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After the initial stabilization phase, a pregnant patient will meet with
the methadone physician every 2-4 weeks depending on the severity of
her addiction and complexity of her other medical problems.
California Regulations require at least one methadone physician visit
per month. At these follow-up visits, the methadone physician verifies
that the patient is participating in prenatal care, reassesses the
adequacy and appropriateness of the methadone dose, reviews the
urine drug test results and inquires about any drug use including use of
opioid drugs and other illicit drugs (stimulants, THC, PCP, etc) and
use of alcohol and cigarettes.

The methadone physician provides information regarding the risks
associated with the use of drugs during pregnancy and works with the
patient to address ongoing use of any of these substances and to
identify strategies to allow and support cessation and abstinence.

Patients who continue to use will be strongly encouraged to enter a
residential treatment program; the methadone physician will also alert
the prenatal care provider. Coordination with the prenatal care
provider helps to assure that prompt and appropriate medical
intervention is provided in the event of a drug-related complication,
allows the prenatal care provider to reinforce the recommendation to
enter residential treatment and to provide medical counsel regarding
the risks of drug use in pregnancy.

During follow up visits the methadone physician provides medical
counsel regarding the importance of prenatal care, good nutrition,
preventive health care (tetanus boosters, HIV and Hepatitis testing),
breastfeeding while on methadone, pain control during and after
delivery, contraception, post-partum depression.

The Effects of Pregnancy on Methadone Metabolism

Often a pregnant woman’s dose needs to be adjusted as her pregnancy
progresses. Pregnancy increases a woman’s blood volume and may
increase the rate at which methadone is broken down to its inactive
metabolite. These changes mean that the woman’s methadone blood
level often fall as her pregnancy progresses, resulting in emergence of