A lot of misinformation and stigma surrounds the use of methadone as treatment for opiate addiction, but the problems are even more apparent when the patient in the treatment program is pregnant. Methadone, the most common treatment for opiate addiction in the United States, is a synthetic opioid that can ease withdrawal symptoms for dependent persons without creating a “high.” Typically, patients at methadone clinics will visit at least once a day to receive a prescribed dose of methadone, often in liquid form. Over time, patients may be allowed to take doses home and many are eventually weaned off the treatment. The goal of methadone treatment for pregnant women is to help them avoid the negative consequences of illicit drug use, including overdose and withdrawal, both of which can jeopardize the pregnancy. Without having to worry about illicit drug use, a woman is in a better position to engage in prenatal care.
Katie Clark, a research assistant at the Yale School of Public Health, began to notice the stigma surrounding pregnant women through her work at an opiate treatment center. “While I was working as a counselor I started to tailor my caseload to work with predominantly pregnant and parenting women. They shared with me that they were looked down upon, by other people in their lives and people in treatment, because they were in methadone treatment during pregnancy. Even though medically, they were doing the best thing for themselves and their pregnancies, this was not the message they were getting from those around them.”
As Katie explains, even within hospitals and drug treatment programs, pregnant women are often judged for methadone use. “People see an infant in withdrawal and start making comments like ‘how could you do this to your baby.’ In one case, a social worker tried to charge a mother with child abuse because she was in treatment during her pregnancy.”
Just as women are cautioned against alcohol use while pregnant, many people assume that women should immediately stop using opiates as well, but actually, quitting opiates can be very dangerous. “Opiate withdrawal can jeopardize the health of the baby and the mother and even cause miscarriages,” says Katie. “Methadone has been used as treatment for pregnant women for 30 years to keep mothers and babies stable during pregnancy.”
In her work, Katie also challenges that myth that babies are “born addicted” to opiates. “There is no such thing as a baby born addicted to opiates, but babies with opiate-dependent mothers can show withdrawal symptoms once they are born, such as diarrhea, stiffness, or not eating or sleeping well,” says Katie. “A baby experiencing withdrawal is usually kept at the hospital and, if clinically indicated, put on medicine to make them comfortable. Doctors will keep the babies in the hospital until they are weaned off the medicine.”
Katie created a website, www.methadoneandpregnancy.com to answer questions about methadone, pregnancy and opiate addiction. “Ideally I’d want more people to be trained on how to work with pregnant women in methadone treatment. There is a lot of stigma and misunderstanding about this population and that can lead to poor health outcomes. If we can educate people more, it will lead to better health outcomes for mothers and infants.”
Voices from the Harbor is an audio documentary Katie created about women’s experiences with pregnancy, opiate addiction and methadone treatment. In the documentary, four women speak of their experiences with addiction, pregnancy, stigma and recovery. Visit http://vimeo.com/41050651 to hear their powerful stories.
Four women discuss their experiences in active addiction, interactions with social service providers, what happens when they enter treatment, and their hopes for the future. Produced by Katie Clark, who is a Research Assistant at the Yale School of Public Health and a student of the Master of Science in Public Health, Maternal and Child Health program at the University of North Carolina at Chapel Hill.
“This documentary is dedicated to Paul MacFarland, who passed away in October 2011. I met Paul when he was the State Opioid Treatment Authority for the State of Maine. Paul was an outstanding mentor and a significant advocate of my efforts to improve the experiences of pregnant women in methadone treatment and provide education on this topic. I will always be grateful to Paul for his wisdom, insight, and his unwavering support.” –Katie Clark