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A lot of misinformation and stigma surrounds the use of methadone as treatment for opiate addiction, but the problems are even more apparent when the patient in the treatment program is pregnant. Methadone, the most common treatment for opiate addiction in the United States, is a synthetic opioid that can ease withdrawal symptoms for dependent persons without creating a “high.” Typically, patients at methadone clinics will visit at least once a day to receive a prescribed dose of methadone, often in liquid form. Over time, patients may be allowed to take doses home and many are eventually weaned off the treatment. The goal of methadone treatment for pregnant women is to help them avoid the negative consequences of illicit drug use, including overdose and withdrawal, both of which can jeopardize the pregnancy.  Without having to worry about illicit drug use, a woman is in a better position to engage in prenatal care.

Katie Clark, a research assistant at the Yale School of Public Health, began to notice the stigma surrounding pregnant women through her work at an opiate treatment center. “While I was working as a counselor I started to tailor my caseload to work with predominantly pregnant and parenting women. They shared with me that they were looked down upon, by other people in their lives and people in treatment, because they were in methadone treatment during pregnancy. Even though medically, they were doing the best thing for themselves and their pregnancies, this was not the message they were getting from those around them.”

As Katie explains, even within hospitals and drug treatment programs, pregnant women are often judged for methadone use. “People see an infant in withdrawal and start making comments like ‘how could you do this to your baby.’ In one case, a social worker tried to charge a mother with child abuse because she was in treatment during her pregnancy.”

Just as women are cautioned against alcohol use while pregnant, many people assume that women should immediately stop using opiates as well, but actually, quitting opiates can be very dangerous. “Opiate withdrawal can jeopardize the health of the baby and the mother and even cause miscarriages,” says Katie. “Methadone has been used as treatment for pregnant women for 30 years to keep mothers and babies stable during pregnancy.”

In her work, Katie also challenges that myth that babies are “born addicted” to opiates. “There is no such thing as a baby born addicted to opiates, but babies with opiate-dependent mothers can show withdrawal symptoms once they are born, such as diarrhea, stiffness, or not eating or sleeping well,” says Katie. “A baby experiencing withdrawal is usually kept at the hospital and, if clinically indicated, put on medicine to make them comfortable. Doctors will keep the babies in the hospital until they are weaned off the medicine.”

Katie created a website, to answer questions about methadone, pregnancy and opiate addiction. “Ideally I’d want more people to be trained on how to work with pregnant women in methadone treatment. There is a lot of stigma and misunderstanding about this population and that can lead to poor health outcomes. If we can educate people more, it will lead to better health outcomes for mothers and infants.”

Voices from the Harbor is an audio documentary Katie created about women’s experiences with pregnancy, opiate addiction and methadone treatment. In the documentary, four women speak of their experiences with addiction, pregnancy, stigma and recovery. Visit to hear their powerful stories.

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Comment Preferences

  •  I know a woman (1+ / 0-)
    Recommended by:
    historys mysteries

    who had addiction problems - opiates and alcohol.

    When she became pregnant - she quit.  She was so strict she wouldn't even take aspirin.

    We were concerned her quitting cold turkey would hurt the baby and encouraged her to seek help - she said no.

    THe baby turned out fine and so did she - we lost touch a bit but it's been about 17 years that she's been clean.

    For her the stigma was within her own self.

    The care of human life and happiness, and not their destruction, is the first and only legitimate object of good government. - Thomas Jefferson

    by ctexrep on Tue May 01, 2012 at 11:58:36 AM PDT

  •  Opiate substitution in pregnancy (1+ / 0-)
    Recommended by:
    historys mysteries

    Thank you for bringing this topic to Daily kos.  With at least one million opiate addicts in the US (many receiving methadone), this is a significant problem.

    An important issue in giving methadone to a pregnant woman is the effect of the opiates on the fetus.  Opiates are remarkably non-toxic (do not kill cells), so the biggest problem is that the infant is born addicted to opiates.  This is generally treated by keeping the infant in the hospital while s/he is gradually weaned off the opiates and observed.  To date, no further ill effects have been observed in the children born to women receiving methadone.  However, long-term studies to follow such children over years have not been done, so we know very little about the long-term sequalae of being born to a mother receiving methadone.

    As you point out, the alternative to treating an opiate addiction in a pregnant woman is to try and get the woman to stop using opiates.  While many addicted mothers are willing to try this, the reality is that most continue to use opiates and other drugs.

    Given the choice between having the addicted mother treated with methadone or having her continue to use drugs (with the attendant risks of withdrawal, overdose, and toxic aditives to street drugs - all of which are health problems for mother and fetus), methadone  treatment is clearly the preferred option.

    One more point: I worked for a number of years with a treatment center in NYC that had a residential methadone program for pregnant women.  The women lived at the rehab for the duration of her pregnancy and many months thereafter.  They received methadone, counseling and supportive services, pre-term health care, regular nutritious meals, and a supportive atmosphere with other pregnant addicts.  Most remarkably, the women AND their new-borns continued in treatment in the rehab for a number of months after mom and baby returned from the hospital, so that mom could receive the full treatment she needs while being available to her child.  The rehab had some data on the childrens' health and mothers success with addiction treatment.  I do not know if the program still exists today.  It was of course expensive, and paid for primarily with state funding.

    Considering that not treating the addicted pregnant woman can result in abandonment and addiction in the children born to these mothers, even expensive treatment ends up being less costly over the long term.

    Thanks again for writing about this important issue.

    "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

    by Hugh Jim Bissell on Tue May 01, 2012 at 04:27:53 PM PDT

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