Frequently Asked Questions(FAQ) about Methadone and Pregnancy

Frequently Asked Questions(FAQ) about Methadone and Pregnancy


Created in consultation with Robert Newman M.D., director of Beth Israel Medical Center’s
Baron Edmond de Rothschild Chemical Dependency Institute
What is methadone?
• Methadone is an opioid medication used to treat individuals who are dependent on opioid drugssuch
as heroin and the prescription drug Oxycodone; it has also been used extensively in recent years for
management of chronic pain.
• Methadone maintenance treatment (MMT) reduces cravings for opioid drugs, prevents the onset of
withdrawal and blocksthe effects of other opiates.
i
• Forty years of well-documented experience with MMT throughout the world has consistently
demonstrated a marked reduction in illicit drug use and the medical and social consequences of such
use – including a major drop in likelihood of overdose and death.
• MMT is most effective when accompanied by availability of counseling and other supportive
services.
What are the main concerns for pregnant women who experience opiate addictions or who try to
overcome them?
• Use of injection drugs during pregnancy is generally associated with poor nutrition and anemia, high
risk of infectious diseases such as hepatitis and HIV, and inadequate prenatal care
ii
, as well as
exposing the patient to significant risk of overdose.
iii
These consequences place both the expectant
mother and the fetus at risk.
• Opiate detoxification (whether by going “cold turkey” or gradually with the aid of medication)
always is associated with a significant risk of relapse to illicit drug use, but is particularly dangerous
during pregnancy because withdrawal can cause uterine contractions, miscarriage or early labor.
i
Is methadone a safe and effective way to manage opiate addiction during pregnancy?
• Yes, there is a scientific consensus recognized by US government authorities and researchers that
methadone issafe and effective for the management of opioid dependence during pregnancy.
iv
*
• Women can conceive, have normal pregnancies and give birth to and raise healthy children while
receiving methadone treatment.
v
• Methadone maintenance should be continued at therapeutic levels throughout pregnancy to prevent
withdrawal symptoms or relapse to illicit opioid use. It is well established that metabolic changes
during pregnancy often require an increase in the dosage of methadone to ensure optimal therapeutic
results.
• Some newborns born to women receiving methadone maintenance may experience “mild to modest
opiate withdrawal signs and symptoms in the early postnatal period…”vi
When such withdrawal
occursit isreadily managed by appropriate treatment with an opiate medication; there is no evidence
indicating any long-term adverse consequences.
vi
• A review of “the methadone maintenance pregnancy” concluded: “Methadone treatment during
pregnancy offers overwhelming advantages . . . [and] has been shown to be an invaluable and often
an essential ingredient in bettering the health of women during pregnancy, in improving the
outcomes of those pregnancies, and in offering opiate-addicted women a chance to improve both
their lives and the lives of their families.”
vii
• A study published in 2005 found that “high doses of methadone were not associated with increased
risks of neonatal abstinence symptoms but had a positive [i.e., favorable] effect on maternal drug
abuse.”
viii
• It is noteworthy that federal regulations require methadone treatment programs to give priority to
pregnant women who seek treatment and explicitly document reasonsfor denying them admission.
ix
* Buprenorphine is an alternatives medication to methadone. Initial experience has also found it to be safe
during pregnancy, although more research is needed.2
Are women who use methadone in pregnancy “abusing” their fetuses?
• No, in fact, MMT for pregnant women protects their fetuses from the harmful effects of opioid
withdrawal and/or resumption of illicit drug use. For women who are addicted to heroin or other
opiates, MMT isthe most thoroughly researched option to improve their health and birth outcomes.
x
• Methadone does not harm the developing fetus, but maternal withdrawal and detox may create
significant risks of harm.
iv
• Methadone does not cause birth defects or other long-term health problems.
iv
• Babies born to mothers on methadone do as well as other babies and much better than babies born to
mothers using heroin.
i
Are women who use methadone capable of being good parents?
• Yes, people who are on MMT are capable of being good parents. Like any group of parents, some
mothers reportedly benefit from additional services to address co-occurring mental health issues and
to develop parenting skills.
xi
• A review of the scientific literature reveals that methadone is compatible with breastfeeding as the
amount of methadone in breast milk is very small.
xii
The Bottom Line: As a brochure entitled, “Methadone Treatment for Pregnant Women,”
produced and distributed by the US Department of Health and Human Services, sums up:
“Methadone maintenance treatment can help you stop using drugs. It issafe for the baby,
keeps you free of withdrawal, and gives you a chance to take care of yourself.”
i
i
U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration.
Methadone Treatmentfor PregnantWomen. Publication number SMA 06-4124. 2006.
ii
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.
Medication-Assisted treatment for opiod addiction during pregnancy. In Medication-Assisted Treatment for Opiod
Addiction in Opiod Treatment Programs, TIP 43. 2005, 211-224.
iii
U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration.
OxyContin: Prescription Drug Abuse. Breaking Newsforthe Treatment Field, 1(1). 2001.
iv
Kaltenbach K, Silverman N, Wapner R. Methadone maintenance during pregnancy. In: Center for Substance Abuse
Treatment. State Methadone Treatment Guidelines. DHHS Publication No. (SMA) 93-1991. Rockville, MD: U.S.
Department of Health and Human Services. 85-93. 1993; Finnegan LP. Treatment issues for opioid-dependent women
during the perinatal period. Journal of Psychoactive Drugs. 23,191-201. 1991; Finnegan LP. Clinical perinatal and
development effects of methadone. In: CooperJR, et al., eds. Research on the Treatment of Narcotic Addiction: State of
the Art. Rockville, MD: U.S. Department of Health and Human Services. 26, 155-61. 1983; Rayburn, WF &
Bogenschutz, MP, Pharmacotherapy for pregnant women with addictions. American Journal of Obstetrics &
Gynecology, 191(6), 1885-97. 2004.
v
The Lindesmith Center-Drug Policy Foundation. About Methadone. 2000.
vi
Institute of Medicine. Federal Regulation of Methadone Treatment. Washington, DC: National Academy Press;
1995:203-4.Retrieved on 8/27/09 from http://www.nap.edu/openbook.php?isbn=0309052408
vii
Kandall, S.R et al. The Methadone-Maintained Pregnancy. Clinicsin Perinatology, 26(1), 173-183. 1999.
viii
McCarthy,J.J. et al. High-Done Methadone Maintenance in Pregnancy: Maternal and Neonatal Outcomes. American
Journal of OBGYN, 193, 606-610. 2005.
ix
Addiction Treatment Forum,retrieved on 8/28/09 from www.atforum.com/newsletters/2009summer.php.
x
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.
Medication-Assisted treatment for opiod addiction during pregnancy. In Medication-Assisted Treatment for Opiod
Addiction in Opiod Treatment Programs, TIP 43. 2005, 211-224.
xi
Dawe S, Harnett P. Reducing potential for child abuse among methadone-maintained parents: results from a
randomized controlled trial. Journal of Substance Abuse Treatment, 32(4), 381-90. 2007; Luthar SS, Suchman NE,
Altomare M. Relational Psychotherapy Mothers' Group: a randomized clinical trial for substance abusing mothers.
Developmental Psychopathology, 19(1),243-61. 2009.
xii
Jansson LM, Velez M, Harrow C. Methadone maintenance and lactation: a review of the literature and current
management guidelines.Journal of Human Lactation, 20(1), 62-71. 2004