Doc’s Research Prompts New Guidelines for Getting Pregnant Women Off Drugs

For the past five years, Dr. Craig Towers has been treating his pregnant patients with addiction issues the way he thought best – at times, against the guidelines of the American Congress of Obstetricians and Gynecologists.

That changed this week – because ACOG has amended its own guidelines as a result of Towers’ research.

ACOG once said detoxing while pregnant should be avoided at all costs. The congress still maintains medication-assisted therapy is the preferred treatment for pregnant women who are misusing prescription or illicit drugs. But it now notes medically supervised detox by an experienced provider “can be considered” for those women who don’t want to take“maintenance” medications or don’t have access to them, though it cautions “more research is needed to assess the safety, efficacy … and long-term outcomes.”

Towers intends to continue that research.

In February 2016, Towers, a maternal- fetal medicine specialist at the University of Tennessee Medical Center, presented research at the Society for Maternal-Fetal

Medicine’s national convention showing that, in his study of more than 300 women who detoxed while pregnant, no fetuses were affected by detox.

That went against both conventional practice and ACOG’s guidelines, which long maintained that detoxing from opioid drugs while pregnant risked harming a fetus. ACOG recommended women stay on a “maintenance drug” such as methadone or, more commonly now, Subutex (buprenorphine) through their pregnancies and then detox afterward.

Towers noted that the studies the guidelines were based on were old, with very small samples. He had access to a larger data set: pregnant women who had detoxed against medical advice – a third of them while in jail.

Towers’ study found no bad outcomes among either babies or moms in any of the groups. Two women lost babies for reasons unrelated to detoxing, but there were no miscarriages, preterm births, ruptured membranes or other adverse effects related to detoxing.

Towers also found many of the women who came into his high-risk OB practice at the University of Tennessee Medical Center didn’t realize that if they were taking Subutex – still an opioid – their babies could suffer withdrawalafter birth. And once it became more common knowledge that maintenance meds could cause Neonatal Abstinence Syndrome, Towers said, “75 percent of my women come in and say, ‘I don’t want to be on anything.’ ” “I don’t talk a single patient into detox,” he said. “I don’t coerce them … or try to give them a guilt trip about NAS.”

The guidelines make a difference, he said, because other providers sometimes tell his patients that he doesn’t follow recommendations, that detoxing could raise their risk of miscarriage or fetal problems.

“I’m very happy,” he said.

Towers thinks in a few more years, ACOG will shift again, to make detox preferred over medication-assisted therapy. He now has data on more than 500 women who have detoxed with no bad outcomes to mothers or babies, he said.

“I’ve delivered 50 or 60 women since January, off opiates, no NAS,” he said.

He also said there’s no research to support the idea that patients who detox during pregnancy and then return to using opioids while still pregnant have poorer outcomes because they detoxed. What has made a difference in his patients, Towers said, is getting the women behavioral health services. Among women in his study, those who didn’t have behavioral health services had a 70 percent chance of returning to substance use, usually the maintenance medications, compared to 17 percent of those who got behavioral health services.

ACOG also recommends “intensive behavioral health followup” for pregnant women who detox.

At a news conference Wednesday,Towers thanked UT Medical Center, his partners and his practice staff for their support.

“We’re making some good headway,” he said.

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