Prenatal Use of Methadone
There has been long-standing concern among family court and child welfare professionals about prenatal use of methadone. After all, won’t the babies by severely damaged?
Prenatal attendance at a methadone program offers mothers and babies several key benefits:
- Pre and post-natal case which leads to better child outcomes
- Breastfeeding is an option
- Supervised withdrawal
- Maternal access to services, including mental health and parenting education and support
- Monitoring of children to assess any safety concerns
- Parents stablized on methadone are more likely to maintain custody
- Increased retention in services
Compared to heroin use, methadone is significantly safer:
- Reduced risk of exposure to other toxins (substances mixed in with street drugs)
- Decreased risk of HIV transmission
- Supervised, so limited likelihood of unmonitored intrauterine withdrawal
Child outcomes
Researchers have found contradictory evidence in terms of child outcomes. Some researchers found no significant differences between children who were exposed to methadone in utero and children who were not exposed to any substances at all.
Other researchers have found lower cognitive functioning in methadone exposed infants, along with lower hearing, speech, and motor development, along with attention issues.
This may be a result to the variation in continued involvement with a “drug subculture”, which typically carries environmental, social, and familial risks.
Withdrawal from Methadone during Pregnancy
The American Society on Addiction Medicine (ASAM) has stated that withdrawal from methadone is rarely appropriate during pregnancy (1990). Women who become pregnant should be continued at their pre-pregnancy established dose. However, physiological changes during the third trimester often require dose increase, and other dose adjustments to improve maternal and fetal stability.
Tips for Working with Women on Methadone
Methadone is often the primary source of support and stability for addicted women, especially those with mental health concerns who may be even more vulnerable to the effects of withdrawal.
1. Know about clinics that have worked specifically with certain populations, for example, with opiate-dependent pregnant women
2. Encourage women to stay with their methadone program throughout their pregnancy, and to take advantage of the full range of support services offered.
3. Recognize that ending methadone might have a dangerous effect on the mother and infant, and is more likely to lead to relapse.
4. Collaborate with methadone program staff around child safety and well-being. Staff are frontline observers of these children, and can assess developmental and physical concerns, and concerns of parental abuse or neglect They can also make referrals to outside services.
Newborn Withdrawal
We know that 60 – 90% of infants born to opiate dependent mothers show symptoms of neonatal abstinence syndrome (NAS) – or what we think of as newborn withdrawal. Neonatal abstinenece syndrome is characterized by:
- Hyperirritability
- Tremors/shaking
- High-pitched cry
- Poor eating
- Failure to thrive
The relationship between methadone and NAS is not clear. Some research shows a positive, or lack of, association between the two. Other shows that high doses of methadone have been linked to longer lasting, and more severe NAS
However, reducing the methadone dose to prevent NAS may lead to relapse, or to intrauterine withdrawal, which are both more dangerous than NAS (NIDA, 2004).
Although the effects of NAS are troublesome, they are often short-lived and reversible with the proper amount of care and safety after the birth, which is available through the comprehensive services provided by methadone programs.
