Hello, congratulations in the Job, and I LOVE that you're inviting Questions on the subject of Methadone. Many years ago, I read a thing on a Website or Forum about breastfeeding, where the author said that, If an opiate-addict is pregnant and wants to keep it, the best thing for the Baby would be for the mother to get on Methadone during the second term, and then stay on the Initial dose until the Baby is three months old, while breastfeeding exclusively, so the Baby gets it through the Milk and doesnt get withdrawals, and then slowly lower the Dose for the mother, while still breastfeeding, so that for the Baby, Weaning in the sense of introducing solid food and drinking less milk, and the Weaning from Methadone, happens at the same time, and gradually. I think that Sounds very plausible, but I was wondering how many pregnant people actually do that? Do actual pediatricians also recommend that? How do other treatments for opiate-addicted newborns Work? How does being in a substitution Program affect someone's chances of keeping custody of their children?
Methadone is a prescribed opioid that prevents withdrawal and cravings when a person with an opioid use disorder wants to cut back or stop using non-prescribed opioids. It makes it so the person can do things like take care of a family, go to work or school, and engage in relationships instead of spending all their time and resources trying to get opioids- they get methadone, know they won't go into withdrawal and will have fewer cravings, and are able to participate in life again.
Methadone has been safely used in pregnancy for more than 50 years. There was a study done a while back that pointed to a small increased risk of birth defects if taken within the first trimester, and methadone may increase the risk of a low birth weight baby. However, using non-prescribed opioids is a serious risk in pregnancy, both from a physiological standpoint and from a social one, so starting methadone as soon as possible is the current preferred method from a harm reduction standpoint.
People start methadone at a low dose, and increase it every day until they no longer experience withdrawal symptoms and cravings, at which point they stay at the same dose unless they start getting cravings/withdrawal again. This is the same strategy used in pregnancy.
A baby who has withdrawal symptoms after they are born is said to have a condition called neonatal abstinence syndrome, or NAS. NAS can effect babies born to parents using non-prescribed opioids, but also to parents using methadone to treat an opioid use disorder.
Babies with NAS are usually treated with morphine while in the hospital to reduce withdrawal symptoms. It usually takes about 2 weeks to wean off the morphine. Breastfeeding while on methadone is generally safe if the person is taking less than about 100mg of methadone. However, the amount of methadone that is actually excreted in breast milk varies, so it doesn't usually prevent NAS. Sometimes breastfed babies with NAS need less morphine, though.
Finally, while some people choose to wean off methadone eventually, most people are on it long term. Stopping methadone increases the risk that a person will go back to using non-prescribed opioids in an uncontrolled way. So it would be very risky for a new parent to reduce the amount of methadone they were on. If there is enough methadone in the breast milk to cause any dependence in the baby, as they naturally wean off the breast milk, they also wean off the methadone, generally without any problems.
Every child birthed by a parent who uses substances has to be reported to a child welfare agency. As far as custody goes, however, being in an opioid treatment program greatly increases the likelihood that the parent is capable of caring for a child, and the courts recognize this.
