Management of Marijuana Use in a Pregnant Woman on Abilify and Wellbutrin
Behavioral interventions are the first-line approach for helping pregnant women quit marijuana use, as they substantially improve abstinence rates while posing minimal risks to mother and fetus. 1
Assessment and Initial Approach
- Evaluate the patient's pattern of marijuana use, reasons for use (recreational, self-medication for symptoms, or substitution for other substances)
- Assess for co-occurring mental health conditions that may be managed by current medications (Abilify/aripiprazole and Wellbutrin/bupropion)
- Continue prescribed medications (Abilify and Wellbutrin) throughout pregnancy to maintain mental health stability 1
First-Line Treatment: Behavioral Interventions
Behavioral interventions have demonstrated substantial effectiveness for substance cessation in pregnant women with minimal risks:
Intensive behavioral counseling: Provide at least 4 sessions over 12 weeks 1
- Include skills training, motivational interviewing, and social support
- Focus on practical problem-solving strategies for marijuana cravings
- Address underlying reasons for marijuana use (anxiety, nausea, etc.)
Cognitive Behavioral Therapy (CBT) and Motivational Interviewing (MI) have shown the most promise for decreasing cannabis use during pregnancy 2
Contingency Management (CM): Consider implementing a rewards-based system for verified abstinence, as this has shown effectiveness for substance use disorders in pregnancy 3
Follow-up and Support
Schedule regular follow-up appointments at minimum 12-week intervals
Provide education about the risks of marijuana use during pregnancy:
- Potential adverse effects on fetal development
- Risk of preterm birth and low birthweight
- Possible long-term neurodevelopmental effects
Consider referral to specialized addiction services for pregnant women
Arrange for social support resources and connection with peer support groups
Important Considerations
Avoid pharmacotherapy specifically for marijuana cessation in pregnancy: The USPSTF concludes that evidence on pharmacotherapy interventions for substance cessation in pregnant women is insufficient, and the balance of benefits and harms cannot be determined 1
Maintain current psychiatric medications: For women with mental health conditions, continuing prescribed medications (Abilify and Wellbutrin) is generally recommended as the risk of untreated mental illness may outweigh potential medication risks 1
Address potential stigma: Pregnant women using cannabis often report experiencing stigma from healthcare providers, which can impede treatment-seeking 4
Treatment duration: Longer treatment duration (4-12 months) is associated with better outcomes for cannabis use disorder treatment in pregnant women 5
Pitfalls to Avoid
- Inadequate behavioral support: Brief interventions alone are insufficient; provide comprehensive behavioral therapy
- Ignoring underlying reasons for use: Many women use marijuana for symptom management (nausea, anxiety); address these symptoms with evidence-based alternatives
- Stigmatizing approach: Avoid judgmental language that may discourage the patient from seeking continued care
- Neglecting mental health needs: Ensure that discontinuation of marijuana doesn't worsen underlying mental health conditions being treated with current medications
By implementing intensive behavioral interventions while maintaining the patient's current psychiatric medication regimen, you can optimize the chances of successful marijuana cessation while supporting both maternal mental health and fetal development.