Seychelles develops policy to deal with pregnant mothers on heroin |18 October 2019

Dr Herminie

Untreated opioid use disorder during pregnancy can have devastating consequences for the unborn baby,including stunted growth, miscarriage, premature births and infant withdrawal from the drugs.

Statistics have shown that over 50 women were admitted in the maternity ward with heroin use in 2018 alone.

With the Ministry of Health recording a dramatic increase in the number of pregnant women displaying dependence on opioid (heroin), the ministry has approached Apdar (Agency for the Prevention of Drug Abuse and Rehabilitation) to develop a policy to manage and treat pregnant women with opioid use disorders.

The policy, which Dr Patrick Herminie, secretary of state for Prevention of Drug Abuse and Rehabilitation, described as a clinical guideline, was developed with the help of the United Nations Office on Drugs and Crime (UNODC).

“The Ministry of Health has also noted that there has been an increase in the country’s infant mortality rate and this has been associated with mothers who take heroin that are mixed or ‘cut’ with various other substances such as rat poison. This has an adverse effect on the foetus,” Dr Herminie explained.

“Because there are no comprehensive treatments for them, the pregnant women cause a lot of difficulties on the maternity ward; they bring in drugs, sometimes sell the drugs on the ward itself, escape to go get their fix or even abandon their babies at the hospital. They even sometimes fail to provide proper post-natal care such as immunisation.”

Moreover, the ministry has noted a disturbing rise in premature babies as well as a rise in miscarriages which occur in the first trimester.

Infants of the opioid users often suffer from neonatal abstinence syndrome (NAS) which occurs when an infant becomes dependent on opioids or other drugs used by the mother during pregnancy. The infant experiences withdrawal symptoms that can include tremors, diarrhea, fever, irritability, seizures and difficulty feeding.

As they grow up, these children have to face various developmental issues, learning difficulties and other conditions such as Attention Deficit Hyperactivity Disorder (ADHD).

Dr Herminie explained that the policy was borne out of the necessity to deal with this “massive public health challenge”.

Four recommendations were made in this policy or guideline to deal with the heroin dependent pregnant women who often neglect to attend ante-natal care programme in clinics.

“As is the case over the world, the ministry recognises that people who are dependent on heroin or methadone do not like to go to general clinics or hospitals because of stigmatisation and discrimination,” Dr Herminie explained.

Pregnant women who come for the ante-natal care at clinics will be proposed to do a drug test which will include a questionnaire developed by Apdar and urine drug screening.

If they are tested positive for opioid, they would be referred to Apdar specialists in order to determine if they are dependent on heroin and once that has been established they will be treated with methadone and buprenorphine.

Even though methadone and buprenorphine are opioids that are used for opioid maintenance therapy, Dr Herminie stressed that they are pure opioid unlike heroin and therefore are released as a stable agent in the body.

He further added that their effects are less severe on babies than heroin that re mixed with other damaging substances.

The policy also details out the treatments that will be given to the opioid-dependent newborns who suffer from neo-natal syndrome.

“Pregnant women who are heroin addicts are considered as a “special population” and they cannot be treated like other pregnant women who are more rational. You cannot tell them to go to the Anse Aux Pins district because they won’t go.”

For this reason, pregnant women will undergo treatment at the medication assisted treatment (MAT) clinic which Apdar is already making use of to give out methadone treatments, provide psycho-social counselling, urine screening and register new cases of heroin addiction.

“We have reserved as space at the MAT for these pregnant women whom we will have to follow closely.”

There would also be an outreach group which surveys ‘ghettos’ to identify vulnerable drug addicts and bring them to the MAT to conduct pregnancy tests since some of them might not even know if they are pregnant.

For those on the methadone programme, the Ministry of Health is working on introducing a contraceptive implant which will avoid unwanted pregnancies.

Apdar has also proposed to provide them with their HIV/AIDS medication, if they have the disease, which they will have to take daily when they come to take their methadone.

These are expected to start next year following the training of doctors, nurses and other personnel who will have to deal with the pregnant women.