Ask Stanton: Being forced into Medication-Assisted Treatment (MAT) against a pregnant patient’s will

Dear Stanton,

I just found out I was pregnant. My husband was told years ago he couldn’t have children so you can imagine our surprise. I was in an accident a few years ago and was prescribed hydrocodone 10mg up to three times a day. I’ve never taken that many a day usually 1 or 2. I talked to my doctor about lowering the mg and how many I take to slowly wean off them. Concerned for my unborn baby, My goal is to be off completely by my fifth month of pregnancy. My OB and pain doctor agrees that was a good plan and expressed how happy they were that I wanted to get off them.

That takes us to my appointment yesterday. My OB said that he feels I should switch and start taking methadone. That confused me because my goal was to get off the ones I was on, not start taking something new. I said I wasn’t sure if I was comfortable with that and he was upset. I just don’t understand why I would switch to that one when my goal is to get off them completely. I know the few studies that were done and it says methadone doesn’t show risk of birth defects or low birth weight in babies.

I guess I’m just confused as to what to do now. So my question is do you think I should follow my plan and get off of the lortab or should I start taking methadone? I was just told that once you take methadone you are on it for a while and it wouldn’t be something I could get off of while I was pregnant. I have two doctors and they both tell me a different story. One says she’s not comfortable with me starting methadone and the other says it’s the best thing for my baby!

Please help!!

 

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Stanton Peele’s response:

Rebecca,

You’ve entered the bizarro universe of medication assisted treatment, where weaning a person from a drug is considered an inferior outcome to helping a motivated patient (or person) to desist using a drug altogether. In this logic, since someone is addicted (and your taking fewer than the prescribed number of pills without discomfort for a prolonged time seriously calls such a diagnosis into question), you are biologically destined to remain drug dependent.

With that fantasized assumption in mind, it then becomes logical to maintain you on a prescribed opiate despite your personal goal of abstinence in line with your impending motherhood.

Let me first take a step back, and commend you and your medical providers’ collaborative plan for tapering from your opioid painkiller, hydrocodone. I cannot offer an opinion about this plan and on the drug’s effects on the fetus. (I am NOT a physician.) However, my impression seems to be in keeping with your medical caretakers’ assessment that opioids per se are not biologically harmful during pregnancy (as your own research with methadone showed) and that your (and the baby’s) being free of the drug for some months at the time of birth offers an excellent prognosis for mother and child at birth and beyond.

Furthermore, contrary to some medical opinion, I know it to be true that people quit addictions entirely all the time, with the key factors involved being motivation to quit and real-world consequences of continued use. Impending motherhood calls both these factors into play loud and clear!

Finally, underlying all drug-use decision-making is the patient’s (person’s) own desires, values, and free choice (all of which are recognized in medical practice under the rubric of “informed consent”). I honestly wonder what set of values this physician is operating under that leads him to so confidently disregard your articulated desire in this case, based on your own information gathering and consultations with other physicians.

So, unless this doctor can provide solid evidence that your baby will be harmed in utero by your current plan (which he seemingly cannot), I urge you to thank him for his concern, disregard his advice, and ask him to please discontinue his involvement in your case — with an implicit promise that you will seek out legal advice or other consequences should he persist in imposing his judgments on you.

Sincerely,
Stanton Peele, Ph.D. (psychology)

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Client response:

Thank you for your feedback!! After reaching out to different people and outlets I have come the conclusion that my original plan to get off of them is what I’m going to do.

I talked to a drug counselor yesterday who also agreed. I received a call from a program which my OB had called to refer me. They wanted to find out if I would be a good candidate for their program. After answering ridiculous quesions. Do I buy them off the street and am I taking a prescriptions prescribed to me? I told them obviously my doctor didn’t tell them that I only take what is prescribed and less than that even. I explained my plan on being off of them completely by the next month or so. The nurse agreed with my plan and didn’t know why my OB even recommended me. I told her I fell like there are two sides when you take opioids. You’re either a drug addict if you take them or you’re not if you don’t. I said some people do take them responsibly.

Anyway I do appreciate your thoughts on the matter and agree that people do and can get off them. I appreciate your approach to addiction. I come from a long line of social workers and therapists.  They all believe it is a disease. I have always argued it’s a learned behavior. It’s nice to see the advice you give to others and the encouragement. Just that in itself along with assuring them it’s not a disease I believe can give people hope of change.

Thank you again,

Rebecca