The One with the Catch-22

“It’s child abuse!” one of my classmates declared, tossing his hands up in the air.

I winced.

“I disagree,” I insisted, gently rocking the baby who’d been wailing inconsolably for the past ten minutes.

The beautiful, redheaded baby girl was detoxing from methadone, a medication used to wean opiate addicts away from their addiction. Her mother, a former heroin addict, had switched to methadone the moment she learned she was pregnant.

———–

Methadone is a narcotic, but it simultaneously prevents opiate withdrawal symptoms and blocks the euphoric effects of other narcotics, like heroin or morphine. It’s a prescribed, controlled substance given to patients who need to be weaned away from an opiate addiction. Though my patient’s mother was addicted to illegal drugs, it’s not uncommon to find patients who require methadone for something like an addiction to Percocet taken for chronic back pain. Regardless of the addiction source, a prescription for methadone is like the promise of a new horizon. It’s a medication sought by individuals who want to change their ways.

As a student at an urban hospital, I saw a fair number of pregnant former drug addicts who had sought out a methadone prescription, intending to straighten their lives out for the new babies. There is not a whole lot of data on using narcotics in pregnancy, but one of my preceptors reasoned that it’s preferable to keep the mother on a controlled, monitored dose while keeping a close eye on baby’s progress than to have her shooting up heroin in a back alley.

However, methadone use is still controversial. The babies are still born addicted to narcotics, and spend their first few weeks having withdrawal symptoms. They’re fussy and inconsolable. They have tremors and diarrhea. They’re easily startled and basically miserable.

So why not have mom go cold turkey and prevent all of this? Because if she cuts off the opiates completely, the baby will withdraw in utero, and we’d have no way to monitor it. Instead, at least, at my hospital, the mother is followed by a special clinic that monitors the methadone dose and obtains frequent urine toxicology screens to ensure compliance.

A common sentiment, however, is that expressed by my classmate: the belief that these women are clearly abusing their child via the narcotics they’re taking in during pregnancy. Child Services inevitably get involved with these cases, and this article details a situation in which a woman is denigrated by her surgeons and her child is eventually placed in foster case. Essentially, she is punished for seeking treatment for her problem.

While I absolutely do not condone drug use in pregnancy (or ever), I absolutely support any woman who seeks to make the right choices and get help for her addiction in light of her new pregnancy. Though I acknowledge there is a risk for relapse, I would argue that one of the most important factors in the mother’s success will be the support of her health care provider and the responsibility of caring for a newborn.

Here’s hoping physicians will learn to support and encourage these mothers as they endeavor to fight addiction AND raise a new child.

———-

I stepped into the hallway and raised one fist, poised to knock on an exam room door.

“Hey, I remember you. You’re from the hospital!”

I paused and looked down the hall. It was the mother and redheaded baby girl who I had taken care of during my pediatrics rotation.

“How ARE you?!” I gushed, taking that beautiful baby into my arms.

Her precious smile said it all.

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One thought on “The One with the Catch-22

  1. This is such an interesting topic. I was pretty shocked when I learned about the concept of giving methadone for opiate addicts. The concept is pretty hard to wrap your had around. It does make sense, however, and if you can wrap your head around it for a non-pregnant person, then it should be easy enough to reason that the principle is the same for someone who is pregnant.

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