Safety during pregnancy has not been established. Methadone has been shown to cross the placenta, and it is found in cord blood, amniotic fluid and in the newborn urine. Children born to mothers who were taking methadone for a prolonged period may exhibit respiratory depression or withdrawal symptoms. Methadone enters breast milk, and this can cause sedation and respiratory depression in the breast feeding infant. The benefit to the mother of taking methadone while breast feeding should be weighed against the risks to the infant.
The many effective behavioral treatments available for heroin addiction can be delivered in outpatient and residential settings. Approaches such as contingency management and cognitive-behavioral therapy have been shown to effectively treat heroin addiction, especially when applied in concert with medications. Contingency management uses a voucher-based system in which patients earn “points” based on negative drug tests, which they can exchange for items that encourage healthy living. Cognitive-behavioral therapy is designed to help modify the patient’s expectations and behaviors related to drug use and to increase skills in coping with various life stressors. An important task is to match the best treatment approach to meet the particular needs of the patient.