to 2012. Even though neonatal abstinence syndrome may still occur while the mother is going through treatment with buprenorphine, it’s to a lesser degree.

“I provide this care in my practice and I'm very passionate about it,” Dr. St. Louis told us. “I theorized that there were not many family physicians providing care for pregnant women with opioid use disorder. I also imagined that there would be a particular dearth of these physicians in rural areas.”  

According to the U.S. Department of Health and Human Services, buprenorphine provides the same effects as opioids such as euphoria but in lower doses. Side effects of buprenorphine may include nausea, vomiting and constipation, muscle aches and cramps, distress and irritability, fever, cravings, and an insomnia. The drug is considered safe for pregnant or breastfeeding women.

“We reviewed survey results of family physicians who are new in their practices (three years after graduating from residency) to determine how many of them were both providing care during pregnancy and were prescribing the medicine buprenorphine,” Dr. St. Louis told us. “We found that only 5.1 per cent of new family physicians were doing this work. Furthermore, these physicians were trained in a very small number of residency training programs.” 

There are three phases in buprenorphine treatment. The first phase is called the Induction Phase and is started in the physician’s office after the patient is in early withdrawal, having not used any opioids for 12 to 24 hours. The second phase is called the Stabilization Phase. In this phase, the dose of buprenorphine might need to be adjusted because the patient should no longer be experiencing cravings for opioids and experiencing less side effects. The third phase is called the Maintenance Phase. The patient during this phase has stabilized on buprenorphine and the length of time in is different for each individual.

“I was not particularly surprised that there were very few family physicians doing this work, though I was surprised to find that so few residency programs were training family physicians to do this,” Dr. St. Louis told us. “I strongly feel that these results should be used to encourage family medicine residency programs to expand their training in this exceptionally important realm of primary care.”