Methadone Treatment and Pregnancy
Methadone is a medication used to treat withdrawal symptoms in patients who are addicted to narcotics, such as heroin. It is an effective choice since patients can use it during detoxification or for long-term maintenance without experiencing the “rush” or “high” they would get if they were taking their drug of choice.
Along with treating heroin addiction, methadone can be used to treat addiction to other opioids, including fentanyl, hydrocodone, morphine and oxycodone. It’s distributed to patients from specific, certified pharmacies.
Heroin Use on the Rise in the United States
In the 1960s, a person addicted to heroin was likely a young man who started using in his mid-teens. He would probably be from a low-income urban area, and heroin would be his first opioid.
Fast forward 50 years or so, and the face of someone who has a substance abuse issue with heroin has completely changed. The Centers for Disease Control and Prevention (CDC) prepared a report in which it released the following facts and statistics:
- The National Survey on Drug Use and Health (NSDUH) reported a significant increase in the rate of heroin use, abuse and dependence over the past several years. An estimated 517,000 respondents stated they either abused heroin or were dependent on the drug during the past year, according to figures collected in 2013. This number represents close to a 150 percent increase since 2007.
- The largest increase among respondents reporting they had used heroin within the past 12 months was among young people between 18-25 years of age, particularly during the years of 2002-2004 and 2011-2013.
- The results of the survey also indicated that the percentage of heroin users who had an opioid pain reliever abuse or dependence issue increased from 20.7-45.2 percent in the period from 2002-2004 and 2011-2013. By the latter time period, opioid pain reliever abuse or dependence was a more common issue among those who used heroin than those who had experienced alcohol, cocaine or marijuana abuse or dependence.
The CDC report revealed one more fact that was particularly striking: Heroin use doubled in women and more than doubled among the non-Hispanic white population. Both of these groups traditionally had lower rates of heroin use than other segments of the general population.
The survey points to lower prices and increased availability for heroin as reasons why the drug is becoming more popular among young people.
Addiction Recovery Using Methadone Treatment
Methadone is a synthetic opiate, which means it is made in a laboratory. Natural opiates, such as morphine, codeine and opium, are derived from the opium poppy. Like its natural counterparts, methadone works on the brain by acting on opioid receptors.
Methadone is different from heroin in that it does not produce a rush of elation when ingested due to its slow onset. Its effects are long-lasting when taken as directed.
Methadone is used for addiction recovery from opiates because people can take this medication without becoming “high” or experiencing the sedating effects of an opioid drug. Taking methadone is a way to ward off the cravings that go along with withdrawal from opiates.
Suppressing cravings is only part of the recovery process, though. From there, clients in addiction recovery treatment need to learn how to function in life without drugs. Methadone therapy is meant to be offered in conjunction with supportive counseling services as part of an addiction treatment program.
Methadone Treatment During Pregnancy
When looking at methadone treatment during pregnancy, it’s important to remember that in a number of instances, a woman is living with substance abuse before she becomes pregnant — and that the pregnancy may not have been planned. Whether the pregnancy was intended or not, both mother and child deserve the best possible care for their health.
If pregnancy isn’t planned or expected, it’s possible for a woman who is using opioids or other drugs to miss the symptoms of early pregnancy. They may interpret symptoms such as fatigue, headache, mild cramping, nausea or vomiting as withdrawal symptoms.
For women who have irregular periods, missing one or more cycles may not immediately raise a red flag that they are pregnant. They may attribute it to stress, exhaustion or poor nutrition.
Some women using opiates, such as OxyContin, oxycodone or heroin may find that they stop getting periods altogether. They may interpret this as a sign that they are unable to conceive, when they may, in fact, be pregnant. It’s also possible to have some spotting in early pregnancy that can be misinterpreted as a lighter-than-usual period.
Rather than assuming anything regarding reproductive health matters, a better option is to make an appointment to see a doctor when one or more menstrual periods are skipped. It’s important to have good prenatal care early on if pregnancy has occurred and to have reliable birth control if it hasn’t.
Risks of Methadone Use During Pregnancy
When a woman who has been taking methadone finds out that she is pregnant, it is only natural that she will wonder whether this treatment is safe for her baby. Methadone has been used for a number of years to successfully treat recovering addicts for opiate addiction, and it has not been linked to any birth defects.
However, methadone use during pregnancy does carry with it certain risks. Pregnant women will need to discuss their methadone program with their doctor, and it’s important they are aware of the possible side effects of methadone use during pregnancy, including:
- Low birth weight
- Smaller than normal head size for the newborn
- Withdrawal symptoms in the newborn
Other health and lifestyle choices can cause the same or similar symptoms in a newborn as well. Methadone is only one factor that can affect the size and appearance of a baby. Other drugs can lead to withdrawal symptoms at birth.
Whether or not a pregnant woman smokes has an effect on birth weight, for example. The amount and quality of the food she eats also helps to determine whether the baby is able to attain a healthy weight at birth.
There is no correlation between the mother-to-be’s dose of methadone and whether the baby will experience withdrawal symptoms at birth. Logic would seem to dictate that women on higher doses of methadone would tend to give birth to babies who are at higher risk for going through withdrawal, but this is not the case.
Potential Danger of Methadone Use on the Child
While there aren’t proven birth risks associated directly with methadone, as with any medication or drug, there are possible side effects.
Some, but not all, babies born to mothers undergoing methadone treatment go through withdrawal after being born. Whether a baby goes through withdrawal is not an indication that the infant was “born addicted.”
Withdrawal symptoms in infants generally begin between two and four days after birth but may not start for between two and four weeks after the child is delivered. Once the symptoms start, they may last for several weeks. Withdrawal symptoms include the following:
- Fussiness and restlessness
- Not eating well
- Not sleeping well
If these symptoms are severe, a doctor can prescribe medication to make the baby feel more comfortable until the withdrawal symptoms have resolved.
Risk of the Child Developing an Addiction
Does using methadone in pregnancy increase the likelihood that a child will grow up to be an addict?
Very few scientific studies have looked at whether being born dependent on methadone was directly related to being an addict later in life. There is a genetic factor at play that does influence whether someone becomes an addict, but it is just one of the things that goes into the “soup” to determine whether a particular person turns to drugs or alcohol.
If genetics was the entire explanation of why someone becomes an addict, you would find entire families of addicts, without exception, but that is simply not the case. In a family unit, you may find some people who are severely addicted to drugs, while others abstain completely. In families where there is a history of drug addiction or one or both parents are addicts, there is a higher risk that a child will become an addict at some point in life — but it’s not a guarantee.
Breastfeeding and Methadone Use
Methadone will transfer to a baby through a mother’s breast milk. Mothers who were being treated with methadone throughout pregnancy will likely still be encouraged to breastfeed, as long as they are not using street drugs.
Breastfeeding can help to decrease methadone withdrawal symptoms in infants, but it won’t eliminate them all together. According to the results of some studies, having mothers breastfeed their babies resulted in shorter hospital stays, shorter times for therapy and shorter abstinence therapy.
Weaning of a breastfed baby who was exposed to methadone before birth should not be done all at once. Instead, it should take place slowly over time. Parents who decide to wean too abruptly may end up dealing with an infant either going into withdrawal or experiencing an increase in withdrawal symptoms.
Warnings for Breastfeeding Mothers
Methadone hits its peak in breast milk approximately four hours after an oral dose is taken. If a nursing mother takes her dose of methadone at 10:00 a.m., she should make a point of nursing her baby shortly thereafter to avoid transferring a high dose to the infant. Feeding the baby between 2:00-3:00 p.m. would mean that the infant would be exposed to the highest level of methadone in the breast milk.
The breastfeeding mother should receive instructions about how to recognize signs of breathing difficulties and excessive sleepiness in the baby caused by exposure to the opioid. She also needs advice on when to seek emergency medical attention for her infant as a result of these symptoms.
Methadone Dosage Increase During Pregnancy Is Not Uncommon
Keep in mind that a woman’s body increases its blood supply during the third trimester by up to 50% of its pre-pregnancy amount in order to keep up with the demands of the growing fetus. Since the mother has almost double the amount of blood as she did before her pregnancy started, the amount of methadone she is taking to avoid going into withdrawal will also need to increase.
Keeping up with the regular doses is extremely important during this time. As the pregnancy progresses, doctor’s appointments get closer together, and there are things to do to get ready for the baby’s arrival. Looking after one’s sobriety has to be a priority — even when there are distractions and discomforts of late pregnancy.
If a dose of methadone is skipped for any reason, your doctor or rehab clinic should be informed right away. In a situation where three doses of methadone are skipped in a row, the dosage may need to be adjusted to a lower level.
Importance of Keeping Mother Sober During Pregnancy
Some women wonder whether they should simply stop taking methadone once they discover they are pregnant. Since the methadone is an important part of their recovery from opioid addiction and it is a tool to help them fight cravings, the answer is that they should stay on their medication.
Preparing for parenthood is a major life change, whether a woman is expecting her first child or she has had more than one baby. Welcoming a new addition to the family is going to mean making changes and adjustments, and it will mean new stresses, whether the pregnancy was planned or came as a surprise.
Helping the mother to maintain her sobriety during this time is an important consideration. If she goes through a relapse while carrying a child, it could be dangerous for both her and her baby. Staying the course with the methadone treatment is the best choice in these circumstances.
Any questions or concerns about the effects of methadone use during pregnancy should be discussed with the primary care physician or with the doctor who is dispensing the methadone. That way, the right methadone dose can be found. Pregnancy may not be the right time to start tapering the dose of methadone. That step can wait until after the baby has been born.
If you or someone you care about is caught up in the cycle of addiction, 12 Keys can help. Contact us today to find out about our programs and to get yourself or your loved one started toward a new life of sobriety.