Opioid use a concern while pregnant

Highly ranked healthcare professionals, Dr Courtney Townsel, Kimberly Karanda, Dr Leandri Hattingh of Tokai, Kate Sims, Dr Linda Matonis and Mary Painter.

A Rotary exchange programme has sparked awareness of the growing use of opioids and their effects on child birth.

A team of highly ranked health-care professionals from Connecticut, in America, visited Western Cape health-care facilities recently and shared knowledge on the complex problem of addiction during childbirth.

The visit followed Tokai resident Leandri Hattingh’s visit to Connecticut in May.

She says a 2010 study on illicit drug use and treatment in South Africa found that 0.1% of South Africans abused opioids, while opioids accounted for 9.2% of admissions to treatment facilities.

“While the national guidelines for the management of opioid use disorders promote the use of opioid substitution treatment, the costs are prohibitive, and access is currently limited mainly to the private health-care system.”

Kimberly Karanda, of the Connecticut Department of Mental Health and Addiction Services, says Connecticut is dealing with the highest opioid crisis in the world with 46 000 deaths in 2016, at 2.8 per day. However, this state is also a leader in child-welfare reform.

As a psychiatrist with the Department of Psychiatry at the University of Stellenbosch, Dr Lize Weich confirms that they have noticed an increased trend in opioid use disorders, including illicit opiates like heroin as well as legal opiates like prescription and over-the-counter opioids (like codeine-containing analgesics and cough syrups), in the country.

Health MEC Nomafrench Mbombo says although the province has the lowest maternal mortality rate in South Africa, substance abuse during pregnancy is still rife among expecting mothers and includes smoking, alcohol and tik.

Mowbray Maternity Hospital is the largest dedicated maternity hospital in South Africa and delivers more than 10 000 babies annually. It reports the incidence of substance use in pregnant women has increased almost threefold over a five-year period with tik being the drug of choice.

Anneline Sweetnam, of Constantia Pharmacy, says they have seen an increase use of opioids -found in pain and cough medications.

In 2015, the Medicines Control Council passed legislation to reduce the dosage per pack size and reduce the quantity of codeine per dosage. Patients have to provide their identity number and each purchase gets recorded by pharmacists who counsel patients on possible problems if overused.

“In certain countries, codeine is a banned substance, or requires a script from a doctor, where it is easier to identify when there is a dependence problem. In South Africa, there is no central database to link all purchase records for medication so people often pharmacy hop to avoid counselling,” says Ms Sweetnam.

Prolonged use of opioids by the mother during pregnancy, she says, can result in physical dependence in the newborn who can suffer from withdrawal symptoms.

Doctors will only recommend the short-term use, if that is the only available option and necessary, because opioid analgesics cross the placenta.

Sihle Ngobese, spokesperson for the Department of Social Development, says that since 2014 they have responded to over 50 000 drug-related cases, and treated 35 502 that make up 92% of all admissions at its 51 treatment sites across the Western Cape.

Most of those treated are male, at 73% of admissions, while 27% are female.

The latest admission data shows that tik, cannabis, alcohol and heroin (in that order) are the most common primary substances of use reported at treatment centres/ programmes.

Dr Hattingh says robust epidemiological information on substance abuse in South Africa is lacking, as is widely accessible intervention.

Around 30% of South African adults are reported to use alcohol, and 30 to 50% of users engage in harmful or hazardous drinking, often binge drinking over weekends.

One of the mitigations by the Western Cape Health Department is the First 1000 Days programme. Launched in February 2016, it focuses on the first 1 000 days of life – the time spanning roughly between conception and a child’s second birthday-a unique period of opportunity when the foundations of optimum health, growth, and neurodevelopment across the lifespan are established.

Assistant professor of maternal foetal medicine at the University of Michigan, Dr Courtney Townsel, says that while women can be educated about the short-term neonatal effects of opioid use in pregnancy, such as neonatal withdrawal, the long-term effects of opiate use in pregnancy are less clear.

“This is a new epidemic for us in America, so the data on long-term outcomes is not robust. Older studies have shown neurodevelopmental and behavioral problems in these children. Added to this are the complications that many mothers are using more than one addictive substance: tobacco, alcohol and other drugs.”

The Americans travelled to various sites across the Western Cape, including health and social care facilities, meeting representatives from NGOs and patient advocacy groups.

They also spent time with FASfacts, a non-profit organisation that educates communities on the devastating effects of alcohol on an unborn baby.

CEO and founder of FASfacts Francois Grobbelaar said the BOB programme makes use of experiential learning and life skills such as responsibility, self-esteem, respect and honesty are taught to the children from a very early age. “There is no such programme in American schools and the visitors would like to implement this programme,” said Mr Grobbelaar.

Dr Hattingh says “Saving Mothers and Children” is one of the six key focus areas of Rotary International.