Becoming pregnant while opioid-dependent can feel scary—but it doesn’t have to be. There are safe and effective medications that can help mitigate some of the risks associated with chaotic black market opioid use. One of these is methadone.
Methadone has been an important mainstay of medication-assisted treatment for opioid dependence and addiction during pregnancy for several decades, supported by a large evidence base demonstrating its safety and efficacy. Because of this, and the spread of harm reduction principles throughout the addiction, recovery, and drug-using communities in the United States, more information about methadone and pregnancy is available than ever before. Here are three key points about methadone use during pregnancy that can help keep you and your baby safe:
Methadone is a long-acting full opioid agonist. This means that, unlike buprenorphine (Suboxone) which is a partial opioid agonist, it fills the entire opioid receptor and will not result in precipitated withdrawal, even if other opioids are still in your system. This makes it an ideal opioid replacement therapy for pregnant people, especially during the age of illicitly manufactured fentanyl, which is lipophilic and can remain in your system longer than conventional opioids like heroin. Methadone also has a very long half-life, and at therapeutic doses can keep patients out of withdrawal for several days. But that is not always the case during pregnancy.
Many pregnant people experience metabolic changes that interfere with the way methadone is processed. While a single dose of methadone in the morning—as it is typically administered in the United States—will usually work fine all day for the average patient, pregnant patients often require two or more doses throughout the day. This helps keep methadone levels stable for both parent and fetus, which prevents the growing baby from experiencing the destabilizing highs and lows associated with fluctuating methadone levels. A test called a peak and trough can determine whether split dosing is appropriate for you, though many pregnant people who benefit from split dosing also report feeling withdrawal symptoms at night or in the morning before dosing, and midday fatigue. Studies have shown that split dosing during pregnancy reduces the likelihood that neonatal abstinence syndrome (NAS), otherwise known as infant withdrawal, will occur, as well as the severity and longevity of NAS if it does occur.
Whether or not to breastfeed after giving birth is a personal decision, and it’s important that methadone patients feel empowered to choose for themselves just like any other parent. Given the body of evidence supporting the safety of breastfeeding while on methadone, it would be lovely if no patient ever had to face discouragement from medical professionals, friends, and family when it comes to breastfeeding. Unfortunately, though, there are still some people whose opinions are influenced by misinformation. If you choose to breastfeed while taking methadone and encounter pushback, remember these facts:
- Studies have shown that the amount of methadone that passes into breast milk is negligible and will not cause harm to the baby, nor will it affect their wean should they experience NAS.
- The well-documented benefits of breastfeeding, as well as the close physical contact inherent to the act of breastfeeding, have been shown to reduce symptoms of withdrawal in infants experiencing NAS, resulting in overall shorter hospital stays.
- Just because methadone is safe in breastmilk does not mean other substances are. If you use other substances while breastfeeding, check with a trusted medical professional about the safety, or wait 12-72 hours (depending on the substance) to ensure it has passed from the milk supply. You do not need to “pump and dump” (though this can help reduce clogged ducts) as substances naturally leave breastmilk.
Supports are Available
Methadone is a safe and effective medication used to treat opioid use disorder, and has been a trusted treatment during pregnancy since the 1970s. Although side effects like NAS can occur, these are temporary. Overall, methadone prevents opioid withdrawal—which can harm a developing fetus if not medically monitored—helps reduce cravings and re-balance neurochemical changes that take place during active addiction, and offers parent and baby a stable dose of opioids rather than the highs and lows that often come with black market and/or chaotic use.
Despite this, stigma remains. Some people believe that methadone is unsafe, that it is “legal heroin,” or that it does not constitute true recovery or sobriety. But none of these things are true. This prescription medication has changed countless lives that may have otherwise succumbed to the harms associated with illicit drug use during prohibition. It is important to keep this in mind and to access support systems that will help you feel empowered in your choice to utilize methadone for your safety and the safety of your child. Various online and in-person groups exist, and your provider should be able to give you some of those resources. If not, search for local groups in your area like SMART Recovery, or Medication-Assisted Recovery Anonymous if you like the 12-step model but want to make sure your medication choices are accepted.