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Recovery from opioid addiction presents a considerable challenge in any situation, but pregnancy creates complications that can often seem overwhelming. One of the ways addiction persists is by convincing you that you aren’t hurting anyone but yourself. With a baby on the way, however, you can’t afford to think this way. For the safety of yourself and your child, your next step should be to educate yourself on your options for treatment and recovery for opioid addiction during pregnancy.
Methadone is one of the most effective medications available for medication-assisted treatment (MAT) programs treating opioid use disorders. Methadone is an opioid agonist, which means it binds fully to the receptors activated by drugs like heroin in a similar way. However, methadone has a significantly longer half-life than heroin or other opioids meaning it lasts much longer and is effective in managing the physical symptoms of withdrawal for 24-36 hours when administered at a therapeutic dose. It also has some opioid blocking properties which limits the euphoric effects of other opioids taken when a patient is in a MAT program.
Methadone also alters the response to pain in your brain and nervous system. This helps reduce the painful symptoms associated with opioid withdrawal. A MAT program gives patients safe access to methadone in a clinic setting. The medication is dispensed under medical supervision and in a wafer or liquid form. Methadone for opioid addiction is not dispensed in a pill form. Early in recovery, patients will attend the clinic each day to receive their medication. This provides much needed structure early in recovery. This system, called methadone maintenance, reduces the potential for misuse while shielding the patient from the worst of opioid withdrawals.
MAT using methadone is one of the most effective forms of treatment available to those struggling with opioid addiction, including expecting mothers.
The highest priority when seeking opioid addiction treatment during pregnancy is ensuring the safety of the baby. For that reason, many expectant mothers hesitate to investigate methadone maintenance treatment options fully. MAT is widely misunderstood, with many people believing that these programs are “substituting one drug for another.” This concept is far from the truth, and understanding the relationship between methadone and pregnancy will help you make the best decision for you and your baby.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), methadone is safe for pregnant women combating opioid addiction. MAT has been used to treat pregnant women since the 1970s. In 1998, the American Society of Addiction Medicine (ASAM) and American College of Obstetricians and Gynecologists (ACOG) established MAT programs as the best practice treatment for pregnant women with opioid use disorders.
Methadone does have potential negative side effects for the baby, but it’s important to remember that they are nowhere near as likely or dangerous as the effects of the most commonly-misused opioids. The risks associated with methadone treatment are minuscule compared to the harm from your baby being exposed to prescription or illicit drugs that are taken in unmanaged doses more frequently than once a day.
It’s significantly more dangerous to continue using opioids than to begin or continue treatment with methadone. Some expectant mothers believe that prescribed painkillers are less dangerous for babies than opioids like heroin. It’s easy to think that because your doctor wrote a prescription, the drug has less potential to do harm. This misconception has led to a massive increase in the number of women diagnosed with opioid use disorder during labor and delivery.
Between 1999 and 2014, the number of women found to have opioid use disorder at labor and delivery more than quadrupled from 1.5 per 1,000 hospital deliveries to 6.5. Those who become dependent on prescribed opioids during pregnancy often take them for the acute pelvic and lower back pain so many women experience during pregnancy. Others may find they become pregnant while already struggling with a previous addiction. Either way, the effects of prescription opioids on pregnancy and birth are no different than those of non-prescription drugs. Effects on newborns include:
This suite of problems at birth is the most common and is called neonatal abstinence syndrome (NAS). NAS occurs when a mother who has been taking opioids or another drug stops for long enough to cause the baby to go into withdrawal. Here are some of the long-term issues prenatal opioid exposure and NAS create:
The more potent the drug and the longer you take it, the more likely your baby is to be born with NAS. Depending on severity, NAS can cause severe malnutrition and cognitive issues in a newborn. If the drug abuse is significant enough, the baby may even die before it is born.
Continuing to misuse an opioid, prescription or otherwise, during your pregnancy is guaranteed to lead to the worst outcomes for your baby. Opioid addiction and pregnancy simply do not mix. In contrast, methadone maintenance treatment is a time-tested tool with minimal risks that can prevent the worst effects of NAS.
Many expectant mothers have concerns about continuing methadone while pregnant. It may seem desirable to taper off before the birth of the baby, but detoxing from methadone while pregnant is more complex than you might realize. Here are three of the most common questions about stopping methadone during pregnancy:
Most women are concerned about detoxing from methadone due to possible effects on their ability to breastfeed once the baby is born. According to SAMHSA, the amount of methadone that transfers from the bloodstream into breast milk is negligible. The benefits to the baby from breastfeeding generally outweigh the effects of the minuscule amount of methadone transferred. Risk can be minimized by scheduling breastfeeding times since peak methadone levels occur two to four hours after taking the medication.
Quitting methadone while pregnant is dangerous in two ways. For the baby, reduction in methadone dosage can lead to withdrawal symptoms and NAS in your baby even if you don’t feel the symptoms yourself. Quitting cold turkey will definitely cause perceptible feelings of discomfort for you, and increase your baby’s chance of more severe NAS symptoms. Attempting to stop cold turkey also vastly increases your chances of misusing opioids again, a risk too dangerous to take during pregnancy.
Mothers who are thinking about detoxing from methadone while pregnant are often concerned that methadone treatment will cause harm to their babies. Studies have not shown methadone to increase the chance of birth defects or complications during pregnancy. There is a chance of your baby developing NAS after birth, but the risk and severity are much lower than with drugs of abuse. The side effects of methadone in pregnancy are negligible compared to what you would experience with heroin, oxycodone or any other opioid.
Stopping methadone maintenance treatment during pregnancy is not recommended, as the resulting withdrawals increase the risk for you and your baby even when the symptoms feel mild. Continuing your treatment program under your doctor’s supervision is the best way to increase your chances of a healthy birth.
There’s no question that MAT with methadone is a safe option for opioid addiction treatment during pregnancy. But even with this knowledge, you may be nervous trying to imagine what one of these programs involves. Health Care Resource Centers (HCRC) is a leading treatment provider with a highly effective methadone maintenance treatment program. We offer a process that is both individualized and effective for pregnant women. Though the overall structure is simple, we take care to make each step more approachable.
Once you’ve decided to begin an MAT program, the first thing you’ll have to do is complete intake appointments. You need both a physical and psychological evaluation to lay the foundation for the course of your treatment. In many cases, your treatment center will schedule the two evaluations together or back-to-back for your convenience.
In the physical evaluation, your doctor will perform a physical examination including a drug screen. It’s important to get a baseline idea of your health as well as the concentration of opioids in your blood before dispensing medication. In the case of pregnancy, your doctor will want to get up to date with any information you have received about the health of the baby so far. Don’t forget to include any supplements or medications you are taking to ensure minimal complications.
Your psychological exam will include a report of your history with opioid misuse and addiction, and the more detail you can give, the better the counselor will be able to help you plan for treatment. With pregnancy, the immediate goal for treatment is to continue adhering to the program up until and through birth, but your counselor will work with you to establish further long-term goals.
Medication is the foundation of an MAT program, and you will receive methadone daily on-site. Methadone is highly regulated and can only be dispensed in licensed facilities by a physician or nurse practitioner. The amount you receive will be informed by the results of your physical screening and level of addiction.
In the last trimester of pregnancy, your metabolism is likely to increase, which means you may actually require more methadone to remain stabilized. Your doctor will carefully monitor your methadone levels to minimize the risk to your baby while ensuring you still get the benefits of MAT.
Medication alone is not enough to meet long-term recovery goals. In combination with more comprehensive counseling and education, however, MAT becomes a powerful tool against addiction. In a quality MAT program, your counselor will help you learn valuable coping skills that last a lifetime, as well as a variety of resources to help support you in long-term recovery. You’ll also gain a comprehensive understanding of how your treatment works on your brain, allowing you to take better control of your healing process.
Giving birth while successfully participating in an opioid addiction treatment program is something to be proud of, but your journey doesn’t end there. There are two main things to attend to after delivery:
After delivery, you may wish to start tapering off methadone and maintaining sobriety without the assistance of medication. It’s crucial to discuss this decision with your doctor, and it may not be a good option if your physician feels you haven’t stabilized completely. A period of one year is usually the recommended minimum treatment length for a methadone maintenance program, but many individuals find it takes longer to stabilize to the point of tapering off.
From the initial appointment to the variety of counseling options we offer, HCRC strives to provide the most effective, compassionate treatment that we always tailor to the individual. Our commitment to improving your quality of life extends to your pregnancy, and our programs are designed to help you succeed in every way possible with compassion and quality care. All of our programs have received state licensure, federal certification and three-year accreditations by the Commission on Accreditation of Rehabilitation Facilities (CARF).
Your choice to prioritize the health of your baby and get treatment for opioid addiction is a weighty one, and you deserve to understand all the details of your options. Questions and concerns are a given in this situation, and at HCRC, we believe the best outcomes stem from the best education on treatment. If you’re ready to learn more about the next steps in addiction treatment during pregnancy, please reach out to us via phone or contact form.
You can request to speak with a certified medical professional who understands the difficulties of recovery and can address your concerns in detail. Don’t hesitate to honest and straightforward with our compassionate staff members. HCRC is here to help.
