Nearly any pregnant woman will tell you that she wants the best for her unborn child. For many mothers-to-be, this means giving up smoking and drinking, recreational drug use or limiting caffeine. For some mothers, this means starting a methadone treatment program.
What is methadone?
Methadone, also known by the brand names Diskets, Dolophine and Methadose is a narcotic pain reliever and a synthetic opiate derivative. Methadone is often compared to the drug morphine and is commonly used as part of a drug detoxification or maintenance regimen. Methadone is known to reduce symptoms of withdrawal in patients who are addicted to drugs such as heroin or opiates.
Methadone is the drug of choice when treating addiction because it is able to lessen the effects of withdrawal without giving the patient the same “high” they would normally get from the drug they would typically use. Methadone use is not taken lightly, and patients must meet certain criteria in order to be considered a candidate for methadone treatment. Additionally, once they are on a methadone treatment plan, patients must adhere to guidelines, as well as check in with their doctors on a regular basis and submit to random drug tests to ensure they aren’t still using illicit drugs. Many caregivers will also require the patient to participate in therapy in addition to the methadone treatment program.
Detoxing during pregnancy without methadone
It can be easy for someone to say “Just stop using,” or “just quit,” to a pregnant woman struggling with addiction or dependence. In fact, she may even face criticism and verbal abuse for her inability to do so. An addiction to heroin or opiates isn’t something that can be stopped abruptly. In fact, if the mother detoxes during pregnancy without the use of medications such as a methadone, she could suffer symptoms such as anxiety, irritability, sore and aching muscles, crying, teary eyes, sweating, abdominal pain and cramping, fever, diarrhea, pupil dilation, nausea and vomiting and seizures that could be life threatening. Withdrawal, on its own, can be horrific, but withdrawal while pregnant can be even more horrific, causing distress on the child and greatly increasing the likelihood of miscarriage or fetal death.
Methadone and pregnancy
Pregnant women have been treated using methadone for over 25 years. For women who were struggling with addiction to heroin or opiates prior to becoming pregnant, methadone can be a much safer alternative for themselves and their developing baby. Making the choice to undergo methadone treatment while pregnant is controversial, but for many women and their babies, it is the healthiest and safest option available.
This isn’t to say that methadone during pregnancy is without risk. Babies born to mothers on methadone don’t always show signs of exposure but among those that do, the most common issues include a smaller-than-average head circumference, lower birth weight and withdrawal symptoms. Fortunately these effects are rarely long-term and most children born to mothers on methadone will fall within the normal ranges for growth and development.
There is no ideal dosage to use during pregnancy, and the dosage needed may vary greatly from woman to woman. Research indicates that there is no connection between the dosage of methadone that the mother is on, and the severity of withdrawal the baby experiences while born. Many patients mistakenly believe that the less they take the better, but if she is feeling withdrawal symptoms, so is the baby and the dosage may need to be increased. It is not uncommon for the dose of methadone to be increased throughout pregnancy due to the woman’s increasing weight and blood volume. A dose that worked for her at a certain weight may not continue to work for her once she’s gained twenty pounds.
Many pregnant women suffer from guilt over taking methadone while pregnant, feeling as though they aren’t doing what is best for their child, when in reality, methadone treatment may be the best option. Without methadone treatment, the mother could experience severe withdrawal that could end in miscarriage or fetal death, or she may be unable to stop herself from using the drugs she used prior to beginning treatment. Most physicians believe it is too risky to attempt to wean a patient off of methadone while pregnant and will not recommend doing so until after the child has been born. And the Center for Substance Abuse Treatment agrees, stating, “Medical withdrawal of the pregnant women from methadone is not indicated or recommended.” Methadone is easier for the mother to wean off of than it is to quit using drugs and is recognized by the medical community as an acceptable treatment option for addiction, comparable to the use of Suboxene. The woman can continue a methadone treatment plan even after she’s given birth and begin tapering down when she feels she is ready and able to do so. Continuing a methadone treatment program also increases the chances of the mother staying clean after she has given birth. Using methadone will not affect her ability to parent, as she is not “high” like she would be with narcotics and heroin.
Moms who choose to undergo a methadone treatment program during their pregnancy often face scorn and criticism for not just quitting “cold turkey,” despite the evidence that abruptly discontinuing these drugs could have serious complications. Many women are accused of using methadone as a “crutch.” Kristi, a mother who underwent methadone treatment while pregnant responds, “What’s the alternative? She’s not walking around high on methadone. She’s not on the streets. She’s taking her dose once a day, usually in a controlled environment like a methadone clinic. Then, she goes about her day just like anyone else does. Everyone has a crutch if you want to look at it that way. I see [methadone] as a treatment for a medical condition, which is what addiction really is.” Choosing to undergo a methadone treatment program can be difficult, and many pregnant women struggle, especially if they lack support from their family members and friends. There are many websites and online communities dedicated to mothers on methadone. Kristi exclaims, “The ladies on the forums were lifesavers. I don’t know how I would have done it without them. The amount of support and information available was incredible.”
Newborns and methadone
Methadone, like any drug, carries some risk to the unborn child and the extent of adverse effects from the medication cannot be determined until the child is born. As stated previously, babies born to mothers who underwent methadone treatment while pregnant may have a smaller-than-average head circumference, be low-birth weight or they may experience neonatal withdrawal syndrome.
A newborn experiencing withdrawal may exhibit symptoms such as shallow and rapid breathing, frequently sneezing and yawning, high muscle tone, intense and prolonged crying and gastrointestinal issues. When these symptoms are present, the baby will need to detox and go through withdrawal, just as an adult undergoing treatment would need to.
Allowing the baby to detox in a supervised and controlled environment, such as a hospital, will greatly reduce the chances of the baby experiencing any unnecessary stress or pain. If the baby is not supervised or medically aided during their detox period, the baby could suffer greatly and may experience dehydration, diarrhea, jaundice, respiratory difficulty and seizures.
In most medical facilities, the infant will be weaned from the methadone using short-acting medications such as morphine, which will help ease the symptoms of withdrawal. The length of time an infant needs to detox varies from baby to baby; some may only need a few days, while others need a few weeks.
Babies born to mothers being treated with methadone are still able to be breastfed. Dr. Hale, author of “Medications & Mother’s Milk” classifies the lactation risk category as L3 (the same classification as over-the-counter Aleve or naproxen) while the American Academy of Pediatrics labels it as “usually compatible with breastfeeding.” Most medications with a relative infant dosing of less than 10% are considered safe, and drugs even as high as 20% are often still considered safe. Methadone has a relative infant dose of 2.8%.
Methadone is an option for pregnant women
In a perfect world, pregnant women wouldn’t need methadone, but they also wouldn’t need inductions, antibiotics or cesareans. Methadone treatment isn’t part of the ideal textbook pregnancy, but for women struggling with addiction or dependence, methadone can help increase the likelihood of a positive outcome for her and her baby.
References
Methadone & Pregnancy
Methadone Therapy for Opioid Dependence
Methadone
Methadone Information
