LongTerm Hydro Use & 5wks Pregnant

[MommasQs]

I have been taking Hydrocodone APAP 10/500 for over 5 years now.  I take 2-3 a day.  I just found out that I am 5 weeks pregnant ... I am going to try to wein myself down, I've already spoken to my doctor about lowering my intake. I am wondering what damage is already done to my fetus, or what damage will be done if I continue the 2-3 a day... Also, I plan on breastfeeding- can this be done if I am taking the meds??

[J T Junig, MD PhD]

Actually, you can breastfeed on narcotics.  The more progressive doctors will allow an opioid-addicted mother on buprenorphine to continue to take buprenorphine while breast feeding, as doing so will effectively taper the infant off opioids over time.  Whenever a woman on opioids breast feeds, the infant receives a tiny fraction of what the mother is on, and much of that is broken down by the infant liver before reaching the general circulation.  It is important to watch for signs of opioid effects in an infant in such a situation, and consider discontinuing breast feeding if signs of narcotization are present in the baby.

MommaQ, you have a tough situation on your hands.  The standard of care for opioid dependent pregnant women is to use methadone or buprenorphine (Suboxone).  BUT I would NOT recommend either in your case, as the dose of opioid you are taking is MUCH lower than the effects of buprenorphine.  In fact, taking Suboxone would be like taking 15 or more Vicodin (hydrocodone) tablets per day!  You would be very doped up by even a small dose of Suboxone, and your tolerance would climb much higher than it is now-- making it much more difficult to taper off.

At the same time, you shouldn't expose you and the baby to the up and down of opioid dependence.  From your current use, I would not anticipate severe withdrawal if you choose to stop.  

The risk to your baby from hydrocodone is very, very low-- if there is any risk at all.  Opioids are  not 'teratogenic'-- they do not cause birth defects-- but the poor diet and repeated withdrawal often associated with opioids are not good for the baby, or for you.  Frankly, if you can continue taking the same 3 tablets of hydrocodone throughout your pregnancy, the risk would be minimal.  But most OB's would likely prefer you stopped them, as you probably already know.

[sickofmeds155]

you cannot breasfeed while on narcotics

[MommasQs]

Thank You so much Dr. Junig.  I appreciate your thoughtful response.  This is a great relief :)  I will continue to taper, but it is nice to know that even if I take 1 a day for the duration of my pregnancy, that there will be no negative effects on my baby.  You mention that the drug does not cause birth defects- does this include physical, mental, aptitudes/abiity wise?