05.10.2015

Pregnant women using methadone

One thing she knows for sure, however, is that her Oxford House, where she lives with four other women in recovery, has become the foundation stone of her sobriety.
Any of the women in Smith’s house can, without explanation, insist that one of the others immediately take a drug test.
Whether Smith likes it or not, addicts who have opted for methadone treatment, and who wish to live at an Oxford House, can no longer be kept out. State health and housing officials, under pressure from the federal government, are telling Oxford Houses throughout the country that people taking methadone are protected under the Americans With Disabilities Act and cannot be discriminated against when they apply for housing. But for heroin addicts such as Smith, methadone patients have simply traded one high for another, and being around them is like being around other users — the last thing someone in recovery should do. Prescription methadone, available to addicts for decades, may be on the cusp of a major resurgence. Today, at the two 36-bed residential centers run by nonprofit Volunteers of America as recovery housing for men and women on probation and parole, up to 15 beds are dedicated for residents taking methadone. At a downtown DePaul Treatment Centers facility, a new program has pregnant women on methadone living side by side with recovering women practicing abstinence (see sidebar). Medication advocates say the changes represent long overdue progress, and that it’s about time people in the recovery community begin to embrace methadone and newer options as treatment for addicts. But others say methadone for the vast majority who receive it is not a treatment because few use it to escape addiction. They are not in recovery, according to this view, but victims of a policy known as harm reduction, driven by data that shows that on methadone, addicts no longer burden society by committing crimes, spreading infections through needle-sharing and overwhelming emergency departments. The controversy surrounding where to place addicts being treated with methadone is a microcosm of the larger controversy about which treatments should be available for whom.
A pilot project was hatched to try methadone on some of those patients, who would have to live with the other clients because the county had no other options.
For instance, addicts treated with methadone are known for chipping — sharing doses or secretly using illicit drugs and psychiatric medications that heighten the high from methadone.


The Volunteers of America staff is learning how to spot signs that clients are chipping, or augmenting their methadone with street heroin. Afternoon sleepiness is a well-known sign that a methadone patient’s morning dose is wearing off, though methadone proponents say careful dosing can limit that side effect. But Kelly says the effect has led to some complaints by other residents in the women’s center. Before accepting methadone patients, the residency centers maintained a rule that anybody using narcotics had to be separated from the rest of the residents.
If some of those men and women can be stabilized and turned away from lives of crime, Kelly says, the benefit to society would be enormous.
Kelly says she’ll consider the pilot program a success if the methadone clients stay in treatment longer than those practicing abstinence. The real data may come a year or more after clients have left inpatient treatment, and that may be a reflection of whether they continue to receive methadone once back living on their own. At Oxford Houses, it’s just five to 10 men or women living and recovering in their own shared home. Mike Hermens, state chairman of Oxford Houses of Oregon, says there are a handful of Oxford-style houses that have been set aside for people on methadone therapy, but that all the houses have been told they cannot discriminate should someone apply who is taking methadone. Smith gave birth to one of her children while on methadone and says withdrawing from the methadone took longer and was just as painful as the withdrawals she’s experienced from heroin. Smith says she’s also concerned about some of the practical safeguards involved in having methadone in the house.
For instance, she says, when a woman in her house needs to take a drug urinalysis, the inexpensive, quick test they use simply shows up negative or positive. A methadone resident would naturally test positive, so the house would have to use a more expensive, mail-in test which specifies what drugs are showing up.
Wheeler says addicts receiving methadone probably don’t think the new situation is ideal, either.


A longtime heroin addict, the 37-year-old Hansen began taking methadone when she discovered she was pregnant in early November. When the recovery community talks about long-term methadone treatment resulting in harm reduction, they are referring to a model which many addicts say could just as easily be called a lesser of two evils choice. Farentinos says that some of the women they see have been taking heroin for so long that permanent structural changes have taken place in their brains. They will never be able to function normally without drug assistance, she says, and lifelong methadone is much preferable to street heroin. Pereira trained at a methadone treatment center in Philadelphia, taking care of pregnant women on methadone.
He says most of his patients became pregnant while hooked on heroin and that asking them to embrace abstinence during their pregnancy would simply not have worked.
Also, if a woman continues to use heroin while pregnant and runs out of cash, the horrific withdrawal associated with the drug could cause her to lose the child she is carrying. With methadone moms, the newborn is given consecutively smaller doses of the drug for the first two weeks of life until weaned off its addiction.
And pregnant women on methadone, he says, are more likely to follow through on doctor visits and other forms of pre-natal care. Constantly chained Most of the pregnant women on methadone therapy that Pereira has treated are in their teens or early 20s, and he’s seen some of them change their lives after getting through pregnancy and delivering a basically healthy baby. Hansen, who graduated from the University of Washington and was divorced seven years ago, knew immediately that she would have to change after a home pregnancy test came up positive.
Her first four or five days at the DePaul residential center, Hansen was kept segregated from the other women because the side effects, including nodding off in the afternoon, might trigger other patients.



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