Suboxone and Methadone Maintenance Therapy: Don’t Our Children Deserve Better?
As a father, my heart belongs to my children. As the owner of a person with substance use disorderion treatment center, my thoughts are with my clients and how to help them return to their families. I recognize in these two roles, that my feelings toward children, mine and those of others, and my obligations toward my clients, often parents who are working to rebuild positive relationships with their children, are sometimes in conflict. Recently, I was asked to address the realities of parents who are on opioid replacement therapies (ORT), particularly methadone and Suboxone, and the needs of their children. It is my considered opinion that the law may side too heavily with the rights of parents, while not adequately protecting the needs of children.
Let’s understand ORT. ORT, whether methadone or Suboxone, is a replacement medication for those who are addicted to opioid pain medications or heroin. It serves as a way to ease withdrawal symptoms and in long-term use, is a replacement or substitute for prescription painkillers or heroin. Suboxone is often preferred over methadone because it is taken in a form that does not require daily doses in a clinical setting. Methadone also is more easily abused than Suboxone, as Suboxone has an additive that makes at least some users sick when it is crushed and used intravenously. ORT is given in a dose that does not allow a person to feel high, but does give enough of the drug to keep the addict from feeling sick. These drugs are “safest” when tolerance is developed and though a person might technically have enough drugs in their system to be high, the addict feels normal. Most doctors are moving away from methadone toward prescribed Suboxone because it is believed that Suboxone has less potential for abuse. Suboxone has a mixed bag in terms of results and its use is highly controversial in the addiction treatment community.
The medical literature on Suboxone says that it is safe to leave children in the care of someone who is on Suboxone, if the medication is being used exactly as prescribed and a preliminary dosing period has provided the patient with a steady dose. This is all well and good if you are among the small percentage of ORT users who do not relapse or die while on an ORT treatment plan. Relapse rates are high and mortality rates are far above average. Do we allow addicts on ORT to supervise children and wait and hope that no relapse occurs? My suggestion is no, because even if a relapse while on Suboxone is minor or short-lived, there is a great deal of evidence that shows that children who have access to Suboxone are at high risk of accidental ingestion and overdose leading to death. Even having Suboxone in the home is playing with fire.
A related problem with Suboxone use is driving under the influence. In some states, it is illegal to drive with Suboxone in one’s system. In other states, the police must show that the medication impairs the ability to drive. Even in that case, it is very possible that those who use Suboxone even as prescribed can be too impaired to drive as the medication has many contraindications for drug mixing. For example, mixing a standard dose of Suboxone with a single beer or prescribed medication for depression can have disastrous results. Is this a situation into which children should be thrown into the mix? Even if it is strictly legal, would you leave your child with an adult you know to be on Suboxone, methadone or other medications that can impair decision-making? I’m a professional in the field and I certainly will not.
Parents, including addicts and especially those in recovery, have rights. Children have rights too. Where do we place our values? As someone who provides care to addicts and knows the real probability of relapse for those who are on ORT, I have to support looking first and foremost at what is in the best interest of children. While it may be legal in the strictest standard of the law for someone who is on ORT to mind children, cook their dinner, drive them to soccer, or supervise their baths, is that what is in the children’s best interest? Do we wait until relapse and disaster strikes to take action? You wouldn’t place your children in the care of someone on methadone or Suboxone, so why allow others to do that very thing? Yes, parents have protected rights, and at the same time, we have to consider the welfare and safety of our children.
I am abstinent from drugs and alcohol for more than a decade. I leave my children in the care of individuals in recovery all the time. I don’t think twice about it because those who are established in an abstinence based recovery have the ability to put the needs of the children in their care first. Those who are on ORT do not have the clarity of mind, in my opinion, to be unsupervised primary caregivers for children. ORT has a role to play in addiction treatment, but it should be a stepping stone to abstinence based care, not the end of the road and a “maintenance” treatment. Our children deserve better than that.