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 Post subject: weening while pregnant
PostPosted: Mon Apr 25, 2016 3:18 pm 
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I am currently 26 wks pregnant. I am weening from subutex, currently down to 1 mg a day. (I'm on day 2 of 1 mg). I drop a half a mg every 3 wks roughly. I feel like weening is the best thing for me as I've been on a maintenance program for almost 4-5 yrs now. only legally prescribed since Dec. 2015.. my sub doc isn't very helpful on the weening but my OB is. I had a case worker from a drug program tell me that it's not safe to ween while I'm pregnant, that I have to stay on it..
my baby is healthy and measuring big, very active and I don't have any concerns about my baby's safety as far as weening. now as far as how I will be and how the baby will be after delivery and NOT being on subs is what concerns me.. I however am not concerned about relapse.
has anyone else ever weened during pregnancy? were you successful? how was the physical withdrawal?
my OB did say that when I drop from .5 mg to 0 that she would like to admit me so that she can monitor the baby and I more closely.


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PostPosted: Mon Apr 25, 2016 3:32 pm 
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Whatever withdrawal you go through your baby will go through also. Still, if you are going slowly enough and your OB is overseeing it, you might do just fine. I'm glad that your OB wants to admit you when you drop to .5mg. The reason that pregnant women are advised not to taper or go off is because it can cause miscarriage! It sounds like you are doing things the right way though.

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PostPosted: Mon Apr 25, 2016 7:54 pm 
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yes, I understand the baby cannot handle WD symptoms which is why I'm weening so slowly. I hope I can go from .5 to 0 safely. I also understand they won't give me comfort meds while pregnant either. OB told me if I'm completely off by 36 wks the baby will not experience any withdrawal symptoms at all- which is what I'm aiming for. I just couldn't stand to put a baby through that. it was obv an accident (getting preggies while on sub)
my man of 6 yrs is also on it. I know we should have been more careful but everything happens for a reason.
thank you for your response!


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PostPosted: Tue Apr 26, 2016 1:30 pm 
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Nobody here blames you for accidentally getting preggers while on suboxone, trust me. We are addicts; we all make mistakes. There used to be a couple of people who were all judgmental about people being pregnant while on sub, but they are either long gone or they don't comment anymore because they get yelled at. :)

The only message I want to give you is that the things that you are scared about, like having to deal with CPS or having people know that you're an addict is all about you. I'm not saying that you're wrong to have these feelings either. But I will say that for your baby, the best thing to do is to stay on your dose, wait it out, and if the baby has NAS the doctors can make the baby comfortable. When/if the baby has to withdraw inside you, it will not have those comforts. It will feel the lousy symptoms you feel. I can understand if you continue on your path, because I understand stigma and guilt. And if you're going super slowly I don't think your baby will have too, too much discomfort. But again, if you do it that way, it's probably more about your fears than your baby's comfort. I wish you the best in whatever you decide to do. And remember, this is a tiny slice of what will hopefully be a nice long life! Keep that in perspective.

Amy

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PostPosted: Sun May 01, 2016 8:46 pm 
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thank you so very much Amy. I don't let it get to the point I feel withdrawal symptoms bc I understand the baby cannot handle that. I'm being closely monitored by my OB. when I go from .5 mg to 0, I will be admitted to the hospital so I can be monitored even closer.. I don't wanna spend more time in the hospital but I understand I need to do this and it actually puts my mind at ease that I will be watched so closely.
I may have already said this, but one of my concerns is dealing with a newborn, newly off of sub and dealing with all of that at once.. being at risk for post partum. I'm willing to swallow my pride and if need be, stay on it to prevent that from happening.
this week I have lowered myself to 1 mg, which I'm pretty proud of! I will stay on 1 mg for probably about 4 wks and drop to .5 mg.
thank you again for your response and kind words!

PS- what is NAS?


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PostPosted: Sun May 01, 2016 9:36 pm 
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NAS is neonatal abstinence syndrome. It's the name for what happens if your baby starts to withdraw after he is born. By the way, breastfeeding seems to help prevent NAS if you're still on any sub because the baby gets a very small amount in the breast milk. This allows them to wean off the medication a little bit more slowly.

Dr. Junig, our resident suboxone/addiction expert, who has a psychiatry practice and treats addicts on a daily basis has noticed that about 1/3 to 1/2 of his pregnant sub patients' babies end up with NAS. The odds are decent that if you remain on sub your baby won't have NAS.

Obviously you are being very careful about your taper and are doing it under a doctor's care, so you and baby should be in good shape. Thank you for being open to my advice. That shows me that you really are putting your baby first. I hope that the rest of your pregnancy is pleasant and uneventful.

Please keep us updated, especially if your taper is a struggle to you mentally. There are plenty of folks here who are happy to support you, including me. :)

Amy

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PostPosted: Mon May 02, 2016 10:37 am 
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Yes-- I see about 50% of patients's babies have NAS, and more importantly, a number of studies have shown a 40-50% incidence of NAS in babies born to moms on buprenorphine.

Interestingly, that incidence was NOT correlated with dose of buprenorphine. Half the babies had NAS, whether moms were on 4 or 16 mg buprenorphine. That doesn't make sense to me, but that's what the studies showed.

It would make sense to me that women who stay on buprenorphine to term should breast-feed their infants. That way the infant received an amount of buprenorphine that slowly decreases as the baby is weaned from the breast, and as the baby's liver develops and becomes more and more efficient at metabolizing buprenorphine. If, at the very worst, the baby receives an insignificant amount of buprenorphine from breast milk, at least the baby would receive the other benefits of breast feeding.

I am also the person here who is in charge of stirring things up now and then. I want people to challenge their thinking, and to not just believe everything they've read on the internet. For example, I think it is great that scarlet wants to wean odd opioids. But babies CAN handle NAS. They can also handle withdrawal while in utero, at least from opioids. I've had three children and I know the feeling of being willing to jump in front of a truck to safe them, no question. I still feel anger from the time my 2-y-o son needed stitches on his face, and the ER resident did the last stitch outside of the numbed area, while I held my son down.

But NAS is not as bad, and intero withdrawal is not as bad. First, much of the misery from NAS is mental; feelings of guilt, shame, and dread that babies simply don't have the ability to experience. And many of the other w/d symptoms simply feel normal to a baby, because of poorly-insulated nerves to the muscles and GI tract. Finally, look at what happens during labor. Babies' heads are squeezed to hard that their heads change shape!! Not to mention circumcision....


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PostPosted: Mon May 02, 2016 1:19 pm 
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Suboxdoc - I am so glad you stir things up so we are able to learn! It's so hard with all the false info out here on the Internet to know what to believe. I feel so much more comfortable knowing I have a resource here that can provide ACCURATE info and people (like you) that aren't afraid to say ..hey I don't know the answer to that or these are just my opinions but here are some good studies to back them up. You are so knowledgeable and have so much experience based info which I feel is just as if not more important than what one book or study or site might claim as "fact" . Thank you for always taking the time to educate us and guide us. Hope you have a great day!

Willow


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PostPosted: Mon May 02, 2016 7:20 pm 
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This may not be the right forum to mention this, but I think that very few people understand what is done during a circumcision. At birth the foreskin of the penis is adhered to the glans of the penis (the mushroom head). Think of what it would be like to have your finger nail ripped off. Then the foreskin is crushed and removed.

The foreskin of a penis is full of nerve endings, and, in fact, has more sensitivity than even the glans. I was asked to change my grandson's diaper when he was only a couple of days home. That baby screamed in pain! He screamed and I cried and I left their house as soon as possible afterwards.

Circumcision is a lucrative surgery that doesn't take very long. And afterwards, the hospital ships the foreskins out to biomedical companies for a price. Of course American doctors are going to find reasons to keep supporting the unnecessary procedure on behalf of their bottom line.

Please consider leaving your baby boys intact people! The foreskin is protective in many ways. Here's a link to an excellent article about the foreskin: http://madsciencewriter.blogspot.com/20 ... et-in.html

Amy

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PostPosted: Wed May 11, 2016 7:06 pm 
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Scarlet, I have a 17 month old that I successfully weened while pregnant. But I will tell you that jumping at .5mg is NOT a good idea, especially if you want to keep the baby from experiencing w/d symptoms.
When I jumped off, it was at .125mg. And WHEN I jumped, it wasn't bad at all.....I kept waiting for the "other shoe to drop" and it never happened. I had experienced much worse w/d's while I was tapering. I think the w/d's weren't that bad when I jumped because I had tapered to such a low dose.

.5 mg really isn't that low, suboxone is very potent. Read up under the tapering section on how to crush up the pills to powder so you can get to a low, accurate dose (of course don't snort it, put the powder under your tongue). Anyway, thats what I would STRONGLY recommend.

I am happy to talk with you if you are interested. I know this is a very scary thing to go through and I am here to tell you that I had your exact same thought and values about coming off of suboxone before the baby was born. And in the end it was the best thing for me and my baby. I will say that i took my last dose of about .125mg 4 weeks before my due date and 5 days after my last dose I went into labor. I was very afraid that because it had only been 5 days that the baby might still have w/d symptoms, but he did not.....I think the fact that I tapered so low also contributed to that.


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PostPosted: Wed May 11, 2016 11:42 pm 
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THANK YOU SO VERY MUCH! I'm having a hell of a time staying at 1 mg a day. I'm doing it.. but I'm not sleeping well through the night. my whole body is restless and I wake up all through the night.. I'm lucky if I get 4-5 hrs and that's not solid. I wake up sneezing and exhausted and just feeling like shit. the past 2 days I've taken 1.25 and that seems to get me through the night.
I was wondering how the hell you could dose .125?! but crushing it into powder makes sense.
I went from 1.5 to 1 mg and I'm thinking that may have been too big of a jump. I didn't have any w/d symptoms jumping from 4 mg to 2 mg though...
being as though I'm having such a hard time at 1 mg I'm kinda scared that I won't be able to get any lower. but I'm gonna take your advice and taper slower. I think as of now I'll continue on 1.25 mg and then go to one.
I've been tapering .5 mg every 3-4 wks roughly.
how did you do it.. like how many mgs and how often?

I really thank you for your response, it gives me hope and makes me feel so much better to hear from someone who did it and who was successful!
did you breastfeed? was your milk production effected? did you experience post partum? I understand physically you didn't experience any w/d, but what about depression or emotionally?
and how long were you on suboxone when you got pregnant?


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PostPosted: Thu May 12, 2016 6:44 pm 
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Ok, first of all let me say that YES most definitely did experience withdrawal symptoms. When I think back on that time the w/d's weren't as bad as i remember feeling while i was in it.....but also last night I went through my posts on this site and I was reminded that yes, I did go through rougher times that I remembered. Its like child birth, you forget the pain after a while.

Anyway, I did not experiencing too much withdrawal symptoms until I tried to go below 8 mgs, and probably even 4 mgs. After that, my w/d's would peak about day 2 and be mostly over around day 4-5 (i think because I was pregnant that my w/d's kicked in sooner than what most other people have reported. I have read that in pregnancy sometimes the girls need to up their dose because of the extra blood flow going through your body or some reason, so that would make sense that our w/d's would kick in sooner). I remember them being tolerable, except for sometimes at night....but the thoughts of taking a little bit extra would always remind me that the pain I had previously been feeing would be for nothing because taking extra would set me back. I try to think of the pain (w/d's) as a good thing, meaning that my body was getting better.

I would recommend making SURE you are stable at a dosage before going lower. I would recommend staying at that dose however long you need to (I'm assuming you have a bit before you deliver), I would stay at my dose for about a week, less if i was feeling strong, more if I needed just a few more days to feel better.

I can't remember for sure how my tapering schedule went, but i think from 16mg i went to 12mg, then to 8mg, then I would decrease 1 or 2 mg at a time depending on how my body tolerated it until i got to 1mg or so and then it was micrograms. Diary of a Quitter, i think it was his posts about tapering schedule that I tried to follow mostly. Just listen to your body and let it guide you. If your jump from 1.5 to 1 mg was too much maybe don't go back up to 1.5 but if you have to take an extra .25mg or so to get you through then do. Also something that might help you a TON is to split your dose, half in am and half in evening. That helped me a ton, especially when i got down below 1mg. When your ready to go below 1mg, just take it really slow from there, .9, .8, .7, .6, .55, .5, .45........and so on. I think thats about how I did it, but like I said look through the other posts for those who have it spelt out for you already.

Yes I did breastfeed and that cause me great stress when the baby got older and I thought about weening him. (I got back on subutex after I had the baby) I was terrified that he got addicted to it through my milk and that he would go through w/d's. But either he wasn't getting enough subutex through my breast milk or I weened him so slowly that he was fine. It didn't seem to effect my breast milk too much, I never really made a huge amount of milk, but i did nurse him for about a year and a half.

Do you have support in all this? I sure hope so because it is very hard to do alone. I was on subutex/suboxone for 5-6 years prior to me getting pregnant and tapering. And yes, one of the things I remember distinctly was that I would get depressed around day 2-4 of a dose decrease, but it would always get better. My postpartum was no worse and no better than I remember it with my other kids, I had the baby blues for about a day or two and then it got better. I have always been pretty lucky in the depression department..... the times i have gotten depressed-it doesn't stay too long. And when I got depressed it was very helpful for me to talk to others about it, so that is why I hope you have support.

I am not about 15 weeks pregnant again, so I am preparing myself to do this all over again--I am not excited that is for sure. But I know it is what is best for me and my family and my baby, so it must be done.

You've done so well so far, don't get down on yourself for having a few bad days. I always told myself that I would just do the best that I could. If I couldn't get al the way off of it, then I would deal with that when I needed to but i was able to do it.....slowly. How far along are you?? I hope you've left yourself plenty of time.


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PostPosted: Thu May 12, 2016 6:53 pm 
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It makes me so mad when I read that a pregnant woman is told by a case worker or other that it is unsafe to ween from suboxone. They are uninformed and naive and should not be passing out medical advice unless they know what they are talking about.


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PostPosted: Thu May 12, 2016 10:48 pm 
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yes I have support from my fiancé but he too is on sub.. he's so very supportive though and is trying to ween himself.. he's not trying too hard but he's not the one with child and is comfortable staying on it anyways.
I've been on it for going on 5 yrs and never went higher than 6 mg so I figured tapering would be easier for me. I'm still working right now so I feel like if I wasn't working I could just "deal" with the w/d symptoms (the not sleeping) I'll be done working here in June so I feel that by then I can really just deal with the symptoms. I jumped from 6 mg, to 4, to 2, then then I went 1.5 and attempted to go down to 1 but as I've said I've been having a hard time and I've been taking 1.25 (roughly) for about a week. I think going from 1.25 down to 1 will be easier for me.
I'm 28 wks pregnant. the OB (who knows not a damn thing about subs or addiction) wants to admit me when I jump from 1 to .5mg. but as you've said .5 mg is still kind of a high dose, being its so potent. I have an appt with her tmrw so I am going to tell her how I've been doing with the tapering and my plans. she said if I'm off by 36 wks the baby would not experience any w/d symptoms. I go for non-stress tests every week to ensure my taper is safe and going as planned. having the baby and I monitored so close makes me feel better.
I read another post on here about a girl who's doc did a medical detox, with comfort meds! I've called around everywhere, even into the city and no one is willing to touch me. I live in a very small rural town in PA.
I'm pretty sure when I go to be admitted I'll just have to deal with the wd and just be monitored.
I was told the baby gets such a minuscule amount of sub through breast milk it actually helps them ween and is encouraged by women who are on sub.


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PostPosted: Fri May 13, 2016 12:10 am 
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Ok, first of all let me tell you that for me working was one of the best things i could have done for myself while i was going through w/d's. But I had an easy desk job. But for me, since the w/d's weren't intolerable and unbearable, forcing myself to get up and get going always made me feel better and it made the day go by quicker so that I could go home and take my second dose :) But i also only worked about 5 hours a day so maybe it just isn't the same for you.

My significant other also takes subutex and he held my meds for me. He would leave me what i was to have for the day and then I wouldn't it right there with me if i started craving. If I wanted more I could get more from him, but it would be less convenient and I would also have to face asking him for more and that would also always make me think twice because I never wanted to disappoint him, if that thinking makes sense.

I also had an OB who really didn't know much about this medication, or at least thats what I figured because he never really gave me any advice about what to do. I would alway tell him how I was doing, what my plan was for the next month and that I was planning to be done before i delivered. He just always said ok. Sometimes, more times than not, he didn't even really bring it up. It was almost like he really wasn't worried about it. Maybe he thought I had a good handle on things, I don't know. He basically let me decide what and how to do it. In fact, I don't plan to even tell him this time around, he seemed that disinterested in it last time.

So listen, this whole thing with being admitted when you jump..... with my last pregnancy I think that would have made me feel better about the whole situation.....now that I've been through it I don't know that I feel like it would help any. But if thats what your going to do just for sure don't jump until your at at least half that, in my humble opinion. Also, you will have been at such a low dose for such an extended period of time that it will make everything much easier, thats how it was for me. I only had about 72 hours completely off before I delivered (i thought it was a week but in looking back at my posts, it was only 3 days) and the baby was fine. So if you go a few days or even a week or two past 36 weeks, its not the end of the world.

Also, comfort meds. I looked into clonodine (blood pressure med that helps with w/d symptoms) but it wasn't really researched too much in pregnant women and I didn't really want to risk it. Hydroxyzine Pamoate (Vistaril) is what my OB gave me for nausea during my early pregnancy and i'm pretty sure it also helps with w/d symptoms. Look into having your OB rx that for you for when you jump, or even just for when your tapering and it gets bad.

Yes, my addictions dr always told me that nursing the baby would help with w/d symptoms, but with the way we plan to do it, we will be off completely before the baby comes so that really won't be an issue.


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