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symptoms of withdrawal. The methadone dose must be increased in
this situation, until symptoms of withdrawal are completely
suppressed.
The most commonly seen pattern is that the methadone dose needs to
increase during the first and the third trimesters and remains fairly
constant during the second trimester. In some women, this can be
dramatic, with the methadone dose doubling over the course of the
pregnancy. In these patients, measuring the methadone blood level
confirms that the level falls dramatically during the pregnancy and
rises again after delivery. These patients need the dose decreased after
delivery to prevent sedation. Some pregnant women cannot be
stabilized on one dose a day and must take a morning and evening
dose of methadone to prevent emergence of symptoms of withdrawal.
Methadone Maintenance Alone is Insufficient to Treat Opioid
Addiction in Pregnancy
In addition to the medical issues surrounding heroin dependence, the
heroin-addicted patient frequently comes from a severely disordered
family. The intensity of chaos and dysfunction seen with heroin
addiction surpasses that associated with other substances. There is
often brokenness that encompasses every aspect of the woman’s life.
Pregnancy in this setting complicates the problem.
Some of the problems include: homelessness, inadequate resources
for food/clothes/other basic needs, hazards in the home environment
(unsafe area, uncontained dogs, lack of hot water, rats, toxic
chemicals), domestic violence, drug using family or friends in the
home, lack of parenting skills, school-aged children in the home who
are not enrolled in school, involvement with criminal justice,
involvement with social services, no high school diploma, little or no
vocational skills/training, lack of access to medical/dental care,
untreated chronic/acute medical/dental problems, poor nutrition,
severed relationships with healthy/sober family/friends.
Perhaps the most critical issue when treating the heroin-addicted
pregnant patient is to understand that unless multiple issues are
