Opioids 13 weeks pregnant, on methadone/heroin...want to switch to suboxone..plz help!

[babettehaze]

Hey everyone,
haven't been on this forum in ages...but I really need some advice.

Okay, so I am 13 weeks pregnant and trying to get and stay clean..with mixed results. Currently I am on 35 mg of methadone. I feel I was rushed into choosing methadone instead of suboxone and wish I had done more research. I have been using heroin still on and off.... very minimally and not IV, but still...I need to stop this ASAP. The guilt is killing me. I am planning on temporarily moving to Brazil to stay with my bf's family, where I will be in a safe environment and able to stay clean. The issue with this is I need to be on suboxone to travel. Does anyone have any experience switching from methadone (35mg) to suboxone while pregnant? I have a suboxone dr... and will be seeing him later today.... but I am not sure he will know anything about pregnancy and suboxone and methadone. Incase a switch is encouraged I have skipped the methadone clinic for the second day now....and have been using the minimal amount of heroin. Since I was already doing this on top the the methadone, I actually feel this is a better choice, as I really want to get on suboxone and leave town ASAP. My bf is still using and we are now homeless due to some of his antics.....worse timing everr to get kicked out of a spot...
I have also been doing research and have found that nowadays some Dr's (search Dr. Craig Towers, in TN) are detoxing pregnant women off of opioids. I want more than anything to be detoxed before the baby is born. I feel I can safely and slowly taper off of suboxone while pregnant. I would start on no higher than 2mgs. I just want a healthy baby! I hate that my baby is suffering because of my life choices. I didnt mean to get pregnant, I have never been pregnant in the past...and I am 100% committed to having this baby, and want to do it right. I feel like a horrible person even taking methadone....ugh. I didnt want to have kids this way but now that it is happening I just want to make the most of it. Please reply!

PS- I found out I was pregnant when I was 6 wks pregnant. Before I knew I was shooting (IV) heroin and meth all day at large doses. The day I found out I was pregnant I immediately stopped doing ALL METH, and stopped IVing. I dont smoke cigs, but have been smoking a little weed ..which helps me stay away from heroin. I have been to all my prenatal appointments, and so far the baby is doing great! My Dr. felt my case was a little out of her scope, so I have been referred to a High Risk OBYGN, and my first appt with them is in 6 days...cant wait!Feel free to ask me anything. THANK YOU!

 

[EP158207]

I would strongly recommend you stay on methadone. You may want to get, and stay clean but withdrawals can be fatal for unborn babies especially in the first trimester. Suboxone requires you to be in WD before you start. Weaning from methadone is also ill advised as you will enter withdrawal if you go too low, especially if you are doing this on your own without a healthcare professional's guidance.

I had a codeine problem, which may not sound like much but it was hard for me to wean off so I had to start methadone when family planning became a concern.

My advise to you is to stop shooting heroin, stay on your methadone and try to find a homeless shelter.

Be Safe.

 

[Chronicpain54]

You know, what you just typed is exactly what I would have told the OP. Stay on the methadone for the entire pregnancy at the lowest dose that you can get away with and do not mess around With stressing out your fetus at this point in time.

Stay away from the heroin completely and just take the methadone and don't worry about Your addiction to it. Believe it or not it's recommended by most gynecologists who have a patient that is addicted to something. While no medicine is really completely safe during pregnancy, methadone is actually been shown to cause very little damage to a fetus and newborn. Hopefully your child will be just fine since you were doing quite a bit of drugs before you knew you were pregnant but your fetus will definitely be okay with 30 to 35 mg of methadone a day.

Don't feel guilty about keeping yourself and your baby in the best condition you can. You are growing a human and they need to feel well to eat and get strong. And if you smoke, stop NOW. I had 4 children and threw down my cigarettes the day I found out a new human was counting on me to make them healthy and strong. I smoked again afterwards though.

 

[tacodude]

Trust your doctors... I'm sure you are not the first one to be in this situation they have worked with. If anything afterwords is confusing come back and let us know whatever concerns and take back whatever response you get that to like to your doctors to see what they say.

Also if you have any questions before you see them I'm sure anyone here would be glad to try to help, but even an off duty doctor that might post here is not qualified to make any decisions on your treatment and can only give advice you can bring to your doctor to help you make the best decision.

As I'm sure you know it's really important to work with your doctors for your babies sake. I'm not saying this to scare you, but because I am trying to say that the drs you will be working with it will definitely understand that arrive or the situation therefore they will be talking it seriously.

Stay strong and best wishes for you and your baby/babies!

 

[speedballs_over]

I feel a need to comment as I have worked in a clinical setting with opioid dependent women in the US (2004-2006, 2011-2014), I am not a clinician, I am a citizen and nothing I am writing is medical advice - it is what is known as "best practices / evidenced based treatment", in the U.S. as directed and advised by SAMSHA and occasionally bent to fit the clinical presentation. Imo, ime - this is thre best sorce of info, even if it is a govt website - it gets little flack for its strsaight forward aproach to the poster's situation. T doesn't know it exists as part of HHS. thankfully.

The poster here sounds like she could use a methadone dose increase - now, if she is still feeling dope - her post indicates she does, so hopefully she's out west (if in U.S.) where fentanyl dope is - for now - rarer than ECP east of Mississippii river, if you have genuine black tar heroin cut with the usual - baked down coffee.

But... we stopping the dope now right? If you can't you must increase your methadone dose so you won't crave or feel dope.

Get naloxone if you do not have it! Needle excahnge or ask every clinician who knows your opioid dependent, but DO NOT put yourself in a situation where you'll need it - it's just best practice to have it around in case you OD, a second trained person can save you both. Naloxone is so easy to administer it's a great thing. So "trained" isn't much - ten minutes tops, pharmacist can demonstarte. It's often given out free to users.

Anyway - I believe the dose increase might need to be up to 90-mg slowly if she continues to use heroin. If she has a huge habit maybe 120-mg. We don't want two opioids for the newborn to be dealing with - so lets get the mother stable and comfortable - so she can feel good, and put the "dope time" into getting into physical condition - eating well, exercise as directed by physicians, etc... finding a stable situation to live in. Pregnant women - sans the troubled male - often get excellent community provided care of no charge or to medicade.

Having a baby at 90-mg methadone I have been witnessed to many times. It is not that much rougher on the baby, which is not all if the post-birth physicians and prescribers are up to date on technique.

The hospital pharmacist(s) may review the protocol for your baby's w/ds - don't forget to ask to speak to him or her directlly, AFAIK in the U.S. any patient in or out of hospital is owed a pharmist (not a physician nor a tech) but a real pharmacist who works at the hospital to consult with them, they are the most knowledgeable in general.

For the most up to date info look into SAMHSA U.S. gov't website. They have excellent pregnant care for opioid dependent mothers and their fetus -> child.

Bets of wishes. I believe you will have a good life and solid family if you make good choices - starting now. The boyfriend sounds like trouble, but it's your life, now is the time to make decisions if he won't be a healthy father. This is none of my business except for HR on both your parts.

If possible, at some point soon get with a thrapist you like - try several if needed - Medicaide may not provide much, but a good CBT therapist will help you more than anything - as long as you are honest and use only ORT (methadone or bupe and not dope).

DO NOT swtich from the plan in place - if anything increase m'done dose to about 90 or until cravings stop cold. You have a lot of time left in your pregnancy. You need to be stable, completely abscent of withdrawals and spikes in opioid or other drug concnetrations.

It is amazing what a fetus can withstand and come out all the same.

Let the hospital pharmacist know you want the baby comfortable and if possible pre-arrange how they will handle the new borns dependency - then let us look it over for ideas. This is nothing to be scared of, we want both you and the little one comfy from now until he/she/whatever is chooses to be is the best possible, and there's no reason that even at 200-mg/day a newborn can be comfortably weened from the m'done.

Get some plans in place and comeback and tell us what you'all came up with, we'll look it over and comment - but never take our advice over your care givers.

It is completely appropriate to seek a pharmacists opinion or three - try to find a hospital based pharmacist or one who works pregnancy as a sort of speciality. Pharmacists are the best source of information for your situations. Most physicians (even "high risk OBGYNs") know jack shit about opioids and pregnancy.

Do not taper anything, stay well - on methadone and methadone only.

Non-medically licensed opion and experince only.

 

[babettehaze]

Hey ! so I talked to my suboxone Dr today and he said that I am fine to take Bupe, without naloxone. As naloxone is considered risky. He said since I am in the second trimester its really not a huge deal to switch, and that he would actually recommend subutex ahead of methadone. Ive been seeing online there are less cases of NAS (natal abstinence syndrome). I'm going to talk to the High Risk Obgyn before I taper down completely, but the Dr. I talked to today said it can be done as long as its very slowly. If anyone has any experience with this PLEASE REPLY!!! and thank you so much everyone who replied. and thankfully Ive NEVER been a cig smoker! gross

 

[babettehaze]

DO NOT swtich from the plan in place - if anything increase m'done dose to about 90 or until cravings stop cold. You have a lot of time left in your pregnancy. You need to be stable, completely abscent of withdrawals and spikes in opioid or other drug concnetrations.

ahhhh now I am so worried... the Dr. I went to today said I'd be okay... I really don't know what to do!I don't really understand why I can't switch, when a lot of pregnant women switch from heroin to suboxone, when they first find out...so I don't rly understand why this is any different?? Sorry if I sound ignorant.

Also, something I don't think people are considering... The suboxone will enable me to be in a stable environment. I can't travel if I'm on the clinic. Not to another country.... They don't really have heroin in Brazil..so I don't know how a methadone clinic would work there...I also have a nice place to stay there. Here I am around people using at the only place I have to sleep inside (friends house).. I am in a motel right now but I can't afford one every day. Last night I slept in a fucking tent. I hadn't done that in over a year. its raining now so I had to figure out a room. And I've stocked up on fluids, etc so I can wait my 24 hrs til I can take suboxone. Tomorrow am its been 3 days since I took methadone...I used this afternoon(dope) so that would mean tomorrow night I could take the sub. Maybe I should spend the 24 hrs in a hospital and have them monitor the baby??

 

[speedballs_over]

ahhhh now I am so worried... the Dr. I went to today said I'd be okay... I really don't know what to do!I don't really understand why I can't switch, when a lot of pregnant women switch from heroin to suboxone, when they first find out...so I don't rly understand why this is any different?? Sorry if I sound ignorant.

Get a second or third opinion. I strongly disagree as have others above.

This is why we have the concept of "second opinion", but you need to work this out with your professionals. We only can give feedback and our experinces / education.

See SAMSHA.gov, if they say switching to bupe from 'done mid-preganacy is ok... then, take that over my opinion.

Best.

 

[SS373dOH]

Methadone was the standard practice for years.

Yes bupe will decrease nas, however it is suggested women already on a mmt, should continue with methadone.

And here's a link to the 2010 john hopkins university study saying that same thing.

https://www.drugabuse.gov/news-even...ine-during-pregnancy-reduces-neonate-distress

I would consider a second opinion, The jump from methadone to bupe is a long, tricky process.

Also you're going to want to let the delivery room know youre on mmt, so they can adjust your dose for labor analgesia.

 

[tacodude]

He meant don't switch the plan in place without approval of your doctor. Only let your doctor make the decisions. If you want to change something talk to your doctors and if they approve them change. The problem isn't changing the treatment, but self treating in any way or not following your doctors instructions, which are there to keep your baby safe.

If you want to switch to subs go ahead. Some people really benefit from them while methadone can be difficult especially with the once daily dosing now that regulation policy makes it impossible to split dose until 9 months into treatment as it requires take homes and it seems pretty much impossible to get split dosed due to requiring to take a dose home. These policies to prevent diversion only prevent patients from from getting thier need met, but I digress.

Just work with your doctors they will know what they are doing

 

[Prescottdave]

If it was my baby I would stay on the methadone. Switching from methadone and H to buprenorphine while pregnant sounds dangerous. I would get a second or even third opinion. I found the WD's from low dose methadone are really similiar to suboxone in terms of intensity.

 

[speedballs_over]

Hi to babettehaze - I dont want to complicate things or bother you, I hope you're doing well.

If you wish, could you let us know what the plan is? How is it going? I ask for the benefit of those who would find this thread in a search or may have been following it. Myself included, I can always learn more but need people like you to educate me about how things are being done today in varying situations, few cases are straight forward.

I was thinking of you tonight and really just wanted to a. ask how you are, feel free to say, "none yo bizniss", or whatever and b. what your care plan is for the months ahead.

We are here to help, getting feedback on critical, life affecting issues is the norm here, so please if you're still monitoring the board here let us know what you wish to share, there are usually about 800 people reading this forum at any one time.

Your experience would definitely be of value to many of us who work in HR, participate here and try to help others access the medical care that is the best standard of care available. There may be several approaches to choose from - I hope you have good care. We have heard the best and the worst, we try to steer people to find the former and avoid the latter.

My sincerest wishes for you to be stable, and for things to work out well. Not easy, we know, but with some good advice & practice by your physicians, pharmacists and nurses - if they are competant - you will have the opportunity to do your best for eveyone involved.

Be well. We care. Thank you.

 

[tacodude]

Speedballs do you know anyone IRL in the situation or am I getting the wrong message?

Either way haze he's right about this place. A lot of caring people and few educated on this situation always curious willing to provide support possibly even researching things for you when labor struggles or dependency challenges come up and you need to answer a question yet just don't feel up to it.... It's one of the few cases where pretty much any question asked most any long timer will do their best to answer or to even just talk you through a present situation if it is not the ? you were hoping for.... Like an ugly ?, but spending eternity opening ? after ? of ugly ?, but at least at the end of this suffering granted everything goes right like it should if you're working with your doctors you'll end up with a beautiful treasure you'll come eternally grateful for. Please update us! We are all curious!

 

[speedballs_over]

No, not currently IRL. I care... and am looking to learn, continue learning and hopefully retain folks in our community who may benefit themselves or others with shared information.

I try my best to include disclaimers about my non-professional status. My experience is as an IVDU, methadone and bupe ORT participant and volunter work in HR clinical settings ( needle exchange, ORT patient advocate, etc...).

Hoping my bump isn't considered out of place. I thought a bit b/f I hit post - "would this be considered riding someone's ass about personal medical info or is it OK to inquire?"

I decided it was the later at my own peril. Hopefully OP is good, and maybe will get back to us.

thanks.

 

[Jabberwocky]

You’re good speedballs.

Situations like this break my heart. The shit female drug users have to deal with are insane. Men don’t have it great, but women - esp pregnant women and mothers - they have it absolutely horrible in most places.

 

[tacodude]

Glad you bumped it balls. Wonder if you work in an exchange near me? I doubt it, but that would be funny. Imagine if you were giving me my sharps every day and neither of us knew it xD

 

[abbylm23]

You can do whatever you want methadone or subs. You just have to get into your mind that you want to stay away from the illicit drugs now. You can do anything you put your mind to, you are stronger than you think! SUbs may be more convenient if you are having to travel. God bless you

 

[speedballs_over]

Well, I'm US based in a fully cannabis legal state, when not in S.A. - my second home is wedged b/w Peru & Columbia.

Our exchange was underground until about 2011.

anyway - absolutely agree that women IVDUs, esp., of the age when conception is believed possible (some people under estimate the wide range of age is all I mean) or when actually pregnant is shameful - and shaming someone already under duress (I suppose a few women are not distressed by pregnancy & opioiod addiction, I know I would be!) is one of the biggest travesties of opioid (ab)use.

That is why I want to learn more, to be more ever more compassionate, knowledgable and helpful with ideas for resources.

thanks everyone. I imagine OP has found a way, let's hope it is a safe, joyous journey rasing the child after being through a fraught period of struggle.

I dislike the US medical community intensely. I was asked to leave an ortho clinic yesterday despite stating up front I did not want opioids. I have a serious issue, likely requires surgery, but they wouldn't even look at me. This is in NYS, I'm not at either home ATM.

To think what if I were pregnant - not possible, wrong equipment under the hood - is nearly unbearable, but I bear it to help others. It is my duty and I accept "thank you"s graciously. I'm not in it for that, I'm in it b/c I owe my life to HR in the form of the online book "Getting Off Right", B.L. and a very compassionate MMT clinic in Tucson, AZ mid-2000s.