• English

    Google Translate Disclaimer

    The Maryland Department of Information Technology (“DoIT”) offers translations of the content through Google Translate. Because Google Translate is an external website, DoIT does not control the quality or accuracy of translated content. All DoIT content is filtered through Google Translate which may result in unexpected and unpredictable degradation of portions of text, images and the general appearance on translated pages. Google Translate may maintain unique privacy and use policies. These policies are not controlled by DoIT and are not associated with DoIT’s privacy and use policies. After selecting a translation option, users will be notified that they are leaving DoIT’s website. Users should consult the original English content on DoIT’s website if there are any questions about the translated content.

    DoIT uses Google Translate to provide language translations of its content. Google Translate is a free, automated service that relies on data and technology to provide its translations. The Google Translate feature is provided for informational purposes only. Translations cannot be guaranteed as exact or without the inclusion of incorrect or inappropriate language. Google Translate is a third-party service and site users will be leaving DoIT to utilize translated content. As such, DoIT does not guarantee and does not accept responsibility for, the accuracy, reliability, or performance of this service nor the limitations provided by this service, such as the inability to translate specific files like PDFs and graphics (e.g. .jpgs, .gifs, etc.).

    DoIT provides Google Translate as an online tool for its users, but DoIT does not directly endorse the website or imply that it is the only solution available to users. All site visitors may choose to use alternate tools for their translation needs. Any individuals or parties that use DoIT content in translated form, whether by Google Translate or by any other translation services, do so at their own risk. DoIT is not liable for any loss or damages arising out of, or issues related to, the use of or reliance on translated content. DoIT assumes no liability for any site visitor’s activities in connection with use of the Google Translate functionality or content.

    The Google Translate service is a means by which DoIT offers translations of content and is meant solely for the convenience of non-English speaking users of the website. The translated content is provided directly and dynamically by Google; DoIT has no direct control over the translated content as it appears using this tool. Therefore, in all contexts, the English content, as directly provided by DoIT is to be held authoritative.



    What are opioids?

    • Opioids include oral opiates like codeine, hydrocodone, oxycodone, fentanyl or meperidine as well as heroin, which can be smoked, used intra-nasally, or injected1
    • Heroin is a synthetic opioid that is lipid soluble and crosses the blood-brain barrier where it is converted to morphine
    • Opioids work by binding to three types of opiate receptors throughout the body causing an analgesic effect resulting in increased pain tolerance and feelings of euphoria2, 3
    • Side effects can include sedation, respiratory depression and decreased gastrointestinal function2, 3
    • Prescription opioids are the most commonly abused prescription drugs in the U.S.4
    • Heroin is the most commonly used non-prescription opioid in the U.S.2

    What are the medical consequences of opioid use?

    • Dependence4
    • Overdose1
    • Respiratory depression4
    • Sedation4
    • Liver disease5
    • Kidney disease5
    • Pulmonary disease like pneumonia, tuberculosis1
    • Chronic constipation5
    • Withdrawal 4,5
    • If injected risks include:
           Increased risk of infection like HIV, HCV5        
           Venous problems5    

    What are the treatment options for opioid abuse?

    • There are multiple options for the treatment of opioid dependence in pregnancy including medical detoxification or medical maintenance with methadone or buprenorphine6

    What are the medical consequences of heroin use in pregnancy?

    • Placental abruption7
    • Preterm labor7
    • Fetal death7
    • Decreased birth weight8
    • Small head circumference
    • If heroin is used intravenously, the fetus and the mother are at increased risk of infections like HIV and hepatitis7, 9
    • There is some evidence that prenatal exposure to heroin can cause babies to be irritable and difficult to console even in the weeks and months after birth8

    What are the medical consequences of prescription opioid use in pregnancy?

    • Inconsistent data is available regarding some of the fetal effects of prescription opioid use in pregnancy

    • Some studies have shown an increased risk of cleft lip and palate, cardiac defects, and gastroschisis with the use of oral opioids1
    • However, other large trials have found no significant increase in risk of congenital malformations with use of opioids in the first trimester

    Neonatal Abstinence Syndrome

    • Use of both prescription opioids and heroin is clearly associated with neonatal abstinence syndrome when the infant withdraws from opiates after the maternal source is removed11
    • It us occurs within 1-10 days of delivery2
    • The syndrome affects multiple organ systems including the brain, the GI tract, and the autonomic nervous system1
    • Associated symptoms include:
           Poor feeding12
           Excessive sweating12
           Temperature instability12

    What are the treatment options for opioid abuse in pregnancy?

    • There are multiple options for the treatment of opioid dependence in pregnancy including medical detoxification or medical maintenance with methadone or buprenorphinebuprenorphine6
    • Prior to the introduction of buprenorphine in 2002, the preferred treatment was with methadone as its use was associated with increased compliance and avoidance of repeated intoxication compared to detoxificationbuprenorphine6
    • Multiple studies have examined the advantages of buprenorphine as compared to methadone6
      While buprenorphine does appear to be associated with less neonatal abstinence syndrome, the two medications seem to be otherwise comparablebuprenorphine6
    • Due to the changes in pharmacokinetics in pregnancy, the dose of methadone or buprenorphine may need to be increased as pregnancy continues6, 7
    • Women who are on medical maintenance for opioid use should receive adequate analgesia during labor and delivery6, 7
    • It is important to avoid narcotic agonist-antagonist medications during labor and delivery such as butorphanol, nalbuphine, and pentazocine as they can cause acute opioid withdrawal7
    1. Heroin: Abuse and Addiction.  Retrieved January 15, 2014 from The National Institute on Drug Abuse Web site: http://www.drugabuse.gov/publications/research-reports/heroin-abuse-addiction
    2. Stanhope, T.J. et al (2013).  Chronic opioid use during pregnancy: Maternal and fetal implications. Clin Perinatol 40. 337-350.
    3. Lindsay, M.K. and Burnett, E. (2013). The use of narcotic and street drugs during pregnancy. Clinical Obstetrics and Gynecology 56. 133-141.
    4. American College of Obstetricians and Gynecologists. (2012).  ACOG Committee Opinion 538: Non-medical Use of Prescription Drugs.  Washington, DC: American College of Obstetricians and Gynecologists.
    5. Drug Screen. Retrieved January 15, 2014 from The National Institute on Drug Abuse Web site: https://nida.nih.gov/​
    6. Jones, H.E. et al. (2012). Buprenorphine treatment of opioid-dependent pregnant women: a comprehensive review. Addiction 107. 5-27.
    7. American College of Obstetricians and Gynecologists. (2012). ACOG Committee Opinion 524: Opioid Abuse, Dependence, and Addiction in Pregnancy. Washington, DC: American College of Obstetricians and Gynecologists.
    8. Bandstra, E.S (2010). Prenatal Drug Exposure: Infant and Toddler Outcomes [Electronic Version]. Journal of Addictive Diseases, 29, 245-358.
    9.   Kuczkowski, K.M (2007).  The Effects of Drug Abuse on Pregnancy [Electronic Version].  Curr Opin Obstet Gynecol, 19, 578-585.
    10. Brenna, M.W. and Rayburn, W.F. (2012). Counseling about risk of congenital anomalies from prescription opioids. Birth Defects Research 94. 620-625.
    11. Wendell, A.D (2013). Overview and epidemiology of substance abuse in pregnancy. Clinical Obstetrics and Gynecology 56. 91-96.
    12. American Academy of Pediatrics Committee on Drugs (1998). Neonatal Drug Withdrawal [Electronic Version].  Pediatrics, 101:6, 1079-1088.
    January, 2014