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Amid the heroin crisis in the 1990s, Professor Ju Lee Oei was part of a team that established a world-first outpatient clinic in Sydney prescribing methadone to newborns exposed to opioids in the womb.
“In the past, if a baby was withdrawing and no one recognised it, they’d likely be sent home and die,” Oei, now a senior neonatologist at The Royal Hospital for Women in Sydney and the Mater Research Institute in Brisbane, says.
“These children often came from poorer parts of the community and were invisible.”
Methadone is a synthetic opioid that can substitute illegal drugs and serve as a treatment for people dependent on heroin or fentanyl.
It’s a life-saving intervention for many, including pregnant women and babies, that blocks cravings but doesn’t trigger the “high” of other drugs.
Treatment of opioid-exposed newborns has improved since the ’90s. But there are still urgent gaps in knowledge, including ways to address long-lasting effects of opioid exposure in infants, which can lead to difficulties with attention, anxiety, learning and impulse control.
Now, a group of researchers including Oei, scientists working in animal models, and people with real-life experience of drug use have come together to find new ways to improve the lives of babies exposed to methadone and other opioids.
Results from a new study have raised early hopes of a promising new treatment.
Giving birth on methadone
Jess Doumany began a methadone program after becoming dependent on heroin. About six months into the program, she fell pregnant.
“I’d lost my mum about six months prior, and my husband had [died by] suicide about 18 months prior to that. It was a really tumultuous time, but methadone really gave me my life and stability back. And obviously gave my body stability back for the fact I got pregnant,” says Doumany, who was living in the Northern Rivers at the time.
“But it quickly became apparent there were no resources or information specifically available for women in this position, in regional areas especially.”
Many of Doumany’s caregivers and midwives admitted they didn’t know much about opioid exposure. “It was only some of the older nurses who were around Lismore and Nimbin in the ’70s and ’80s, who had experience with heroin and knew a bit more.”
After Doumany’s son, Billy, was born, he required morphine-assisted withdrawal due to the methadone exposure. But Doumany says there was little consultation with her about the evaluation of his symptoms, and a lack of information and clear protocols regarding treatment.
“Two days before discharge, I had two males from child safety walk into my room while I was breastfeeding. Like, no knocking, no announcement, no nothing.
“According to them, the fact that Billy had withdrawals of any nature, even though it was from the methadone, constitutes a notification.
“And I was like, well, if that’s the protocol, then I would appreciate if someone had told me that, you know?”
The experience inspired Doumany to pursue a PhD at UNSW focused on improving support for mothers and babies impacted by perinatal opioid exposure, in part by bringing in the stories of people with real-life experience.
Part of what’s missing, she says, is a focus on babies’ health once they leave hospital, as well as follow-ups and wrap-around supports for mothers and their children.
That’s one of the reasons she’s excited about new research that could one day help mitigate potential downstream effects of prenatal opioid exposure.
Gut supplement tested in rats
Babies exposed to opioids in the womb go “off a cliff edge” at birth, says Associate Professor Kelly Clemens from UNSW’s School of Psychology.
“If you imagine going cold turkey with someone with a heroin dependence, you’re kind of doing the same thing with that infant … they can have seizures in the worst cases. Generally, they end up in the neonatal intensive care unit,” Clemens says.
Once weaned off opioids, developmental and behavioural issues may arise years down the track.
“What we now know is that their long-term health, especially mental health and cognition, is really impacted.”
The new study, led by Clemens and published in Translational Psychiatry, investigates sodium butyrate as a possible treatment for these effects.
It’s produced naturally in the gut upon the breakdown of fibre, helping to nourish a healthy microbiome, and it’s also one of the chemicals produced in the gut that travels to the brain.
“It really does span that gut-brain axis in the same way that opioids are involved in both gut and brain functions,” Clemens says.
The researchers tested sodium butyrate on pregnant rats. Some were also given methadone. The methadone-exposed pups proved more fearful and anxious than their counterparts and had some damage to brain tissue.
Those treated with sodium butyrate had less damage, better learning behaviours and were more curious.
“We were honestly surprised by how broad the improvements were,” Dr Isobel Williams, who led the experiments, says. “It wasn’t just one area; we saw benefits across memory, attention, and even brain structure.”
Real-life experience, real-life impact
The study in rats is preliminary and there is much more research needed before human trials. Sodium butyrate led to slightly worse outcomes in rats not exposed to methadone, underscoring the need for greater scrutiny and further study.
But the researchers are excited about the prospect of a first-of-its-kind long-term treatment for babies exposed to opioids.
“Treatments like methadone are life-saving, and they make a huge difference,” Clemens says. “We’re just thinking about how we can better support that journey so that the outcomes for everyone are more positive.”
Doumany and the UNSW scientists say insight from people who have real-life experiences with drug dependence and treatment keeps research squarely focused on real-life impact.
“What’s really exciting about this research – and it’s early because it is at the stage of animal models – is that it confirms the relationship or axis between gut health and mental health,” Doumany, who didn’t work on the research directly but is working with the UNSW team on other studies, says.
Doumany is also the Director of Research at the Australian Injecting and Illicit Drug Users League (AIVL), which co-developed a first-of-its-kind national research strategy for and by people who use drugs.
“It’s about establishing our own ethical standards and protocols,” she says.
“It doesn’t make sense that we’ve got people who have never used drugs, who aren’t part of our community, setting research priorities.
“Our community needs to be involved every step of the way.”
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Angus Dalton is the science reporter for The Sydney Morning Herald.Connect via X or email.From our partners
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