https://www.vox.com/first-person/2017/8/9/16119194/methadone-pregnancy-heroin-opiates

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She wouldn’t stop crying. Lying in her crib in the NICU, her tiny body clenched into a ball, she let out a shrill, eerie wail that no infant should ever make. I instinctively went to comfort her.

“No,” said the nurse, picking her up and out of my reach.

“Let me hold her,” I said. The nurse refused.

I was a new mother. I was an opioid addict. And my nurse wouldn’t let me hold my baby.

I became pregnant in the summer of 2013. I was addicted to heroin. I told my husband — also an addict — his parents, and his two brothers that I was using. No one else.

I knew the stigma surrounding addicted mothers. I’d taken part in it. I remembered the pregnant cocaine addict who used to stand on the street corner near my apartment, begging for change, her pregnant belly protruding into traffic. I’d judged her as much as everyone else. I didn’t want to be thought of like her.

When I told my doctor I was pregnant, I was told to take methadone, a legal opioid often used as an alternative to street drugs. The drug helped ensure my child would be born nine months later — alive, but struggling with her own addiction.

When my daughter spent a month and a half being weaned in the NICU, I made up other reasons for her hospitalization. When Child Protective Services questioned my mom about my ability to care for my child, I deflected blame onto a brother-in-law with an arrest warrant. When that nurse wouldn’t let me hold my baby, I felt like a criminal.

And most of all, I felt guilty for drugging my growing baby.

Taking methadone while pregnant is my biggest shame. But it is a shame built by stigma, a shame that tramples on the backs of other opiate-addicted women who are trying their best to do what’s right for their children. And it’s a stigma that affects medical caretakers, seeping into the way my pregnancy and aftercare were handled.

My shame is an acquiescence to the idea that heroin addicts are bad people who don’t care about their kids. That those of us who have experienced addiction can never change. But that isn’t true — everything I did was to protect my future child. I gave birth to a “methadone baby,” and I wouldn’t change anything I did to bring her into this world.

“Whatever you do, don’t go into withdrawals”

My husband stole the pregnancy test from the pharmacy down the street. We didn’t want to use the money we’d begged off my mom — that was for heroin. I didn’t expect a positive result. Street drugs are notorious for disrupting periods.

I cooked my dope sitting over the toilet with my panties around my ankles. I peed on the stick, took a shot, and lulled into the warm embrace of the rush. When my vision came back into focus, I was staring at a little plus symbol.

In that state of mind, addiction wasn’t even my first concern. I was worried that traveling home by bus would somehow harm the baby. I was in Seattle then but lived in Colorado, where I attended grad school. I’d gone to Boulder to get clean, thinking school would finally give me the motivation to get back on track. Of course, it hadn’t worked out. I was self-medicating my PTSD due to domestic violence; distracting myself wasn’t the cure.

The doctor I visited to verify my pregnancy must have seen the addiction on my face. He asked, and I told the truth.

“You need to get on methadone,” he said.

I was shocked. I’d heard nothing but terrible things about it from fellow addicts. They told me it was harder to get off than heroin. The withdrawals lasted months. Everyone I knew who had tried it ended up relapsing.

I remember my own mother talking disdainfully about the rash of “methadone babies” in the ’80s, the result of the lascivious ’70s. I asked the doctor if methadone was really necessary. Wouldn’t it be better to just get off opiates?

“No,” he insisted. “Any withdrawals you go through, your fetus goes through. They could cause a miscarriage or growth abnormalities.”

“You need to get on methadone,” he continued. “I’m not licensed to prescribe it, so you’ll need to enroll in a treatment program when you get back to Colorado. Until you do, you need to keep yourself from going through withdrawal.”

I couldn’t believe what I was hearing. “So you want me to keep doing heroin until I get back home?”

I remember how he looked down at his chart, began fiddling with the pages. “It would be better if you could ingest something. Vicodin or Oxycodone. I understand those can be more difficult to come by, and I can’t write you a prescription.”

I smiled then. It was the addict in me. I didn’t want to do heroin while pregnant, but it’s every addict’s dream to have a doctor condone their use. “So you want me to keep doing heroin.”

This time, he met my eyes. “Whatever you do, don’t go into withdrawals.”

Methadone makes you sleepy, not high

I quickly learned that dosing on methadone is not like taking a regular prescription. Methadone patients have to go to the clinic every day to get their dose while a nurse watches to ensure ingestion. After several months of clean urine tests and consistent daily attendance, patients can earn “take-homes”: doses that come in sealed plastic bottles inscribed with their names and clinic numbers. My clinic was closed on Sundays, so all patients got take-homes on the weekend.

I will never forget the sour pink syrup in which the methadone was dissolved, a failed attempt to mask the bitter taste of opiate. Every day the dispensing nurse greeted me with a smile, a plastic cup of thick pink methadone fluid, and a paper cup of water that was supposed to wash away the foul taste.

I understood, almost immediately, why so many people believe methadone patients are “getting high on the government’s dime.” I spent several hours each day struggling to stay awake. I remember lying on the lawn next to the public library, nodding out for the hour and a half between dosing and going to class. In school, I could barely stay awake. When my dose peaked, about three hours after ingestion, I fell asleep. Sitting at a desk in writing class, knees crossed for meditation group, slumped against the bus window — wherever I was when that medicine hit, I slept.

I want you to understand one thing: Methadone makes you sleepy, but it does not get you high. Opiate addicts don’t take drugs like heroin or Oxycodone to fall asleep. We take them for the euphoria — for that three-minute buzz when our entire bodies hum with pleasure, and for the few hours afterward when our minds lapse into a numb, calm blankness.

Methadone doesn’t do that. It makes you sleepy. It makes your thoughts a little fuzzier. I remember it was harder to concentrate in class, but I was never high.

Even if my body wasn’t going through withdrawal, I missed heroin. I missed having that good feeling to look forward to every day, even if it only lasted a minute or two. Even more than that, I missed feeling sane. As soon as the heroin flushed out of my system, my PTSD symptoms returned with a vengeance. It was when I finally got clean during my pregnancy that I had some of the worst flashbacks of my life.

Despite these regulations, and a few close calls, once I started methadone, I never missed a dose

I was 38 weeks pregnant when my body decided to go into labor without warning. My husband said I’d been tossing and groaning in my sleep the night before. He thinks the painkilling effects of the methadone may have masked my early labor. Whatever the reason, I ended up giving birth unexpectedly on my bed.

My husband started the delivery via instructions a 911 operator gave him over the phone. Paramedics showed up in time to complete it. I’ll never forget the way everyone at the hospital burst into applause when I was wheeled in, new baby in arms.

I vomited my daily dose during labor, but my body was so flooded with pregnancy hormones that I barely missed it. My daughter, on the other hand, began experiencing withdrawals almost immediately.

How can I explain the heartbreak of watching my newborn go through methadone withdrawals? This tiny little creature was curled into herself, sweating and shaking. She was fussy. She refused to latch to my breast. Her skin yellowed with jaundice. I wanted only to hold her to me, to take her home and soothe her, but instead the nurses came to our room with a small wheeled crib and brought her to the neonatal intensive care unit.

There, the doctor started her on morphine therapy. My husband and I were devastated when we learned she was being prescribed morphine. We’d been warned of this possibility already and coached through what it would look like. Infants with severe enough withdrawals receive tiny oral doses of morphine, which are slowly decreased until the baby is weaned off of opiates. This means a stay of at least two weeks, and possibly longer. Our daughter stayed for a month and a half.

What people who pity the plight of “methadone babies” don’t understand is that whatever sorrow they feel is amplified a thousand times within the mothers. We are not heartless monsters. I sat in that unit wracked with guilt over my daughter’s pain and the knowledge that my actions caused it.

But paired with that knowledge was the understanding that the methadone also saved her life. Even if I had managed to make it through cold-turkey withdrawals, she could have died in the process. Methadone saved my baby’s life.

The stigma of addiction

Would you be less judgmental if I told you that I am a survivor of domestic violence? That I was raped and strangled to the point of seizure more than once when I was a teenager? Would it help if you knew that I discovered opiates through a prescription? Should these facts matter? I don’t think so. The reasons people become addicted to heroin and other opiates are as various as the number of addicts on this planet, but the reason a pregnant woman engages in a methadone program is always the same: to do what’s best for her growing baby, under the guidance of a doctor.

But addiction stigma is rampant even within the medical community. At one point, the NICU nurses refused to let me hold my own baby. One of them called CPS, though I had my urinalysis records to prove my program compliance. I was not allowed to breastfeed. Later, I would learn that the amount of methadone that enters breast milk is negligible, and that if I had breastfed while tapering, it may have helped my daughter’s weaning process.

My “methadone baby” today

It was not until we spoke to the NICU doctors that my husband and I learned the potential long-term effects of methadone on children. I’d tried to get information throughout my pregnancy, but every professional I asked had been vague and reassuring. The goal was, clearly, to keep me on methadone, no matter the cost.

Now we were learning that potential side effects included hyperactivity and a higher likelihood to be diagnosed with ADD or ADHD later in life. At age 3, my daughter has an intense temper and shows signs of possible hyperactive behaviors.

But she is also an ambitious, creative child who loves making people laugh. She impressed her pediatrician by speaking her first words at 8 months, and continues to show a proclivity for language, now almost fluent in both English and Spanish. My husband and I are treated to daily concerts, which always begin with a Sally Bowles-esque exclamation of “Hello, darlings!” Her eyes are hazel green. She tells stories all the time. Some days she hopes to become a doctor; other days, a singer.

She was born addicted, but without methadone, she may never have been born at all.

Elizabeth Brico is a freelance writer living in the Pacific Northwest. Her blog, Betty’s Battleground, focuses on living and parenting with PTSD. She recently joined Healthy Place as a contributing writer for Trauma! A PTSD blog. When she isn’t actively momming or blogging, she can usually be found reading, writing, or watching speculative fiction.

 

Comment;

It’s sad that buprenorphine is not more widely known and used for addiction in general especially for neonates and during the pre-natal period.  It’s a safer, better alternative.  I practice in Asheville NC.  Methadone clinics everywhere I’ve been immediately escalate the methadone dose well above what I would consider necessary and/or needed.  Doses of 30 mg per day may be adequate for a particular patient.  In no time at all the patient is on 130 mg/d!  Why?  Simple!  At that dose, the withdrawal syndrome is horrible, much worse than it would be at 30 mg/d.  These poor folks will do whatever is necessary to get their daily dose and never miss a visit to the clinic.

The really GOOD NEWS is that switching from the methadone clinic where you’re more of an annuity than patient to a private facility that is willing to wean the methadone dose down to about 30 mg/d will then allow transition from methadone to buprenorphine (Suboxone, et al).  The first week is a bit bumpy, but there are numerous other medications that I prescribe for that week to make the transition tolerable.  After that I tell my patients to take as much buprenorphine as necessary, but as little as possible and we wean them down on THEIR time table, when THEY feel ready to decrease the dose–all while strongly encouraging 12-step program participation.

It works if you work it, so work it ’cause you’re worth it!

Dr. Raymond Oenbrink
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