MoonDragon's Pregnancy Information
PREGNANCY & DRUG DEPENDENCE
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Pregnancy & Drug Dependency Description Frequent Signs & Symptoms Substance Abuse Risk Factors Preventive Measures Expected Outcome Potential Complications Conventional Medical Management Medications Opioid Medical Screening Activity Recommendations & Restrictions Diet & Nutrition Herbal Recommendations Nutritional Supplements Recommendations Notify Your Midwife or Health Care Provider Recommended Herbs & Nutritional Supplement Products
PREGNANCY & DRUG DEPENDENCY DESCRIPTION
Drug dependence is a compulsive and destructive use of mood altering and perception-altering substances despite adverse medical, psychological and social consequences. These substances can affect the central nervous system, liver, kidneys, and blood. Some abused drugs are legal substances such as benzodiazepines, barbiturates, amphetamines and pain-killers. Alcohol, caffeine, and tobacco can be included as legal drug dependent substances. Illegal substances include, but are not limited to, marijuana, cocaine, crack, heroin, LSD, PCP (angel dust), and volatile substances, such as glue, solvents and paints.
MoonDragon's Health & Wellness: Teratogens List
MoonDragon's Health & Wellness: Drug Addiction (Substance Abuse)
In pregnancy, the continued use of these substances can cause mild to major problems for the mother and for the unborn child.
STATISTICS ON DRUG USE DURING PREGNANCY
More than 5 percent of the 4 million women who gave birth in the United States in 1992 used illegal drugs while they were pregnant, according to the first nationally representative survey of drug use among pregnant women. The NIDA-sponsored survey provides the best estimates to date of the number of women who use drugs during pregnancy, their demographic characteristics, and their patterns of drug use. Information from NIDA's National Pregnancy and Health Survey can help to guide public health policymakers who have to make decisions about prevention and treatment programs aimed at reducing the problem of drug abuse during pregnancy, said NIDA Director Dr. Alan I. Leshner.
Dr. Leshner reported the survey's findings at a press briefing held during NIDA's conference on Drug Addiction Research and the Health of Women. The survey gathered self-report data from a national sample of 2,613 women who delivered babies in 52 urban and rural hospitals during 1992. Based on these data, an estimated 221,000 women who gave birth in 1992 used illicit drugs while they were pregnant.
Marijuana and cocaine were the most frequently used illicit drugs 2.9 percent, or 119,000 women, used marijuana and another 1.1 percent, or 45,000 women, used cocaine at some time during their pregnancy. The survey found that an estimated 113,000 white women, 75,000 African-American women, and 28,000 Hispanic women used illicit drugs during pregnancy.
The survey found a high incidence of cigarette and alcohol use among pregnant women. At some point during their pregnancy, 20.4 percent, or 820,000, pregnant women smoked cigarettes and 18.8 percent, or 757,000, drank alcohol.
Practitioners know for certain that these "legal" substances affect the health of the fetus and a woman during and after pregnancy, said Dr. Loretta D. Finnegan, NIDA's former senior advisor on women's issues. Health care practitioners should ask women about their use of cigarettes and alcohol during prenatal checkups and educate them about the health risks of licit drugs, said Dr. Finnegan, who now directs the Women's Health Initiative at the National Institutes of Health.
The survey also uncovered a strong link between cigarette smoking and alcohol use and the use of illicit drugs in this population. Among those women who used both cigarettes and alcohol, 20.4 percent also used marijuana and 9.5 percent took cocaine. Conversely, of those women who said they had not used cigarettes or alcohol, only 0.2 percent smoked marijuana and 0.1 percent used cocaine. This finding reinforces the need for health practitioners to monitor the status of both licit and illicit drug use during pregnancy, said Dr. Leshner.
Besides providing the first national estimates of drug use during pregnancy, the survey also examined differences in the amount and types of drugs used by several racial and ethnic groups of women. Overall, 11.3 percent of African-American women, 4.4 percent of white women, and 4.5 percent of Hispanic women used illicit drugs while pregnant. While African Americans had higher rates of drug use, in terms of actual numbers of users, most women who took drugs while they were pregnant were white. The survey found that an estimated 113,000 white women, 75,000 African-American women, and 28,000 Hispanic women used illicit drugs during pregnancy.
The survey also described different patterns of licit and illicit drug use among white women and ethnic minorities. African-American women had the highest rates of cocaine use, mainly crack, during pregnancy. About 4.5 percent of African-American women used cocaine compared with 0.4 percent of white women and 0.7 percent of Hispanic women who did so. White women had the highest rates of alcohol and cigarette use. Nearly 23 percent of white women drank alcohol and 24.4 percent smoked cigarettes. By comparison, 15.8 percent of African-American women and 8.7 percent of Hispanic women drank alcohol and 19.8 percent of African-American women and 5.8 percent of Hispanic women smoked cigarettes. These findings point to the importance of attending to cultural issues in drug abuse prevention and treatment efforts, said Dr. Finnegan.
Although women who used drugs during pregnancy generally decreased their rates of drug use throughout their pregnancy, they did not discontinue drug use, Dr. Leshner noted. This finding indicates how gripping an illness drug addiction can be, even in the face of what may seem to be the ultimate incentive to stay drug free, Dr. Leshner said. Nevertheless, it is a disease that can be treated and managed with appropriate interventions, he stressed.
With the information the survey provides about the patterns of drug use by women during pregnancy, practitioners will be better able to identify priorities we must address, said Dr. Finnegan. This will enable researchers to develop and test more effective approaches to the differential drug abuse treatment and prevention needs of women of childbearing age, she concluded.
OPIOID USE IN PREGNANCY
Opioid use in pregnancy is not uncommon, and the use of illicit opioids during pregnancy is associated with an increased risk of adverse outcomes. The current standard of care for pregnant women with opioid dependence is referral for opioid-assisted therapy with methadone, but emerging evidence suggests that buprenorphine also should be considered. Medically supervised tapered doses of opioids during pregnancy often result in relapse to former use. Abrupt discontinuation of opioids in an opioid-dependent pregnant woman can result in preterm labor, fetal distress, or fetal demise. During the intrapartum and postpartum period, special considerations are needed for women who are opioid dependent to ensure appropriate pain management, to prevent postpartum relapse and a risk of overdose, and to ensure adequate contraception to prevent unintended pregnancies. Patient stabilization with opioid-assisted therapy is compatible with breastfeeding. Neonatal abstinence syndrome is an expected and treatable condition that follows prenatal exposure to opioid agonists.
Opioid abuse in pregnancy includes the use of heroin and the misuse of prescription opioid analgesic medications. According to the 2010 National Survey on Drug Use and Health, an estimated 4.4 percent of pregnant women reported illicit drug use in the past 30 days. A second study showed that whereas 0.1 percent of pregnant women were estimated to have used heroin in the past 30 days, 1 percent of pregnant women reported nonmedical use of opioid-containing pain medication. In this study, the rates of use varied by setting and by mode of assessment. The urine screening of pregnant women in an urban teaching hospital resulted in a detection rate for opioids of 2.6 percent. The prevalence of opioid abuse during pregnancy requires that health care practitioners be aware of the implications of opioid abuse by pregnant women and of appropriate management strategies.
FREQUENT SIGNS & SYMPTOMS
Signs and symptoms depend on the substance of abuse. Most produce:
- A temporary, pleasant mood.
- Relief from anxiety.
- False feelings of self-confidence.
- Increased sensitivity to sight and sounds (including hallucinations).
- Altered activity levels (such as stupor and sleep-like states or hyperactivity).
- Unpleasant or painful symptoms when the abused substance is withdrawn.
Substances of abuse may produce addiction (a physiological need) or dependence (a psychological need). Some people seem to be more susceptible to dependency than others.
People take drugs for many reasons: peer pressure, relief of stress, increased energy, to relax, to relieve pain, to escape reality, to feel more self-esteem, and for recreation. They may take stimulants to keep alert, or cocaine for the feeling of excitement it produces. Athletes and bodybuilders may take anabolic steroids to increase muscle mass.
Opioid addiction may develop with repetitive use of either prescription opioid analgesics or heroin. Heroin is the most rapidly acting of the opioids and is highly addictive. Heroin may be injected, smoked, or nasally inhaled. Heroin has a short half-life, and a heroin user may need to take multiple doses daily to maintain the drug's effects. Prescribed opioids that may be abused include codeine, fentanyl, morphine, opium, methadone, oxycodone, meperidine, hydromorphone, hydrocodone, propoxyphene, and buprenorphine (the partial agonist). These products may variously be swallowed, injected, nasally inhaled, smoked, chewed, or used as suppositories. The onset and intensity of euphoria will vary based on how the drug was taken and the formulation; however, all have the potential for overdose, physical dependence, abuse, and addiction. Injection of opioids also carries the risk of cellulitis and abscess formation at the injection site, sepsis, endocarditis, osteomyelitis, hepatitis B, hepatitis C, and human immunodeficiency virus (HIV) infection.
Opioids bind to opioid receptors in the brain and produce a pleasurable sensation. Opioids also depress respiration, potentially resulting in respiratory arrest and death. Opioid addiction is associated with compulsive drug-seeking behavior, physical dependence, and tolerance that lead to the need for ever higher doses. Once physical dependence to an opioid has developed, a withdrawal syndrome occurs if use is discontinued. With short-acting opioids, such as heroin, withdrawal symptoms may develop within 4 to 6 hours of use, may progress up to 72 hours, and usually subside within a week. For long-acting opioids, such as methadone, withdrawal symptoms are usually experienced between 24 hours and 36 hours of use and may last for several weeks. Obsessive thinking and drug cravings may persist for years, thus leading to relapse. Although heroin withdrawal is not fatal to healthy adults, fetal death is a risk in pregnant women who are not treated for opioid addiction because their offspring experience acute opioid abstinence syndrome.
SUBSTANCE ABUSE RISK FACTORS
Women can have special risk factors for drug abuse. Women can become addicted quickly to certain drugs, such as crack cocaine. Therefore, by the time they seek help, their addiction may be difficult to treat. Women who use drugs often suffer from other serious health problems, sexually transmitted diseases, and mental health problems, such as depression. Many women who use drugs have had troubled lives. Studies have found that at least 70 percent of women drug users have been sexually abused by the age of sixteen. Most of these women had at least one parent who abused alcohol or drugs. Women who use drugs tend to have low self-esteem, little self-confidence, and feel powerless. They often feel lonely and are isolated from support networks. Women from certain cultural backgrounds or who have difficulty with the English language may not know how to find help for their addiction.
Drug use is a serious health problem for many reasons. Women who use drugs risk becoming infected with HIV, the virus that causes AIDS. The virus can be spread through needles used to inject drugs. Therefore, women who inject drugs and share needles are especially at risk. The AIDS virus is also spread through sexual contact; women who have sex with men who inject drugs are at great risk. Today, almost 70 percent of AIDS cases in women are related to either injecting drugs or having sex with a man who injects drugs. AIDS is now the fourth leading cause of death among women.
A mother who uses drugs risks her life and her baby's. When a pregnant woman uses drugs, she and her unborn child face serious health problems. During pregnancy, the drugs used by the mother can enter the baby's bloodstream. The most serious effects on the baby can be HIV infection, AIDS, prematurity, low birth weight, Sudden Infant Death Syndrome, small head size, stunted growth, poor motor skills, and behavior problems. A mother's continuing drug use puts her children at risk for neglect, physical abuse, and malnutrition. However, National Institute on Drug Abuse (NIDA) research shows that care and treatment for the pregnant drug abuser can reduce many of the negative effects on the baby.
RISK FACTORS FOR DRUG ADDICTION & DEPENDENCY
The type, frequency and the method of use of certain drugs, e.g., cocaine. Different drugs have different dependency/addiction risks. Illness requiring prescription pain relievers or tranquilizers. Family history of drug abuse. Genetic factors (possibly). Some persons may be more susceptible to addiction. Excess alcohol consumption. Fatigue or overwork. Poverty. Psychological problems, including depression, dependency or poor self-esteem. Peer pressure.
HEALTH RISKS ASSOCIATED WITH DRUG ABUSE MOTHER
Poor Nutrition High Blood Pressure Rapid Heart Beat Low Weight Gain Low Self Esteem Pre-term Labor Sexually Transmitted Disease Early Delivery HIV/AIDS Depression> Physical Abuse BABY
Prematurity Low Birth Weight Infections Small Head Size Sudden Infant Death Syndrome Birth Defects Stunted Growth Poor Motor Skills HIV/AIDS Learning Disabilities Neurological Problems
OPIOID EFFECTS ON PREGNANCY & PREGNANCY OUTCOME
An association between first-trimester use of codeine and congenital heart defects has been found in three of four case-control studies. Previous reports have not shown an increase in risks of birth defects after prenatal exposure to oxycodone, propoxyphene, or meperidine. The authors of one retrospective study observed an increased risk of some birth defects with the use of prescribed opioids by women in the month before or during the first trimester of pregnancy. However, methodological problems with this study exist, and such an association has not been previously reported. The observed birth defects remain rare with a minute increase in absolute risk. Although none of these studies investigated methadone or buprenorphine specifically, concern about a potential small increased risk of birth defects associated with opioid-assisted therapy during pregnancy must be weighed against the clear risks associated with the ongoing use of illicit opioids by a pregnant woman.
During pregnancy, chronic untreated heroin use is associated with an increased risk of fetal growth restriction, abruptio placentae, fetal death, preterm labor, and intrauterine passage of meconium. These effects may be related to the repeated exposure of the fetus to opioid withdrawal as well as the effects of withdrawal on placental function. Additionally, the lifestyle issues associated with illicit drug use put the pregnant woman at risk of engaging in activities, such as prostitution, theft, and violence, to support herself or her addiction. Such activities expose women to sexually transmitted infections, becoming victims of violence, and legal consequences, including loss of child custody, criminal proceedings, or incarceration.
Do not socialize with persons who use and abuse drugs.
Seek counseling for mental health problems, such as depression or chronic anxiety, before they lead to drug problems. Develop wholesome interests and leisure activities. After surgery, illness or injury, discontinue the use of prescription pain relievers and tranquilizers as soon as possible. Do not use more than you need.
Strong motivation, good medical care and support from family and friends offer the best chance for improved maternal and infant outcome.
Drug use and abuse by a pregnant woman may be considered "high risk" and would not usually be suitable for a homebirth due to the possibility of severe complications associated with both the mother and the baby.
ILLEGAL DRUG USE & PREGNANCY
Pregnant women who use drugs such as heroin, cocaine, marijuana, PCP, methadone, and/or amphetamines may give birth to drug-addicted babies. Many of these babies experience withdrawal symptoms known as neonatal abstinence syndrome (NAS). Symptoms of NAS may include:
- Increased sensitivity to noise or other stimuli.
- Feeding problems.
- Poor coordination.
- Excessive crying and/or irritability.
THE RISKS - ILLEGAL DRUG USE DURING PREGNANCY
The effects of illegal drugs, such as cocaine, can be devastating on a fetus. Unfortunately, many women of childbearing age in the US use some form of illegal drug.
A mother taking illegal drugs during pregnancy increases her risk for anemia, blood and heart infections, skin infections, hepatitis, and other infectious diseases. She also is at greater risk for sexually transmitted diseases. Almost every drug passes from the mother's bloodstream through the placenta to the fetus. Illicit substances that cause drug dependence and addiction in the mother also cause the fetus to become addicted.
A laboratory test, called a chromatography, performed on a woman's urine can detect many illegal drugs, including marijuana and cocaine. Both marijuana and cocaine, as well as other illegal drugs, can cross the placenta. Marijuana use during pregnancy may be linked to behavioral problems in the baby. Cocaine use can lead to premature delivery of the fetus, premature detachment of the placenta, high blood pressure, stillbirth. Infants born to cocaine-using mothers may have an increased risk of sudden infant death syndrome (SIDS). The effects of cocaine on the fetus may include, but is not limited to, the following:
- Growth defects.
- Intestinal abnormalities.
- Uncontrollable trembling.
- Learning problems.
Heroin and other opiates, including methadone, can cause significant withdrawal in the baby, with some symptoms lasting as long as four to six months. Seizures may also occur and are more likely in babies born to methadone users.
If a woman stops taking illegal drugs during her first trimester, she increases her chances of having a healthy baby.
SEEKING TREATMENT FOR DRUG PROBLEMS
Many women with drug problems are afraid to seek treatment. Studies have found that more than 4 million women need treatment for drug abuse. Unfortunately, there are many important reasons why women do not seek help. Some women may not be able to find child care. Or they fear that the authorities may take away their children. Some women fear they will be punished if they admit their drug addiction. Many women fear violence from their husbands, boyfriends, or partners. Friends and family can help relieve these fears for the woman who uses drugs. They can support her by helping her find good drug abuse treatment and by providing child care and transportation. Women can get help for their drug addiction.
It is hard to beat drug addiction. But the woman who uses drugs can get better with the right kind of treatment - even if she has tried to quit before and failed. Treatment is available, often close to home. The first step is to find out what kind of treatment a woman needs and where she can get it. For a referral to a local treatment program, call the free National Drug Information Treatment and Referral Line, at 1-800-662-HELP or 1-800-66-AYUDA. Women who get treatment can rebuild their lives.
LONG-TERM INFANT OUTCOME
Recent data on long-term outcomes of infants with in utero opioid exposure are limited. For the most part, earlier studies have not found significant differences in cognitive development between children up to 5 years of age exposed to methadone in utero and control groups matched for age, race, and socioeconomic status, although scores were often lower in both groups compared with population data. Preventive interventions that focus on enriching the early experiences of such children and improving the quality of the home environment are likely to be beneficial.
Sexually transmitted diseases, which are more frequent among addicts. Severe infections, such as endocarditis (infection of the heart). Hepatitis, HIV or blood poisoning from intravenous injections with non-sterile needles. Malnutrition caused by poor appetite. Accidental injury to oneself or others while in a drug-induced state. Loss of job or family. Irreversible damage to body organs. Death caused by overdose.
Preeclampsia-Eclampsia (Toxemia of Pregnancy). Abruptio placenta. Premature rupture of membranes.
- Premature Rupture of Membranes (PROM)
- Pre-labor Rupture of Membranes, Pre-Term Guidelines
- Pre-labor Rupture of Membranes At Term Guidelines
- Prolonged Rupture of Membranes Guidelines
- Newborn Care For Prolonged (PROROM) or Premature (PROM) Rupture of Membranes
FOR THE FETUS OR NEWBORN
Intrauterine growth retardation. Congenital abnormalities (birth defects) Medical problems in a newborn, including withdrawal syndromes to the drug, death of the fetus, stillbirth or infant death shortly after birth.
NEONATAL ABSTINENCE SYNDROME
Although maternal methadone or buprenorphine therapy improves pregnancy outcomes and reduces risky behavior, its use puts the neonate at risk of neonatal abstinence syndrome, which is characterized by hyperactivity of the central and autonomic nervous systems. Infants with neonatal abstinence syndrome may have uncoordinated sucking reflexes leading to poor feeding, become irritable, and produce a high-pitched cry. In infants exposed to methadone, symptoms of withdrawal may begin at anytime in the first 2 weeks of life, but usually appear within 72 hours of birth and may last several days to weeks. Infants exposed to buprenorphine who develop neonatal abstinence syndrome generally develop symptoms within 12 to 48 hours of birth that peak at 72 to 96 hours and resolve by 7 days. Close communication between the maternal health care practitioner and pediatrician is necessary for optimal management of the neonate.
All infants born to women who use opioids during pregnancy should be monitored for neonatal abstinence syndrome and treated if indicated. Treatment is adequate if the infant has rhythmic feeding and sleep cycles and optimal weight gain.
CONVENTIONAL MEDICAL MANAGEMENT
PATIENT'S STEPS TO RECOVERY
Acknowledge that you have a problem and seek professional help.
Advise your midwife or health care provider about what drugs are used, frequency of use, how the drug was administered, when it was last used, any history of withdrawals or overdose. NOTE: Please be honest with your midwife or health care provider. Withholding information about drug usage and frequency can cause problems with you and your baby during your pregnancy and at the time of your delivery. Setting up proper prenatal care guidelines and preparations must be made accordingly to provide the best of care for you and your baby.
Appropriate laboratory tests will be obtained and prenatal tests will be performed to determine fetal well-being.
Be open and honest with your family and close friends, as ask for their help. Avoid friends who tempt you to resume your habit.
Treatment will involve a coordination of medical, social, nutritional and psychological help with long-term follow-up.
Depending on the specific drug(s) of abuse, outpatient or inpatient withdrawal treatment may be indicated.
Join self-help groups.
TYPES OF SUBSTANCE ABUSE
There are many levels of substance abuse and many kinds of drugs, some of them readily accepted by society.
LEGAL DRUG SUBSTANCES: Legal substances, approved by law for sale over the counter or by a health provider's prescription, include caffeine, alcoholic beverages (see alcoholism), nicotine (see smoking), and inhalants (nail polish, glue, inhalers, gasoline). Prescription drugs such as tranquilizers, amphetamines, benzodiazepines, barbiturates, steroids, and analgesics can be knowingly or unknowingly over prescribed or otherwise used improperly. In many cases, new drugs prescribed in good conscience by health care providers turn out to be a problem later. For example, diazepam (Valium) was widely prescribed in the 1960s and 70s before its potential for serious addiction was realized. In the 1990s, sales of fluoxetine (Prozac) helped create a $3 billion antidepressant market in the United States, leading many people to criticize what they saw as the creation of a legal drug culture that discouraged people from learning other ways to deal with their problems. Prescription drugs are regulated by the Food and Drug Administration and the Drug Enforcement Administration.
ILLEGAL DRUG SUBSTANCES: Prescription drugs are considered illegal when diverted from proper use. Some people shop until they find a health care provider who freely writes prescriptions; supplies are sometimes stolen from laboratories, clinics, or hospitals. Morphine, a strictly controlled opiate, and synthetic opiates, such as fentanyl, are most often abused by people in the medical professions, who have easier access to these drugs. Other illegal substances include cocaine and crack, marijuana and hashish, heroin, hallucinogenic drugs such as LSD, PCP (phencycline or "angel dust"), "designer drugs" such as MDMA (Ecstasy), and "party drugs" such as GHB (gamma hydroxybutyrate).
EFFECTS OF SUBSTANCE ABUSE: The effects of substance abuse can be felt on many levels: on the individual, on friends and family, and on society.
On the Individual: People who use drugs experience a wide array of physical effects other than those expected. The excitement of a cocaine high, for instance, is followed by a "crash": a period of anxiety, fatigue, depression, and an acute desire for more cocaine to alleviate the feelings of the crash. Marijuana and alcohol interfere with motor control and are factors in many automobile accidents. Users of marijuana and hallucinogenic drugs may experience flashbacks, unwanted recurrences of the drug's effects weeks or months after use. Sudden abstinence from certain drugs results in withdrawal symptoms. For example, heroin withdrawal can cause vomiting, muscle cramps, convulsions, and delirium. With the continued use of a physically addictive drug, tolerance develops; i.e., constantly increasing amounts of the drug are needed to duplicate the initial effect. Sharing hypodermic needles used to inject some drugs dramatically increases the risk of contracting AIDS and some types of hepatitis. In addition, increased sexual activity among drug users, both in prostitution and from the disinhibiting effect of some drugs, also puts them at a higher risk of AIDS and other sexually transmitted diseases. Because the purity and dosage of illegal drugs are uncontrolled, drug overdose is a constant risk. There are over 10,000 deaths directly attributable to drug use in the United States every year; the substances most frequently involved are cocaine, heroin, and morphine, often combined with alcohol or other drugs. Many drug users engage in criminal activity, such as burglary and prostitution, to raise the money to buy drugs, and some drugs, especially alcohol, are associated with violent behavior.
Effects on the Family: The user's preoccupation with the substance, plus its effects on mood and performance, can lead to marital problems and poor work performance or dismissal. Drug use can disrupt family life and create destructive patterns of co-dependency, that is, the spouse or whole family, out of love or fear of consequences, inadvertently enables the user to continue using drugs by covering up, supplying money, or denying there is a problem. Pregnant drug users, because of the drugs themselves or poor self-care in general, bear a much higher rate of low birth-weight babies than the average. Many drugs (e.g., crack and heroin) cross the placental barrier, resulting in addicted babies who go through withdrawal soon after birth, and fetal alcohol syndrome can affect children of mothers who consume alcohol during pregnancy. Pregnant women who acquire the AIDS virus through intravenous drug use pass the virus to their infant.
Effects on Society: Drug abuse affects society in many ways. In the workplace it is costly in terms of lost work time and inefficiency. Drug users are more likely than nonusers to have occupational accidents, endangering themselves and those around them. Over half of the highway deaths in the United States involve alcohol. Drug-related crime can disrupt neighborhoods due to violence among drug dealers, threats to residents, and the crimes of the addicts themselves. In some neighborhoods, younger children are recruited as lookouts and helpers because of the lighter sentences given to juvenile offenders, and guns have become commonplace among children and adolescents. The great majority of homeless people have either a drug or alcohol problem or a mental illness, many have all three.
The federal government budgeted $17.9 billion on drug control in 1999 for interdiction, prosecution, international law enforcement, prisons, treatment, prevention, and related items. In 1998, drug-related health care costs in the United States came to more than $9.9 billion.
Additional information is available from:
Cocaine Abuse Hotline
1 (800) COCAINE
Do It Now Foundation
6423 S. Ash Ave.
Tempe, AZ 85283
Drug Abuse Clearinghouse
11426 Rockville Pike, Suite 200
Rockville, MD 20852
FURTHER INFORMATION & EDUCATION
Crack Mothers: Pregnancy, Drugs, and the Media - Beginning in the late 1980s, the crack mother scare led to an unprecedented alliance between doctors and prosecutors, where health care providers turned in addicted low-income minority pregnant women to the police for arrest, trial, and incarceration. While middle class white women weren't treated in the same manner. The instant addiction of crack cocaine and its threat to the health of women and infants were exaggerated by the media and used to justify harsher social agendas regarding women and minorities. The book is a well-researched examination of the severe treatment of addicted low-income minority pregnant women. An issue that has not gone away.
Pregnant Women on Drugs: Combating Stereotypes and Stigma - A book that tries to fight stereotypes of pregnant drug users as selfish and unfeeling women who don't care about their baby. It shows the extent to which many drug-using women develop the motivation to achieve their dual goals of improving their children's health and maintaining maternal custody.
Pregnant Women on Drugs
The Nature of Nurture: Biology, Environment, and the Drug-Exposed Child - Explores the biological and environmental factors that impact the ultimate development of drug-exposed children and presents practical strategies for helping children reach their full potential at home and in the classroom. The health consequences for children exposed to alcohol, cocaine, and other drugs are enormous, but the implications for behavior and learning are even greater.
The Nature of Nurture
When the Bough Breaks: Pregnancy and the Legacy of Addiction - This is a remarkable book! It deals with the problem of pregnancy and addiction in a genuinely unique way, combining poems and photographs to bring home the gravity of the issue and the way it impacts on so many women's lives.
When the Bough Breaks
Methadone for narcotic abuse. This drug is a less potent narcotic used to decrease the severity of physical withdrawal symptoms. It can have undesirable side effects on the fetus.
After delivery, your baby may need to be treated for drug withdrawal and/or birth defect problems (which may include surgery, such as in the case of congenital heart defects).
MEDICAL SCREENING FOR OPIOID USE, ABUSE & ADDICTION
Screening for substance abuse is a part of complete obstetric care and should be done in partnership with the pregnant woman. Both before pregnancy and in early pregnancy, all women should be routinely asked about their use of alcohol and drugs, including prescription opioids and other medications used for nonmedical reasons. To begin the conversation, the patient should be informed that these questions are asked of all pregnant women to ensure they receive the care they require for themselves and their fetuses and that the information will be kept confidential. Maintaining a caring and nonjudgmental approach is important and will yield the most inclusive disclosure. Routine screening should rely on validated screening tools, such as questionnaires including 4P’s and CRAFFT (for women aged 26 years or younger).
CLINICAL SCREENING TOOLS FOR PRENATAL SUBSTANCE USE & ABUSE
- Parents: Did any of your parents have a problem with alcohol or other drug use?
- Partner: Does your partner have a problem with alcohol or drug use?
- Past: In the past, have you had difficulties in your life because of alcohol or other drugs, including prescription medications?
- Present: In the past month have you drunk any alcohol or used other drugs?
Scoring: Any "yes" should trigger further questions.
Ewing H. A practical guide to intervention in health and social services with pregnant and postpartum addicts and alcoholics: theoretical framework, brief screening tool, key interview questions, and strategies for referral to recovery resources. Martinez (CA): The Born Free Project, Contra Costa County Department of Health Services; 1990.
CRAFFT - Substance Abuse Screen for Adolescents and Young Adults
- C Have you ever ridden in a CAR driven by someone (including yourself) who was high or had been using alcohol or drugs?
- R Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
- A Do you ever use alcohol or drugs while you are by yourself or ALONE?
- F Do you ever FORGET things you did while using alcohol or drugs?
- F Do your FAMILY or friends ever tell you that you should cut down on your drinking or drug use?
- T Have you ever gotten in TROUBLE while you were using alcohol or drugs?
Scoring: Two or more positive items indicate the need for further assessment.
Center for Adolescent Substance Abuse Research, Children’s Hospital Boston. The CRAFFT screening interview. Boston (MA): CeASAR; 2009. Available at: CRAFFT. Retrieved February 10, 2012. Copyright Children’s Hospital Boston, 2011. All rights reserved. Reproduced with permission from the Center for Adolescent Substance Abuse Research, CeASAR, Children’s Hospital Boston, 617-355-5133, or www.ceasar.org.
In addition to the use of screening tools, certain signs and symptoms may suggest a substance use disorder in a pregnant woman. Pregnant women with opioid addiction often seek prenatal care late in pregnancy; exhibit poor adherence to their appointments; experience poor weight gain; or exhibit sedation, intoxication, withdrawal, or erratic behavior. On physical examination, some signs of drug use may be present, such as track marks from intravenous injection, lesions from interdermal injections or "skin popping," abscesses, or cellulitis. Positive results of serologic tests for HIV, hepatitis B, or hepatitis C also may indicate substance abuse. Urine drug testing is an adjunct to detect or confirm suspected substance use, but should be performed only with the patient's consent and in compliance with state laws. Pregnant women must be informed of the potential ramifications of a positive test result, including any mandatory reporting requirements. Laboratory testing for HIV, hepatitis B, and hepatitis C should be repeated in the third trimester, if indicated.
According to standard medial protocol, drug addiction during pregnancy has been managed in two ways: the detoxification program and the methadone-maintenance treatment program. In the detoxification program, there have been few complications for the mother and child except for low birth weight, meconium-stained amniotic fluid, and an increase in breech presentation. The methadone-maintenance treatment program at this time is the most satisfactory approach to the treatment of heroin addiction. The complications of pregnancy in this program are similar to those of the average obstetric population. Low birth weight at term is still frequent for those on methadone maintenance. The problem of multiple drug abuse, including heroin, cocaine, alcohol, tranquilizers, and amphetamines, requires more attention. The characteristics of the withdrawal syndrome and its treatment in infants are described. Excessive weight loss and irritability are common in these infants. Of the many drugs available for the treatment of the newborn withdrawal syndrome, diazepam is currently favored. The long-term effects of intrauterine drug exposure, the withdrawal syndrome, and treatment are generally unknown. Schedules for management of adult narcotic, alcohol, and barbiturate abuse and newborn narcotic withdrawal are suggested.
MEDICAL TREATMENT & MAINTENANCE THERAPY
Since the 1970s, maintenance therapy with methadone has been the standard treatment of heroin addiction during pregnancy. Recently, this treatment also has been used for nonheroin opioid addiction although the benefits are less well documented than for the treatment of heroin dependence.
The rationale for opioid-assisted therapy during pregnancy is to prevent complications of illicit opioid use and narcotic withdrawal, encourage prenatal care and drug treatment, reduce criminal activity, and avoid risks to the patient of associating with a drug culture. Comprehensive opioid-assisted therapy that includes prenatal care reduces the risk of obstetric complications. Neonatal abstinence syndrome is an expected and treatable condition that follows prenatal exposure to opioid agonists and requires collaboration with the pediatric care team. Methadone has significant pharmacokinetic interactions with many other drugs, including antiretroviral agents.
Methadone maintenance, as prescribed and dispensed on a daily basis by a registered substance abuse treatment program, is part of a comprehensive package of prenatal care, chemical dependency counseling, family therapy, nutritional education, and other medical and psychosocial services as indicated for pregnant women with opioid dependence. Perinatal methadone dosages are managed by addiction treatment specialists within registered methadone treatment programs. A list of local treatment programs for opioid addiction can be found at the Substance Abuse and Mental Health Services Administration's Web Site. Health care practitioners should communicate with the addiction treatment program whenever there are concerns about the patient's care and methadone dosage. The dosage should be adjusted throughout the pregnancy to avoid withdrawal symptoms, which include drug cravings, abdominal cramps, nausea, insomnia, irritability, and anxiety. If a woman is treated with a stable methadone dosage before pregnancy, pharmacokinetic changes may require dosage adjustments, especially in the third trimester. Some women develop rapid metabolism to the extent that it becomes difficult to control withdrawal symptoms for 24 hours on a single daily dose; in these cases, split dosages may be optimal. Not all women require dose increases during pregnancy and any dosage adjustments should be made on clinical grounds by the addiction specialist. Methadone dosages usually are initiated at 10 to 30 mg/d. If a woman begins treatment with methadone while pregnant, her dosage should be titrated until she is asymptomatic in accordance with safe induction protocols. An inadequate maternal methadone dosage may result in mild to moderate opioid withdrawal signs and symptoms and cause fetal stress and increased likelihood for the maternal use of illicit drugs. Separate studies examined the extent to which the maternal methadone dosage is related to the severity of neonatal abstinence syndrome. The results are inconclusive and conflicting. One systematic literature review and meta-analysis concluded that the severity of neonatal abstinence syndrome does not appear to differ based on the maternal dosage of methadone treatment. These maternal, fetal, and neonatal findings all underscore the need to provide pregnant women with an adequate methadone dosage that relieves and prevents opioid withdrawal signs and symptoms and also blocks the euphoric effect of misused opioids.
In most situations, it is advisable for pregnant women to initiate methadone induction in a licensed outpatient methadone program. In situations when a pregnant woman requires hospitalization for initiation of methadone treatment, an arrangement must be made before discharge for next day admission to an outpatient program. With the exception of buprenorphine, it is illegal for a health care practitioner to write a prescription for any other opioid for the treatment of opioid dependence, including methadone, outside of a licensed treatment program. Buprenorphine, when prescribed by accredited practitioners who have undergone specific credentialing, is the only opioid approved for the treatment of opioid dependence in an office-based setting. Health care practitioners should be familiar with federal and state regulations regarding prescribing of medications for the treatment of opioid dependence.
Emerging evidence supports the use of buprenorphine for opioid-assisted treatment during pregnancy. Buprenorphine acts on the same receptors as heroin and morphine. With appropriate informed consent, including disclosure of the lack of evidence from long-term neurodevelopmental studies, buprenorphine also may be offered to patients in need of opioid-assisted therapy during pregnancy. The advantages of buprenorphine over methadone include a lower risk of overdose, fewer drug interactions, the ability to be treated on an outpatient basis without the need for daily visits to a licensed treatment program, and evidence of less severe neonatal abstinence syndrome. The disadvantages compared with methadone include reports of hepatic dysfunction, the lack of long-term data on infant and child effects, a clinically important patient dropout rate due to dissatisfaction with the drug, a more difficult induction with the potential risk of precipitated withdrawal, and an increased risk of diversion (ie, sharing or sale) of prescribed buprenorphine. Buprenorphine is available as a single-agent product or in a combined formulation with naloxone, an opioid antagonist used to reduce diversion. Buprenorphine with naloxone is formulated to prevent injected use because naloxone causes severe withdrawal symptoms when injected. However, because of poor naloxone absorption, the formulation has rare adverse effects when used sublingually as directed. The single-agent product is recommended during pregnancy to avoid any potential prenatal exposure to naloxone, especially if injected. The single-agent buprenorphine product has a higher potential to lead to abuse as well as a higher street value than the combination product. Thus, all patients should be monitored for the risk of diversion of their medication, especially if the single product is prescribed. Unlike methadone, which may be administered only through very tightly controlled programs, buprenorphine may be prescribed by trained and approved health care practitioner in a medical office setting, which potentially increases the availability of treatment and decreases the stigma. The Substance Abuse and Mental Health Services Administration publishes a directory of practitioners licensed to dispense buprenorphine. Patients considered for using buprenorphine need to be able to self-administer the drug safely and maintain adherence with their treatment regimen. Compared with methadone clinics, the less stringent structure of buprenorphine treatment may make it inappropriate for some patients who require more intensive structure and supervision.
Until recently, data on use of buprenorphine in pregnancy were relatively limited. A 2010 multicenter, randomized clinical trial compared the neonatal effects of buprenorphine and methadone in 175 opioid-dependent gravid women. In that study, the buprenorphine-exposed neonates required, on average, 89 percent less morphine to treat neonatal abstinence syndrome, a 43 percent shorter hospital stay, and a 58 percent shorter duration of medical treatment for neonatal abstinence syndrome. These results support the use of buprenorphine as a potential first-line medication for pregnant opioid-dependent women who are new to treatment. It is important to understand that buprenorphine will not be effective for all patients.
Women who become pregnant while already undergoing a treatment with a stable co-formulated buprenorphine dosage generally are advised to continue the same dosage but to transition to the single-agent product. The indications for the use of buprenorphine during pregnancy are in flux currently. Previous recommendations have limited use of buprenorphine to women who have refused to use methadone, have been unable to take methadone, or those for whom methadone treatment was unavailable. The current trend is moving toward considering a patient as a potential candidate for buprenorphine if she prefers buprenorphine to methadone, gives informed consent after a thorough discussion of relative risks and benefits, and is capable of adherence and safe self-administration of the medication. If the pregnant woman is receiving methadone therapy, she should not consider transitioning to buprenorphine because of the significant risk of precipitated withdrawal. The potential risk of unrecognized adverse long-term outcomes, which is inherent with widespread use of relatively new medications during pregnancy, should always be taken into consideration.
Medically supervised withdrawal from opioids in opioid-dependent women is not recommended during pregnancy because the withdrawal is associated with high relapse rates. However, if methadone maintenance is unavailable or if women refuse to undergo methadone or buprenorphine maintenance, medically supervised withdrawal should ideally be undertaken during the second trimester and under the supervision of a health practitioner experienced in perinatal addiction treatment. If the alternative to medically supervised withdrawal is continued illicit drug use, then a medically supervised withdrawal in the first trimester is preferable to waiting until the second trimester.
It is important that frequent communication be maintained between the patient's obstetric care provider and the addiction medicine provider to coordinate care. The federal confidentiality law 42 CFR Part 2 applies to addiction treatment providers. Patient information release forms with specific language regarding substance use are required.
INTRAPARTUM & POSTPARTUM MANAGEMENT
Women receiving opioid-assisted therapy who are undergoing labor should receive pain relief as if they were not taking opioids because the maintenance dosage does not provide adequate analgesia for labor. Epidural or spinal anesthesia should be offered where appropriate for management of pain in labor or for delivery. Narcotic agonist-antagonist drugs, such as butorphanol, nalbuphine, and pentazocine, should be avoided because they may precipitate acute withdrawal. Buprenorphine should not be administered to a patient who takes methadone. Pediatric staff should be notified of all narcotic-exposed infants.
In general, patients undergoing opioid maintenance treatment will require higher doses of opioids to achieve analgesia than other patients. One study showed that after cesarean delivery, women who used buprenorphine required 47 percent more opioid analgesic than women who did not use buprenorphine treatment, but adequate pain relief was achieved with short-acting opioids and antiinflammatory medication. Injectable nonsteroidal antiinflammatory agents, such as ketorolac, also are highly effective in postpartum and postcesarean delivery pain control. Daily doses of methadone or buprenorphine should be maintained during labor to prevent withdrawal, and patients should be reassured of this plan in order to reduce anxiety. Dividing the usual daily maintenance dose of buprenorphine or methadone into three or four doses every 6 to 8 hours may provide partial pain relief; however, additional analgesia will be required.
Women should be counseled that minimal levels of methadone and buprenorphine are found in breast milk regardless of the maternal dose. Breastfeeding should be encouraged in patients without HIV who are not using additional drugs and who have no other contraindications. The current buprenorphine package insert advises against breastfeeding; however, a consensus panel stated that the effects on the breastfed infant are likely to be minimal and that breastfeeding is not contraindicated. Swaddling associated with breastfeeding may reduce neonatal abstinence syndrome symptoms, and breastfeeding contributes to bonding between mother and infant as well as providing immunity to the infant.
Although most pregnant women who receive methadone will experience dosage increases during pregnancy, and a need for dosage reduction might be expected, one study demonstrated little need for immediate postpartum methadone dosage reduction. Most women who undergo buprenorphine maintenance therapy will not experience large dosage adjustments during their pregnancies and may continue the same dosages after delivery. However, the postpartum patient who receives opioid therapy should be closely monitored for symptoms of oversedation with dosages titrated as indicated. Women should continue in their treatment and addiction support postpartum. Discussions of contraceptive options should begin during pregnancy and contraception, including long-acting reversible contraceptive methods, should be provided or prescribed before hospital discharge. Access to adequate postpartum psychosocial support services, including chemical dependency treatment and relapse prevention programs, should be ensured.
OPIOID MEDICAL TREATMENT SUMMARY
Early identification of opioid-dependent pregnant women improves maternal and infant outcomes. Contraceptive counseling should be a routine part of substance use treatment among women of reproductive age to minimize the risk of unplanned pregnancy. Pregnancy in the opioid-dependent woman should be co-managed by the health care practitioner and addiction medicine specialist with appropriate 42 CFR Part 2-compliant release of information forms. This collaboration is particularly important when the woman receives opioid maintenance treatment or is at high risk of relapse. When opioid maintenance treatment is available, medically supervised withdrawal should be discouraged during pregnancy. It is essential for hospitalized pregnant women who initiated opioid-assisted therapy to make a next-day appointment with a treatment program before discharge. Infants born to women who used opioids during pregnancy should be closely monitored for neonatal abstinence syndrome and other effects of opioid use by a pediatric health care provider.
ACTIVITY RECOMMENDATIONS & RESTRICTIONS
Regular daily exercise is recommended and will help get you in the best physical condition for delivery. Any exercise program will need to be reviewed with your midwife or health care provider.
DIET & NUTRITION
Eat a normal, well-balanced diet high in protein. Eat a nutrient-dense, well-balanced diet that includes vegetables, fruits, grains, seeds, and nuts. Eat quality Protein from vegetable sources. Increase your intake of fresh raw foods. Nutritional supplements may be necessary if you suffer from malnutrition.
Add high Protein drinks to the diet.
Avoid heavily processed foods, all forms of sugar, and junk food. These foods are a quick source of energy, but are followed by a low feeling that may increase cravings for drugs.
Drink at least 2 quarts of quality water every day to keep well hydrated.
Fasting is beneficial. Follow the instructions. NOTE: Do not fast during pregnancy or while breastfeeding.
Many drug users suffer from malnutrition. Because drugs rob the body of necessary nutrients, those addicted to drugs need to take high doses of supplemental nutrients.
SUBSTANCES THAT ROB THE BODY OF NUTRIENTS
Different substances deplete the body of different nutrients. Use the list below to determine which supplements you may need as a result of the use of prescription or over-the-counter drugs, including alcohol and caffeine.
SUBSTANCE DEPLETED NUTRIENTS
Antibiotics, General (See Isoniazid, Penicillin, Sulfa Drugs, & Thimethoprim)
Vitamin B-Complex; Vitamin K; Acidophilus "friendly bacteria".
Beta-blockers (Corgard, Inderal, Lopressor, & Others)
Carbamazenpine (Atretol, Tegretol)
Dilutes blood solution.
Chlorothiazide (Aldoclor, Diuril, & Others)
Clonidine (Catapres, Combipres)
Corticosteroids, General (See Prednisone)
Digitalis Preparations (Crystodigin, Digoxin, & Others)
Diuretics, General (See Chlorothiazide, Spironolactone, Thiazide Diuretics, & Triamterene)
Hydralazine (Apresazide, Apresoline, & Others)
Isoniazid (INH & Others)
Laxatives (Excluding Herbs)
Nitrate/Nitrite Coronary Vasodilators
Prednisone (Deltasone & Others)
Spironolactone (Aldactone & Others)
Para-Aminobenzoic Acid (PABA); Acidophilus "Friendly" Bacteria.
Trimethoprim (Bactrim, Septra, & Others)
Acidophilus Supplement Products Biotin Supplement Products Calcium Supplement Products Choline Supplement Products Chromium Supplement Products Folic Acid Supplement Products Inositol Supplement Products Iodine Supplement Products Iron Supplement Products Magnesium Supplement Products Para-Aminobenzoic Acid (PABA) Products Phenylalanine Supplement Products Phosphate Supplement Products Potassium Supplement Products Protein Supplement Products Selenium Supplement Products Vitamin A Supplement Products Vitamin B-1 (Thiamine) Supplement Products Vitamin B-2 (Riboflavin) Supplement Products Vitamin B-3 (Niacin) Supplement Products Vitamin B-5 (Pantothenic Acid) Supplement Products Vitamin B-6 (Pyridoxine) Supplement Products Vitamin B-12 Supplement Products Vitamin B-Complex Supplement Products Vitamin C Supplement Products Vitamin D Supplement Products Vitamin E Supplement Products Vitamin K Supplement Products Zinc Supplement Products
NOTE: Consult with your midwife or health care provider before using any herbal or nutritional supplement while pregnant or breastfeeding your baby. Information given below is general information for substance abuse recovery and does not necessarily take into account that you may be pregnant or lactating.
Siberian Ginseng helps those experiencing cocaine withdrawal. Siberian Ginseng, also known as Eleuthero helps bronchial disorders and boosts energy. Caution: Do not use this herb if you have hypoglycemia, high blood pressure, or a heart disorder. Siberian Ginseng strengthens the adrenal and reproductive glands. It enhances immune function, helps prevent infection, promotes lung functioning and stimulates the appetite. It useful for bronchitis, circulatory problems, diabetes, infertility, lack of energy, and stress. There is some evidence that it can help ease withdrawal from cocaine, and help improve drug or alcohol induced liver dysfunction in older adults. Siberian Ginseng protects the body against the effects of radiation exposure. It is used by athletes for overall body strengthening. Siberian Ginseng is most effective in the treatment of prolonged exhaustion and debility, resulting from overwork and long-term stress. As a decoction take 35 ml of Siberian Ginseng 2 times a day for use as a general tonic. To take in tincture form, use 1/2 teaspoon with water 3 times a day. For other forms, read follow product label directions. Caution: Do not use this herb if you have hypoglycemia, high-blood pressure, or a heart disorder.
Valerian root has a calming effect. Used with the amino acid Tyrosine, it has been found to be helpful for those undergoing withdrawal from cocaine.
ACNE NUTRITIONAL SUPPLEMENTS
Unless otherwise specified, the dosages recommended in this section are for adults. For a child between the ages of 12 and 17 years, reduce the dose to 3/4 the recommended amount. For a child between 6 and 12, use 1/2 the recommended dose, and for a child under the age of 6, use 1/4 the recommended amount.
NUTRIENTS Supplement Suggested Dosage Comments
Vitamin B-Complex 100 mg of each major B vitamin 3 times daily or as directed by a health care provider. Amounts of individual vitamins in a complex will vary. B-Complex Injections: 2 cc weekly or as prescribed by health care provider. Needed when under stress to rebuild the liver. Injections are most effective, under care of health care provider. Vitamin B-12 1,000 to 2,000 mcg daily on an empty stomach.
Injections: 1 cc once weekly or as prescribed by a health care provider.
Linked to the production of the neurotransmitter acetylcholine. Important in making myelin, the substance of which the sheaths covering the nerves are made. Injections are best. All injectables can be combined in a single injection. If injections are not available, use a lozenge, sublingual, or spray form.
Calcium 1,500 mg daily at bedtime. Nourishes the central nervous system and helps control tremors by calming the body. Use chelate forms. And Magnesium 1,000 mg daily at bedtime. Works with calcium. Use magnesium asprotate or magnesium chelate form. Free Form Amino Acid Complex
Amino Acid Complex: As directed on label.
Glutamine: 500 mg 3 times daily, on an empty stomach.
Passes the blood-brain barrier to promote healthy mental functioning. Increases levels of Gamma-AminoButyric Acid (GABA), which has a calming effect. Gamma-Aminobutyric Acid
As directed on label, on an empty stomach. Acts as a relaxant and lessens cravings.
GABA is a non-essential amino acid found mainly in the human brain and eyes. It is considered an inhibitory neurotransmitter, which means it regulates brain and nerve cell activity by inhibiting the number of neurons firing in the brain. GABA is referred to as the brain's natural calming agent. Together with niacinamide and inositol, it prevents anxiety and stress related messages from reaching the motor centers of the brain by occupying the receptor sites.
GABA Supplement Products And L-Tyrosine 500 mg twice daily, on an empty stomach. Take these supplements with water or juice, not milk. Take with 50 mg Vitamin B-6 and 100 mg Vitamin C for better absorption. Tyrosine and Valerian root taken every 4 hours have given good results for cocaine withdrawal. Vitamin A 100,000 IU daily for 5 days, then 50,000 IU dally for 5 days, then reduce to 25,000 IU daily. If you are pregnant, do not exceed 10,000 IU daily. Strengthens cell walls to protect against invasion by bacteria and promote tissue repair. Essential to the immune system. Use an emulsion form for easier assimilation and greater safety at high doses.. Glutathione As directed on label. Aids in detoxifying drugs to reduce their harmful effects. Also reduces the desire for drugs or alcohol. Lithium As prescribed by a health care provider. A trace mineral that aids in relieving depression. Available by prescription only.
Lithium Orotate: Lithium has long been used for manic-depression. High doses depress dopamine release, flattening elevated moods; lower doses stimulate serotonin synthesis, producing an antidepressant effect. Lithium reputedly is also neuroprotective, suggesting its use in Alzheimer's, Parkinson's, and amyotrophic lateral sclerosis. It is thought to lower blood glucose levels and to have immune-enhancing and antiviral effects (especially against herpes simplex). Nieper used lithium orotate to treat depression, headaches, migraine, epilepsy, and alcoholism.
Lithium Supplement Products Phenylalanine 1,500 mg daily, taken upon arising. Necessary as a brain fuel. Use for withdrawal symptoms. Caution: Do not take this supplement if you are pregnant or nursing, or suffer from panic attacks, diabetes, high blood pressure, or PKU. Vitamin B-5
500 mg 3 times daily. Essential for the adrenal glands and for reducing stress. Vitamin C 2,000 mg every 3 hours. Detoxifies the system and lessens the craving for drugs. Use a buffered form such as sodium ascorbate. Intravenous administration (under a health care provider's supervision) may be necessary. Enhances immune function.
As directed on label. All nutrients are needed in high amounts for healing. Use a high potency formula. Vitamin B-3
500 mg 3 times daily. Important for brain function. Caution: Do not substitute niacin for niacinamide. Niacin should not be taken in high doses.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER
If you or a family member abuse or is addicted to and/or dependent on drugs and wants help. New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
MoonDragon's Health Information: Drug Addiction (Substance Abuse)
DrugSafetySite: Drug Safety During Pregnancy & Lactation
Teen Substance Abuse Treatment - Teenage Drug Addiction Rehab Treatment
MoonDragon's Pregnancy Information: Pregnancy Information & Survival Tips
MoonDragon's Pregnancy Information Index
MoonDragon's Womens Health Pregnancy Information Index
MoonDragon's Pediatric Information Index
MoonDragon's Parenting Information Index
MoonDragon's Nutrition Information Index
1. Substance Abuse and Mental Health Services Administration. Results from the 2010 National Survey on Drug Use and Health: summary of national findings. NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville (MD): SAHMSA; 2011.
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3. National Institute on Drug Abuse. Research report series - heroin abuse and addiction. Bethesda (MD): NIDA; 2005.
4. National Institute on Drug Abuse. Commonly abused prescription drugs. Bethesda (MD): NIDA; 2011.
5. Kaltenbach K, Berghella V, Finnegan L. Opioid dependence during pregnancy. Effects and management. Obstet Gynecol Clin North Am 1998;25:139-51.
6. Rothman KJ. Causes. Am J Epidemiology 1976;104:587-92.
7. Zierler S, Rothman KJ. Congenital heart disease in relation to maternal use of Bendectin and other drugs in early pregnancy. N Engl J Med 1985;313:347-52.
8. Bracken MB. Drug use in pregnancy and congenital heart disease in offspring. N Engl J Med 1986; 314:1120.
9. haw GM, Malcoe LH, Swan SH, Cummins SK, Schulman J. Congenital cardiac anomalies relative to selected maternal exposures and conditions during early pregnancy. Eur J Epidemiol 1992;8:757-60.
10. Bracken MB, Holford TR. Exposure to prescribed drugs in pregnancy and association with congenital malformations. Obstet Gynecol 1981;58:336–44.
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12. Broussard CS, Rasmussen SA, Reefhuis J, Friedman JM, Jann MW, Riehle-Colarusso T, et al. Maternal treatment with opioid analgesics and risk for birth defects. National Birth Defects Prevention Study. Am J Obstet Gynecol 2011.
13. Center for Substance Abuse Treatment. Medication-assisted treatment for opioid addiction during pregnancy. In: SAHMSA/CSAT treatment improvement protocols. Rockville (MD): Substance Abuse and Mental Health Services Administration; 2008.
14. Ewing H. A practical guide to intervention in health and social services with pregnant and postpartum addicts and alcoholics: theoretical framework, brief screening tool, key interview questions, and strategies for referral to recovery resources. Martinez (CA): The Born Free Project, Contra Costa County Department of Health Services; 1990.
15. Chang G, Orav EJ, Jones JA, Buynitsky T, Gonzalez S, Wilkins-Haug L. Self-reported alcohol and drug use in pregnant young women: a pilot study of associated factors and identification. J Addict Med 2011;5:221-6.
16. Substance abuse reporting and pregnancy: the role of the obstetrician-gynecologists. Committee Opinion No. 473. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;117:200-1.
17. Alto WA, O’Connor AB. Management of women treated with buprenorphine during pregnancy. Am J Obstet Gynecol 2011;205:302-8.
18. Pond SM, Kreek MJ, Tong TG, Raghunath J, Benowitz NL. Altered methadone pharmacokinetics in methadone-maintained pregnant women. J Pharmacol Exp Ther 1985;233:1-6.
19. Dryden C, Young D, Hepburn M, Mactier H. Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources. BJOG 2009;116:665-71.
20. Velez ML, Jansson LM, Schroeder J, Williams E. Prenatal methadone exposure and neonatal neurobehavioral functioning. Pediatr Res 2009;66:704-9.
21. Cleary BJ, Donnelly J, Strawbridge J, Gallagher PJ, Fahey T, Clarke M, et al. Methadone dose and neonatal abstinence syndrome-systemic review and meta-analysis. Addiction 2010;105:2071-84.
22. Institute of Medicine. Federal regulation of methadone treatment. Washington DC: National Academy Press; 1995.
23. Drug addiction treatment act of 2000, Pub. L. No. 106-310 3502, 114 Stat. 1223-7. (2000).
24. Fudala PJ, Bridge TP, Herbert S, Williford WO, Chiang CN, Jones K, et al. Office-based treatment of opiate addiction with a sublingual-tablet formulation of buprenorphine and naloxone. Buprenorphine/Naloxone Collaborative Study Group. N Engl J Med 2003;349:949-58.
25. Johnson RE, Jones HE, Fisher G. Use of buprenorphine in pregnancy: patient management and effects on the neonate. Drug Alcohol Depend 2003;70:S87-101.
26. Jones HE, Kaltenbach K, Heil SH, et al. Neonatal abstinence syndrome after methadone or buprenorphine exposure. N Engl J Med 2010;363:2320-31.
27. Jones HE, O’Grady KE, Malfi D, Tuten M. Methadone maintenance vs. methadone taper during pregnancy: maternal and neonatal outcomes. Am J Addict 2008;17:372-86.
28. Substance Abuse and Mental Health Services Administration. Frequently asked questions: applying the substance abuse confidentiality regulations to health information exchange (HIE). Rockville (MD): SAHMSA; 2010.
29. Meyer M, Wagner K, Benvenuto A, Plante D, Howard D. Intrapartum and postpartum analgesia for women maintained on methadone during pregnancy. Obstet Gynecol 2007;110:261-6.
30. Jones HE, O’Grady K, Dahne J, Johnson R, Lemoine L, Milio L, et al. Management of acute postpartum pain in patients maintained on methadone or buprenorphine during pregnancy. Am J Drug Alcohol Abuse 2009;35:151-6.
31. Jones HE, Johnson RE, Milio L. Post-cesarean pain management of patients maintained on methadone or buprenorphine. Am J Addict 2006;15:258-9.
32. Wojnar-Horton RE, Kristensen JH, Yapp P, Ilett KF, Dusci LJ, Hackett LP. Methadone distribution and excretion into breast milk of clients in a methadone maintenance programme. Br J Clin Pharmacol 1997;44:543-7.
33. Johnson RE, Jones HE, Jasinski DR, Svikis DS, Haug NA, Jansson LM, et al. Buprenorphine treatment of pregnant opioid-dependent women: maternal and neonatal outcomes. Drug Alcohol Depend 2001;63:97-103.
34. Jones HE, Johnson RE, O'Grady KE, Jasinski DR, Tuten M, Milio L. Dosing adjustments in postpartum patients maintained on buprenorphine or methadone. J Addict Med 2008;2:103-7.
35. Johnson RE, Jones HE, Fischer G. Use of buprenorphine in pregnancy: patient management and effects on the neonate. Drug Alcohol Depend 2003;70:S87-101.
36. Kaltenbach K, Finnegan LP. Developmental outcome of children born to methadone maintained women: a review of longitudinal studies. Neurobehav Toxicol Teratol 1984;6:271-5.
37. Hans SL. Developmental consequences of prenatal exposure to methadone. Ann N Y Acad Sci 1989;562:195-207.
38. Figures and Data ON Drug Use During Pregnancy by Robert Mathias.
39. NIDA - The National Institute on Drug Abuse.
QUALITY SUPPLIES & PRODUCTS
DRUG DEPENDENCY RECOVERY SUPPLEMENT PRODUCTS
Information and nutritional supplements for recovery from drug dependency. These supplements are used during and after treatment to improve health and replace deficiencies caused by malnutrition associated with the drug dependency and abuse. These recommendations are for general use and some may be contraindicated for use with certain health conditions, pregnancy and lactation. For more detailed information about specific nutritional requirements, consult with your health care provider and treatment center.
Acidophilus Supplement Products Amino Acid Complex Products Beta Carotene Products Bioflavonoids Supplement Products Biotin Supplement Products Calcium Supplement Products Carotene Complex Products Choline Supplement Products Chromium Supplement Products Eleuthero Herbal Products Folic Acid Supplement Products >GABA Supplement Products Glutamine Supplement Products Glutathione Supplement Products Inositol Supplement Products Iodine Supplement Products Iron Supplement Products Lithium Supplement Products Magnesium Supplement Products Multimineral Complex Products Multivitamin Complex Products PABA Supplement Products
Phenylalanine Supplement Products Phosphate Supplement Products Potassium Supplement Products Prenatal Supplement Products Protein Herbal Products Selenium Supplement Products Tyrosine Supplement Products Valerian Herbal Products Vitamin A Supplement Products Vitamin B-1 Supplement Products Vitamin B-2 Supplement Products Vitamin B-3 Supplement Products Vitamin B-5 Supplement Products Vitamin B-6 Supplement Products Vitamin B-12 Supplement Products Vitamin B-Complex Products Vitamin C Supplement Products Vitamin D Supplement Products Vitamin E Supplement Products Vitamin K Supplement Products Zinc Supplement Products
AROMATHERAPY: ESSENTIAL OILS DESCRIPTIONS & USES
Allspice Leaf Oil Angelica Oil Anise Oil Baobab Oil Basil Oil Bay Laurel Oil Bay Oil Benzoin Oil Bergamot Oil Black Pepper Oil Chamomile (German) Oil Cajuput Oil Calamus Oil Camphor (White) Oil Caraway Oil Cardamom Oil Carrot Seed Oil Catnip Oil Cedarwood Oil Chamomile Oil Cinnamon Oil Citronella Oil Clary-Sage Oil Clove Oil Coriander Oil Cypress Oil Dill Oil Eucalyptus Oil Fennel Oil Fir Needle Oil Frankincense Oil Geranium Oil German Chamomile Oil Ginger Oil Grapefruit Oil Helichrysum Oil Hyssop Oil Iris-Root Oil Jasmine Oil Juniper Oil Labdanum Oil Lavender Oil Lemon-Balm Oil Lemongrass Oil Lemon Oil Lime Oil Longleaf-Pine Oil Mandarin Oil Marjoram Oil Mimosa Oil Myrrh Oil Myrtle Oil Neroli Oil Niaouli Oil Nutmeg Oil Orange Oil Oregano Oil Palmarosa Oil Patchouli Oil Peppermint Oil Peru-Balsam Oil Petitgrain Oil Pine-Long Leaf Oil Pine-Needle Oil Pine-Swiss Oil Rosemary Oil Rose Oil Rosewood Oil Sage Oil Sandalwood Oil Savory Oil Spearmint Oil Spikenard Oil Swiss-Pine Oil Tangerine Oil Tea-Tree Oil Thyme Oil Vanilla Oil Verbena Oil Vetiver Oil Violet Oil White-Camphor Oil Yarrow Oil Ylang-Ylang Oil Aromatherapy
Healing Baths For Colds
Using Essential Oils
AROMATHERAPY: HERBAL & CARRIER OILS DESCRIPTIONS & USES
Almond, Sweet Oil Apricot Kernel Oil Argan Oil Arnica Oil Avocado Oil Baobab Oil Black Cumin Oil Black Currant Oil Black Seed Oil Borage Seed Oil Calendula Oil Camelina Oil Castor Oil Coconut Oil Comfrey Oil Evening Primrose Oil Flaxseed Oil Grapeseed Oil Hazelnut Oil Hemp Seed Oil Jojoba Oil Kukui Nut Oil Macadamia Nut Oil Meadowfoam Seed Oil Mullein Oil Neem Oil Olive Oil Palm Oil Plantain Oil Plum Kernel Oil Poke Root Oil Pomegranate Seed Oil Pumpkin Seed Oil Rosehip Seed Oil Safflower Oil Sea Buckthorn Oil Sesame Seed Oil Shea Nut Oil Soybean Oil St. Johns Wort Oil Sunflower Oil Tamanu Oil Vitamin E Oil Wheat Germ Oil
HELPFUL RELATED MOONDRAGON NUTRITION BASICS LINKS
MoonDragon's Nutrition Basics Index MoonDragon's Nutrition Basics: Amino Acids Index MoonDragon's Nutrition Basics: Antioxidants Index MoonDragon's Nutrition Basics: Enzymes Information MoonDragon's Nutrition Basics: Herbs Index MoonDragon's Nutrition Basics: Homeopathics Index MoonDragon's Nutrition Basics: Hydrosols Index MoonDragon's Nutrition Basics: Minerals Index MoonDragon's Nutrition Basics: Mineral Introduction MoonDragon's Nutrition Basics: Dietary & Cosmetic Supplements Index MoonDragon's Nutrition Basics: Dietary Supplements Introduction MoonDragon's Nutrition Basics: Specialty Supplements MoonDragon's Nutrition Basics: Vitamins Index MoonDragon's Nutrition Basics: Vitamins Introduction
NUTRITION BASICS ARTICLES
MoonDragon's Nutrition Basics: 4 Basic Nutrients MoonDragon's Nutrition Basics: Avoid Foods That Contain Additives & Artificial Ingredients MoonDragon's Nutrition Basics: Is Aspartame A Safe Sugar Substitute? MoonDragon's Nutrition Basics: Guidelines For Selecting & Preparing Foods MoonDragon's Nutrition Basics: Foods That Destroy MoonDragon's Nutrition Basics: Foods That Heal MoonDragon's Nutrition Basics: The Micronutrients: Vitamins & Minerals MoonDragon's Nutrition Basics: Avoid Overcooking Your Foods MoonDragon's Nutrition Basics: Phytochemicals MoonDragon's Nutrition Basics: Increase Your Consumption of Raw Produce MoonDragon's Nutrition Basics: Limit Your Use of Salt MoonDragon's Nutrition Basics: Use Proper Cooking Utensils MoonDragon's Nutrition Basics: Choosing The Best Water & Types of Water
RELATED MOONDRAGON HEALTH LINKS & INFORMATION
MoonDragon's Nutrition Information Index MoonDragon's Nutritional Therapy Index MoonDragon's Nutritional Analysis Index MoonDragon's Nutritional Diet Index MoonDragon's Nutritional Recipe Index MoonDragon's Nutrition Therapy: Preparing Produce for Juicing MoonDragon's Nutrition Information: Food Additives Index MoonDragon's Nutrition Information: Food Safety Links MoonDragon's Aromatherapy Index MoonDragon's Aromatherapy Articles MoonDragon's Aromatherapy For Back Pain MoonDragon's Aromatherapy For Labor & Birth MoonDragon's Aromatherapy Blending Chart MoonDragon's Aromatherapy Essential Oil Details MoonDragon's Aromatherapy Links MoonDragon's Aromatherapy For Miscarriage MoonDragon's Aromatherapy For Post Partum MoonDragon's Aromatherapy For Childbearing MoonDragon's Aromatherapy For Problems in Pregnancy & Birthing MoonDragon's Aromatherapy Chart of Essential Oils #1 MoonDragon's Aromatherapy Chart of Essential Oils #2 MoonDragon's Aromatherapy Tips MoonDragon's Aromatherapy Uses MoonDragon's Alternative Health Index MoonDragon's Alternative Health Information Overview MoonDragon's Alternative Health Therapy Index MoonDragon's Alternative Health: Touch & Movement Therapies Index MoonDragon's Alternative Health Therapy: Touch & Movement: Aromatherapy MoonDragon's Alternative Therapy: Touch & Movement - Massage Therapy MoonDragon's Alternative Health: Therapeutic Massage MoonDragon's Holistic Health Links Page 1 MoonDragon's Holistic Health Links Page 2 MoonDragon's Health & Wellness: Nutrition Basics Index MoonDragon's Health & Wellness: Therapy Index MoonDragon's Health & Wellness: Massage Therapy MoonDragon's Health & Wellness: Hydrotherapy MoonDragon's Health & Wellness: Pain Control Therapy MoonDragon's Health & Wellness: Relaxation Therapy MoonDragon's Health & Wellness: Steam Inhalation Therapy MoonDragon's Health & Wellness: Therapy - Herbal Oils Index
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MOONDRAGON'S REALM - WEBSITE DIRECTORY
A website map to help you find what you are looking for on MoonDragon.org's Website. Available pages have been listed under appropriate directory headings.