Need to focus on the next generation to solve this public health problem.
Pradip KThakur, Medical Research,
March 22, 2016
Dr. Mactier has done an excellent service by writing this article and
bringing this issue to the fore front. It is indeed a huge public health
problem and we do need many more studies to understand better treatment
for long term outcomes for children of opiate dependent mothers. However,
until such treatments and alternatives to methadone/buprenorphine are
available, we need to keep treating these women with
methadone/buprenorphine. Leaving them in the street and allowing them to
use heroin is not only a disservice to these patients but also to future
generation. People working in the field of addiction are not arguing that
methadone/buprenorphine is the best alternative but they are better than
using the heroin during pregnancy as use of heroin brings other lifestyle
issues and dangers to the pregnant mother as well as the fetus. NAS is an
important issue with respect to newborns, but proper management of NAS can
far minimize the adverse consequences. It is true that there are trans-
atlantic differences in attitude with regards to this population but this
is true in lot of other areas of health care. Having a comprehensive
system of primary care, UK can do better job of providing the adequate
care to these pregnant women. The essential thing is that we need to keep
an eye on the future generation. If these women are entered into a long
term comprehensive program with a support structure that is not only good
for their recovery but also provides a better future to these children,
the outcome will be drastically different. As the author has indicated,
the poor suffer from ongoing social deprivation. Right at the time of
their first encounter with the health care system, pregnant women can be
entered into a training/job/recovery program which will provide them
future support and lead to a better environment for growing children.
Lastly, since this article is focussed on pharmacotherapy, we do not need
to discuss much about behavior therapy/modification but one thing that has
proven extremely useful for this population is CM (contingency management)
and we should look to exploit the good effects of this very important tool
The key is to keep an eye on the future generation in spite of maternal
drug use.
Dr. Mactier has done an excellent service by writing this article and bringing this issue to the fore front. It is indeed a huge public health problem and we do need many more studies to understand better treatment for long term outcomes for children of opiate dependent mothers. However, until such treatments and alternatives to methadone/buprenorphine are available, we need to keep treating these women with methadone/buprenorphine. Leaving them in the street and allowing them to use heroin is not only a disservice to these patients but also to future generation. People working in the field of addiction are not arguing that methadone/buprenorphine is the best alternative but they are better than using the heroin during pregnancy as use of heroin brings other lifestyle issues and dangers to the pregnant mother as well as the fetus. NAS is an important issue with respect to newborns, but proper management of NAS can far minimize the adverse consequences. It is true that there are trans- atlantic differences in attitude with regards to this population but this is true in lot of other areas of health care. Having a comprehensive system of primary care, UK can do better job of providing the adequate care to these pregnant women. The essential thing is that we need to keep an eye on the future generation. If these women are entered into a long term comprehensive program with a support structure that is not only good for their recovery but also provides a better future to these children, the outcome will be drastically different. As the author has indicated, the poor suffer from ongoing social deprivation. Right at the time of their first encounter with the health care system, pregnant women can be entered into a training/job/recovery program which will provide them future support and lead to a better environment for growing children. Lastly, since this article is focussed on pharmacotherapy, we do not need to discuss much about behavior therapy/modification but one thing that has proven extremely useful for this population is CM (contingency management) and we should look to exploit the good effects of this very important tool The key is to keep an eye on the future generation in spite of maternal drug use.
Conflict of Interest:
None declared