Buprenorphine/naloxone, an opiate substitution medication, is not recommended for use by pregnant patients, yet Irish doctors working in addiction services are prescribing the drug to pregnant patients due to a shortage of a potentially safer alternative
A medication shortage is causing Irish doctors to prescribe opiate-dependent patients with a drug that may be hazardous to their child, IMT has learned.
Doctors working in addiction services and General Practice are prescribing buprenorphine/naloxone to pregnant, opiate-dependent people instead of buprenorphine alone, the recommended safer alternative, as pharmacies cannot get the latter medication recently.
The recent media focus on OTC codeine misuse and dependence has increased awareness of the problem and increased demand for treatment. Buprenorphine is often the preferred Opiate Substitution Treatment medication in such cases.
Buprenorphine/naloxone is a combination medication used to treat patients suffering from opioid dependence. It contains buprenorphine, an opioid medication; and naloxone, which reverses the effects of opiates. The naloxone component is present to discourage intravenous use of the tablets. Its safety has not been established in pregnancy.
Naloxone is not recommended for use by pregnant patients except in emergency situations where it can be lifesaving. Children born to patients who took naloxone during pregnancy may experience neonatal opioid withdrawals.
One doctor who works with opioid-dependent patients told IMT he believes that pregnant people, a small but very vulnerable cohort impacted by the shortage, have been forgotten about somewhere along the supply chain.
“No-one seems to care,” said the doctor, who wished to remain anonymous. “Prescribers are being put in a very difficult situation here; what if something happens to these patients’ babies after a doctor has prescribed this drug? It’s not the first time such shortages of Buprenorphine, caused by bureaucratic SNAFUs, have occurred in Ireland.”
Ireland had an estimated 19,875 problem opioid users aged 15-64 in 2019, according to a report published in October by the Health Research Board. Women represent just over a quarter (27.7 per cent) of all problem opioid users, the same report found.
These figures, however, focus mainly on heroin users and may not consider the often hidden but significant numbers of codeine-dependent patients. A spokesperson for the HSE told IMT that pharmaceutical company Indivior have confirmed additional stock will be shipped from the UK to arrive in Ireland ‘in the coming weeks.’ The spokesperson added that the HSE is in regular contact with the company to ensure that access to the medication is available.
There was no explanation as to why the repeated shortages of this essential lifesaving medication have occurred in Ireland.
