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2012 Jordan Institute
for Families

Vol. 17, No. 1
March 2012

Methadone: Intro for Child Welfare Workers

In the field of child welfare today there is growing emphasis on evidence-based practice. While we have yet to develop a solid base of empirical evidence for much of what we do in child welfare, there are interventions that have been proven to be effective and which we should embrace. Methadone maintenance—the best known form of medication-assisted drug treatment—is one such intervention.

What is methadone?
Methadone is an opioid medication that is used as a pain reliever and, together with counseling and other psychosocial services, is used to treat individuals addicted to heroin and certain prescription drugs (US Children’s Bureau, 2009). Methadone:

  • Blocks the euphoric and sedating effects of heroin and other opiates;
  • Relieves the craving for heroin and other opiates that is a major factor in relapse;
  • Relieves symptoms associated with withdrawal from heroin and other opiates;
  • Does not cause euphoria or intoxication (with stable dosing), thus allowing a person to work and participate in society (APT Foundation, 2010).

What is methadone maintenance treatment?
Methadone maintenance is an outpatient treatment program in which people currently dependent on heroin or other opiates receive a daily dose of methadone (often in liquid form), with counseling and other social and rehabilitation services (APT Foundation, 2010).

Where Do You Stand?
Would you tell an insulin-dependent diabetic parent that she may not have her children back unless she stops taking insulin and manages her diabetes solely through nutrition and exercise?

Individuals engaged in methadone maintenance treatment can face heavy discrimination within the child welfare system from judges, attorneys, and caseworkers who believe the ultimate goal of treatment should be a completely drug-free individual.

Stopping the methadone treatment, however, leaves the individual at a very high risk for relapse to illicit opiate use and its associated high-risk factors, including unsafe injection practices and illegal behavior in order to support a habit. All of these can significantly increase the risk of abuse or neglect to children in the custody of these parents.

Hence, the decision to require a detoxification from methadone must be considered carefully and based upon sound clinical principles rather than upon the stigma associated with methadone treatment.

Adapted from SAMHSA, 2009

How long does treatment last?
Treatment duration should be decided by each individual and his or her physician. Some people leave treatment after a few weeks; others choose to stay in treatment indefinitely. Those who quit after short-term treatment are more likely to return to drug use than those who stay in treatment until they have obtained optimal benefits (SAMHSA, 2009).

Safety
Methadone treatment is medically safe and used even with pregnant women. It creates the same physical dependence, but reduces the deaths, HIV infections, crime, and violence associated with heroin use. It allows people to work and parent, live productive lives, and improve their health (Joseph, 2000; Brady, 2007).

Effectiveness
Studies have shown methadone to be a highly effective treatment for addiction to heroin and other opiates. Methadone maintenance has been endorsed by organizations such as the American Public Health Association, NIDA, and others; public health insurance programs, such as Medicaid, often pay for it (Lundgren, et al., 2006).

Do methadone clinics do drug testing?
Yes. Clinics are required to provide drug abuse testing, with a minimum of 8 random urine drug tests per year (Lundgren, et al. 2006).

Impact on parenting capacity
With stable dosing, methadone does not cause euphoria or intoxication. That said, the extent to which any drug will negatively impact someone’s ability to parent depends on a variety of case-specific factors. Assessments of parenting capacity must focus on the needs of children and their parents’ ability to provide for them. Each family should be assessed individually.

Benefits to families and children
Benefits of methadone treatment for opiate addicted parents include improvements in health and employment status and reduced risk of death, HIV, crime, and violence (Kott, et al., 2001). Participation in methadone treatment also has been linked with improved child rearing and reduced involvement with child protective services (Kott, et al., 2001). Methadone can make it possible for families of opiate-dependent mothers to remain together while the mothers receive treatment (Lundgren, et al., 2006).

References for this and other articles in this issue