Opioid Addiction and Pregnancy: Why Are Doctors Ignoring Best Practices?

By Elizabeth Brico 09/20/17

Mothers using methadone for opioid addiction face unprecedented hassles, and their children are frequently given a standard of care far different than what experts recommend.

Pregnant woman with doctor

When Pammy became pregnant, she had been using methadone to stay clean from heroin and pills for over a year. She and her husband were happy about the news. They had each been doing well in their recovery, and felt ready to care for the needs of someone besides themselves, an accomplishment Pammy credited to her Medication Assisted Treatment. But her OB, who worked at a state-funded clinic, had a different view.

"I won't treat you while you're taking methadone," he informed Pammy at her first visit. "If you want prenatal care from me, you have to get off of methadone first."

Pammy was shocked. Heroin had nearly destroyed her--until she enrolled in a methadone program. She never wanted to return to an active addiction, and she was terrified that discontinuing methadone would lead to a relapse. Later, she would also learn that if she had followed the doctor's instructions, she could have lost her baby. A fetus will experience the same physical highs and lows as its mother. Severe withdrawals can lead to miscarriage.

Nancy Rosenbloom, Director of Legal Advocacy at National Advocates for Pregnant Women, says the United States suffers from "widespread misinformation and lack of training" in the medical field regarding opioid addicted women who become pregnant. Although just about every trusted medical association--including the World Health Organization--has certified methadone or buprenorphine as the standard of care for managing opioid dependency during pregnancy, experiences like Pammy's remain all too common.

Because of the known danger of withdrawal, Destiny stopped her blind methadone taper when she learned she was pregnant in the fall of 2008. She'd been hoping to get off of methadone, but she understood that the health of her unborn child depended on her continuing treatment. When she visited her OB, he labeled her pregnancy "high-risk." Although research does not suggest a higher rate of defects in babies born to mothers who use methadone, Destiny's OB referred her to a specialist, who would take several detailed sonograms throughout her pregnancy.

At one of these high-risk screenings, the specialist noticed markers for Trisomy 21, one of the genetic variations associated with Down Syndrome. Destiny reports that the specialist recommended she get an abortion, telling her the baby was unlikely to survive. When she refused the procedure, he urged her to re-consider. She did not. Later, amniocentesis would reveal that her baby did not carry a higher likelihood for Down Syndrome after all. Destiny believes the specialist pushed an abortion on her because she was using methadone. Her baby was later born healthy with no noticeable genetic problems.

There is no other medical condition in which a woman is denied access to prenatal care or confronted by Child Services for following the recommendations of her doctor. Although opioid addiction is now widely recognized as a brain disorder that necessitates medical treatment, too many people still believe that mothers on methadone are selfishly harming their children. I should know: I also used methadone while pregnant.

Like many people who become addicted to opiates, I tried to stop using heroin almost as soon as I realized I was dependent on it. But abstinence didn't work, and everyone I spoke with told me that methadone felt terrible, and was more addicting than heroin. They called it "liquid handcuffs." I was warned the withdrawals would last longer and feel more intense than from heroin. Everyone I knew who tried methadone had relapsed.

When I became pregnant, however, my doctor informed me that it was the only choice I had if I wanted a healthy baby. I'm glad I listened. Because of methadone, I am now sober, my daughters are healthy and live with my husband and me at home, and my writing career is finally taking off--all things that could never have happened if I was still using heroin. But my time in methadone treatment was riddled with difficulties, and most of the problems I faced resulted from stigma and misinformation.

When I asked the clinic staff whether they thought my baby would experience withdrawals, they each told me firmly, "no,” that my dose was low, and withdrawals were very unlikely.

After my daughter was born, she spent a month and a half in hospital-supervised withdrawal. The clinic staff can’t be blamed for that, but I would have been better emotionally prepared if they had offered a more honest response rather than one aimed at keeping me in treatment.

When I asked if I would be allowed to breastfeed, everyone assured me I would. My counselor told me breastfeeding was recommended and supported. My doctor said it could help prevent the neonatal withdrawal I was worried about.

The hospital did not allow me to breastfeed, and wouldn't even store the little milk I was able to pump.

For seven months, I spent my mornings walking miles so that I could take my medicine at the clinic, where new patients were required to dose each day. When my monthly urinalysis results returned drug-free enough times to merit a "take-home" dose, I was denied it on the basis that I had admitted to experiencing PTSD flashbacks and sometimes still craving heroin, a normal reaction during early recovery.

Compared to some women, my problems were mild. Destiny's clinic, for example, was ill-equipped to raise her dose in a timely manner, even though it is well documented that pregnant women often require several dose adjustments due to fetal growth and increased blood volume. Destiny spent a good amount of those nine months vomiting and in withdrawal while she waited for her dose adjustments to be approved.

Pammy delivered by C-section, and was denied appropriate pain medication because of her addiction history. She was given only Tylenol and her regular dose of methadone to combat her post-operation pain.

All three of us, and many more mothers I spoke with, saw our babies sent to the Neonatal Intensive Care Unit.

Dr. Loretta Finnegan, who began working with opioid dependent women and their babies in 1969 and is now the Executive Officer of the College on Problems of Drug Dependence, says "unless there is another associated problem [besides Neonatal Abstinence Syndrome], the babies should not be in the NICU." She has observed that the bright lights, loud noises, and lack of breastfeeding opportunities cause significantly elevated discomfort in newborns born with opioid dependencies. Yet every mother I interviewed whose infant was diagnosed with NAS because of methadone saw her child spend time in the NICU. Most were not allowed to breastfeed.

The mothers I spoke with were grateful that they had access to Medication Assisted Treatment. They rated their experiences with methadone as positive. Yet each also cited complaints that a pregnant woman on any other kind of medication would never have endured in silence. This society is so inured to addiction stigma, which is especially harsh against addicted mothers, that those in recovery internalize feelings of low self-worth. We make outcasts of ourselves, and endure a lower standard of care as a result.

Methadone is currently among one of the most highly regulated prescription drugs in the United States. Mothers using methadone to treat opioid addiction face unprecedented hassles, and their children, when born with NAS, are typically given a standard of care far different from that which the most qualified experts recommend. Dr. Finnegan, who often acts as an expert for the defense in the state of New Jersey, reports that she has seen mothers brought to court simply because their babies were born dependent on the drug the mothers were prescribed. But it's not mothers on methadone who are harming these children. The culprit is stigma, and the trend of misinformation that affects medical professionals, addicted communities, and lawmakers alike.

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Elizabeth Brico is a writer from the Pacific Northwest. She got her MFA in Writing & Poetics from Naropa University, where she justified spending more time shooting dope than doing homework because William Burroughs once taught there. Now, she writes about trauma, addiction, and recovery on her blog Betty's Battleground. She's also a regular contributor to the PTSD blog on HealthyPlace, and freelances as much as she can for The Fix and Tonic/VICE. Her work has also appeared on VoxStatOzyTalk PovertyRacked, and The Establishment, among others. In her free time she can usually be found reading, writing, or watching speculative fiction. Find her portfolio and ramblings about writing on eb-writes.com, or stalk her on Twitter: @elizabethbrico (if you're interesting, she might even stalk you back).