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PostPosted: Fri Jan 26, 2018 6:59 am 
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Hello all! Iam hoping I can someone who has been they this to help. I am 29 weeks pregnant and need to start subutext immediately! (I know I should have done this a long time ago but I made my choices and need to fix them now) all my research tells me that the 3rd trimester can cause early labor if withdrawing. Since I need to wait 24 hours to start dosing for subutext will that put my baby in harm? Am I better off just doing methadone since I'm this far a long? Would much rather do subutext that I was prescribed months ago but scared to call my dr because I don't want it on record that I have not been clean. I don't need options and such but just an answer. Can I start this and not go into early labor or is there anything I can take herbal to help keep my baby cooking so I can start this medication and turn my life around?? Thank you!!!


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PostPosted: Fri Jan 26, 2018 7:11 pm 
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This is a very serious issue, and I encourage you to find a doctor who understands these medications well who you can be open with. I treat pregnant women who are on each of those medications, and I'll provide some information-- but there are many aspects of your care that I can't know without a full work-up, and so I can't tell you specifically what is best for you.

Opioid withdrawal can trigger premature labor and birth, and can also cause harm through changes in blood flow and oxygen delivery to the placenta. As you know, withdrawal can be triggered by discontinuing opioids, or by taking an opioid blocker. Buprenorphine is an opioid blocker AND activator. Note that whether you take Suboxone or 'Subutex' (Subutex brand no longer exists, so the accurate name is 'buprenorphine'). Precipitated withdrawal on induction is caused by BUPRENORPHINE, not naloxone. There are some concerns about taking naloxone during pregnancy, but naloxone is not associated with any fetal abnormalities. The concern is only because in general, we try to give as few meds as possible during pregnancy. Beyond that, effects of medications on organ development almost always occur during the first trimester, and you are beyond that. My point with this paragraph is that Suboxone or Subutex (buprenorphine) are equivalent from where you are now, so the issue is whether or not to start buprenorphine in any form.

As I wrote earlier, buprenorphine is both a blocker and an activator of mu opioid receptors (the official term is partial agonist or agonist/antagonist). What it does to a specific person depends on two things—the person’s opioid tolerance, and the presence/absence of opioid agonists at the receptor. For the first issue, the effect of buprenorphine at the ceiling effect is about equal to the effect of 40 mg methadone per day. For that reason, patients on methadone must taper their dose (and their opioid tolerance) down to 40 mg methadone or less in order to avoid at least moderate withdrawal symptoms.

On the other hand, if a person’s opioid tolerance is zero or low, buprenorphine will activate the receptor and cause a narcotic effect. So the first question you should ask is ‘what is my tolerance?’ The second question is ‘what opioid is in my system, and how long does that opioid stick around?’

Even if your methadone dose is 40 mg or less, methadone takes a long time to leave the body—so a person must stop methadone for a few days before taking buprenorphine, or precipitated withdrawal is likely. Normally that’s not a bid deal, because PW never lasts very long. But a pregnant woman should not be in significant withdrawal for any length of time.

I’ll ask a few questions to help educate you—but again, do not take my comments as ‘advice’. The bottom line for any pregnant woman, though, is if you are in a methadone-assisted treatment program and your dose is moderate to high—say 60 mg or over-- you are not going to be able to convert to buprenorphine medications without significant and inappropriate risks. There is not enough time to get the dose down to 40 mg without causing withdrawal. We typically taper methadone by about 5% every week or two, which from 80 mg would be 2-4 mg per week, at the fastest. Getting from 80 to 40 mg therefore takes 15-25 weeks (and frankly it is rare for someone to do that fast of a taper without stopping for a couple weeks now and then to adjust to the lower dose).

Some questions: Are you in a methadone program? What is your dose? What week of pregnancy are you in?

If we don’t communicate again, please see an OB asap and be open and honest. People using opioids are monitored MUCH more closely during pregnancy, with much more frequent ultrasounds and stress tests, and rechecks any time the mother experiences significant withdrawal. You have to bite the bullet and be honest. I am not judging you—I am just concerned for you and your baby.


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PostPosted: Sat Jan 27, 2018 1:07 am 
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Thank you for your response.

Iam not on any methadone whatsoever. Iam still using heroin unfortunately. I just want to start the buprenorphine that my doctor prescribed me that I never took in the first trimester and then start seeing him again after.

I was seeing an obgyn until 2 months ago because I need to get blood work done and I need to get off the heroin first so I can get this over withand go back to seeing my doctor for my final trimester.
The blood work is just normal pregnancy tests but because I have marks Iam not sure if phlebotomist call cps either or else I would just do it already.

The only reason I haven't been honest is because I do not want it put down that I haven't started and have cops involved if my obgyn thinks I have been clean this whole time.

I just need to make sure that while I'm at 29 weeks and 3 days I can go 24 hours and start taking my bupe and what signs to look out for if this does make me go into early labor. If the risk is too high then I'll just do methadone and come clean but if there is a chance to start bupe and have less NAS for the baby then i would rather do that. My whole entire family thinks I have been clean so this will be a huge shock and a huge let down.

The last time i saw my obgyn (2 months ago tomorrow) my baby was 100% healthy and growing fine but no updates since.


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PostPosted: Sat Jan 27, 2018 2:34 pm 
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With heroin, people usually avoid precipitated withdrawal during induction if they wait 24 hours. But if you use a lot of heroin-- in the range of a gram or more per day intravenously-- you will have a high tolerance, and so you might have very minor withdrawal for a couple weeks until your tolerance comes down. The situation is sometimes referred to as 'tolerance mismatch'. It doesn't cause severe symptoms, or even moderate symptoms-- just some mild drop in mood and decrease in energy level.

Again, your decision must be made with a physician who understands these issues. There is no doubt that pregnant women have healthier outcomes on buprenorphine or methadone. It sounds like you understand the issues, but for the sake of other readers the question is whether to take on the risk of buprenorphine induction, or instead enter into methadone treatment, which does not require that you are abstinent from opioids for 24 hours.

Jumping ahead, you pointed out that buprenorphine typically results in less NAS than methadone. At this point there are no known differences in long-term health of infants born to mothers on buprenorphine vs. methadone, but the babies on methadone are likely to spend more time in the hospital after they are born.

The safest approach would be to go on buprenorphine AFTER seeing your OB. I'm not an OB/GYN, but whenever I have a pregnant patient experience significant withdrawal, the OB wants to see the patient ASAP afterward to do nonstress tests. So ideally you would be plugged into treatment, so if you DID have problems, your OB would be able to intervene quickly. You asked 'how would you know?' You would know about the labor because of the onset of contractions. But there could be other problems that you are not able to notice on your own, without monitoring the baby's heartbeat for example.

If a pregnant woman is using heroin and having withdrawal often, then maybe one more period of withdrawal is less of an issue-- but that isn't the appropriate way to make medical decisions. A better way is to look forward from where you are now, and make the right call going forward.

I think you understand the issues. I also realize that many physicians out there do not understand buprenorphine as well as they should. I can't help you with decisions that take into account involvement of the police or CPS. In my area, CPS usually becomes involved after any baby is born with NAS, regardless of the cause. But their involvement ends quickly if the woman is providing a safe home for the baby, providing appropriate care, keeping appointments, and maintaining sobriety from illicit substances.

Maybe others will have opinions on some of these issues. Good luck!


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PostPosted: Tue Jan 30, 2018 2:27 am 
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Thank you so much for your opinion/advice. It really helped since I have done countless searches on the internet for answers with no luck.

I will be updating on here all the way thru this process in case anyone has any more advice for me or if someone is going thru the same thing. Thank you for creating this forum.

One more question..
I know xanex is bad to take while pregnant but would the benefit outweigh the risk if I were to take it while I'm with drawling waiting to take my bupe? Would it maybe help lessen the chance of going into early labor? This would be the only time o would take it. I was prescribed this before I was pregnant and stopped taking it. But I still have them on hand. I have read that it's ok to take if the benefit outweighs the risk. Is that maybe the case with this situation? If not is there anything I can take to help me out on the first 24 hours? Over the counter, herbal teas, anything?

And also what about Kratom? Any information on that while pregnant? Can I drink this to help me take my bup in 24 hours?

The reason I ask is because the first 24 hours is the hardest for me and taking xanex to wait 24 hours always helped calm me down but now that I'm pregnant it's much harder. Once the bup starts to work I feel normal and can do it.. it's just getting there.

Thank you again


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PostPosted: Tue Jan 30, 2018 2:39 am 
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Sub doc I saw your reply on my post in the induction forum so I figured I would respond on here since this is a better place for readers.

If I have dosed after my 24 hours with no relief yet not worse is this bad for my pregnancy? Or should I not worry because the bup is in my system doing its job and I just will feel crappy for a while longer until finally normal? I know to dose again in an hour or two if nothing gets better but I just want to be sure that my baby is at least getting relief if Iam not.
Pretty much if I'm creeping crappy for 2 days should I be worried for the baby or not because the bup is in my system and I should be fine granted no early labor contractions?

This makes me nervous as well and plan on getting clean tomorrow night when I have time off of work.
I have my appointments set up for next week as well.

Thank you for the support!!!


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PostPosted: Tue Jan 30, 2018 12:00 pm 
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Hey Rsholves.

Please don't take kratom! It can contain contaminates that can make u VERY sick, even on the first use. Be very afraid of kratom. It's also addictive, nothing good about it, especially being pregnant.

I would assume the benzo wouldn't be a great idea either but hopefully suboxdoc can comment more on that. I've never been a benzo taker so I don't know very much. I do know my doctor won't even prescribe buprenorphine if u have any benzodiazepines in ur system. Not all doctors are like this and some ppl do take it occasionally but with u being pregnant, I don't know that would be a good idea.

I know u don't want to experience sickness and withdrawal, and maybe it won't be as bad as u think this go around. I'm wishing u tons of luck!! It's never to late for recovery and I'm so happy u have decided to take this route!!

_________________
Jennifer


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PostPosted: Fri Feb 02, 2018 8:54 pm 
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Rsh (do I have that right?)- I'm confused, so I'm hesitant to try to give advice. I think you wrote that you 'induced' (i.e. you started buprenorphine) but you were still feelig sick? That would most-likely occur in a person taking methadone. In that case, the MAIN THING is to avoid taking agonists(!). If the person just keeps taking buprenorphine, say 8 mg twice per day, any withdrawal symptoms will be gone VERY quickly.

Please let us know where things are at this point.


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PostPosted: Sat Feb 03, 2018 3:12 pm 
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Subdoc

Yes it's rshloves! Lol

So no I have not started my bup yet due to work. Monday morning is the day!

The reason I always put it off or end up using is because after 24 hours of not using heroin and I start to take bup I don't feel worse but I don't feel better. I know if I just wait it out until that night or the next day to dose again I will feel better (this time I will not give up) but after taking my bup and not feeling better should I be worried about the baby too? Or is everything ok and the bup is doing its job and I just need to wait it out until I start to feel better. The reason I worry is because I don't want my baby to go thru w/d symptoms that long especially since I'm not feeling better physically and risk early labor but it's the only way I can get off heroin. Am I just thinking too much into this and need to just take the bup and everything is going to be ok?

Iam not on methadone and never have taken it, strictly heroin.

Also, can I take xanex one time to help with the craving and anxiety until the bup takes away my w/d since the benefit outweighs the risk?
Before being pregnant this has helped me to actually go thru with igerring clean but now that I'm pregnant idk how I'm going to get thru the first 24-48 hours until I can dose/ feel normal. Is there anything I can take to relax me / knock me out until I can take my bup? Over the counter?

Hope this makes sense.

Thank you
Rshloves!


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PostPosted: Sat Feb 03, 2018 3:49 pm 
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The transition from Heroin to Buprenorphine is very difficult, because the cravings persist for several days even if the withdrawal has been stopped.
I would strongly consider Methadone. More women on Methadone get to delivery with just Methadone than women on Buprenorphine. Not a big difference but it has been reported. Whether it is the actual drug or the much closer monitoring they get I am not sure. However, with methadone, you do not have to be in withdrawal, they just start it and work your dose up to what will be effective or tolerated by you.
If I remember correctly from your other post the Buprenorphine was prescribed months ago. You have been thinking/contemplating, maybe even trial runs and have been unable to start Buprenorphine. Time to consider plan B.


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