Unmanaged maternal opioid addiction poses health and social risks to both mothers and children in their care. Methadone maintenance treatment (MMT) is a targeted public health service to which nurses and other allied health professionals may refer these high risk families for support. Mothers participating in MMT to manage their addiction and their service providers were interviewed to identify resources to maximize mothers’ engagement in treatment and enhance mothers’ parenting capacity. Twelve mothers and six service providers were recruited from an outpatient Atlantic Canadian methadone treatment program. Two major barriers to engagement in MMT were identified by both mothers and service providers including (1) the lack of available and consistent childcare while mothers attended outpatient programs and (2) challenges with transportation to the treatment facility. All participants noted the potential benefits of adding supportive resources for the children of mothers involved in MMT and for mothers to learn how to communicate more effectively with their children and rebuild damaged mother-child relationships. The public health benefits of integrating parent-child ancillary supports into MMT for mothers are discussed. 1. Introduction In North America, opioid addiction to methadone, hydrocodone, and oxycodone has been described as an epidemic [1, 2]. In Canada, nearly 10% of women self-report an addiction to some form of illicit substance (e.g., cannabis; [3]) and nearly 2% abuse highly addictive opioid substances like oxycontin and heroin [4]. Many of these women are mothers of childbearing age [5] and face greater challenges than nonusers with raising their children and meeting their children’s developmental, social, cognitive, and emotional needs [6]. Substance abusing mothers are at increased risk of developing affective disorders, low self-esteem, anxiety, and depression and are often challenged by social isolation, reduced support networks, and exposure to violent relationships [7] and all of these factors can influence a mother’s capacity to parent her children [8, 9]. Taken together, unmitigated maternal substance abuse exacts social and health care costs by increasing the need for child protective, mental health and criminal justice services. Protecting children from exposure to maternal substance abuse is a public health priority [10, 11], particularly for nurses who work with childbearing families in the community [12]. Children exposed to maternal substance abuse are at increased risk for developmental problems, such as cognitive deficits,
References
[1]
P. Hall, D. Hawkinberry, and P. Moyers-Scott, “Prescription drug abuse and addiction: past, present and future: the paradigm for an epidemic,” Western Virginia Medical Jounral, vol. 104, pp. 26–32, 2010.
[2]
L. Manchikanti and A. Singh, “Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids,” Pain Physician, vol. 11, no. 2, pp. S63–S88, 2008.
[3]
M. Tjepkema, “Alcohol and illicit drug dependence,” Supplement To Health Reports, Statistics Canada, vol. 15, pp. 1–24, 2004.
[4]
E. M. Adlaf, P. Begin, and E. Sawka, Eds., Canadian Addictions Survey: A National Survey of Canadians’ Use of Alcohol and Other Drugs, Prevalence of Use and Related Harm, Health Canada, Ottawa: Canada, 2005.
[5]
Health Canada, “Best practice: methadone maintenance treatment,” in Office of Canada's Drug Strategy, Health Canada, 2002.
[6]
C. Montgomery, J. E. Fisk, and L. Craig, “The effects of perceived parenting style on the propensity for illicit drug use: the importance of parental warmth and control,” Drug and Alcohol Review, vol. 27, no. 6, pp. 640–649, 2008.
[7]
K. T. Jones, “Prenatal substance abuse: Oregon's progressive approach to treatment and child protection can support children, women, and families,” Willamette Law Review, vol. 35, pp. 797–826, 1999.
[8]
N. L. Letourneau, C. B. Fedick, and J. D. Willms, “Mothering and domestic violence: a longitudinal analysis,” Journal of Family Violence, vol. 22, no. 8, pp. 649–659, 2007.
[9]
N. Letourneau, M. Salmani, and L. Duffett-Leger, “Maternal depressive symptoms and parenting of children from birth to 12 years,” Western Journal of Nursing Research, vol. 32, no. 5, pp. 662–685, 2010.
[10]
S. Dawe and P. Harnett, “Reducing potential for child abuse among methadone-maintained parents: results from a randomized controlled trial,” Journal of Substance Abuse Treatment, vol. 32, no. 4, pp. 381–390, 2007.
[11]
S. Dawe, P. H. Harnett, V. Rendalls, and P. Staiger, “Improving family functioning and child outcome in methadone maintained families: the parents under pressure programme,” Drug and Alcohol Review, vol. 22, no. 3, pp. 299–307, 2003.
[12]
F. Go, M. Dykeman, J. Santos, and J. Muxlow, “Supporting clients on methadone maintenance treatment: a systematic review of nurse's role,” Journal of Psychiatric and Mental Health Nursing, vol. 18, no. 1, pp. 17–27, 2011.
[13]
J. Middlebrooks and N. Audage, The Effects of Childhood Stress on Health Across the Lifespan, Centres for Disease Control, National Center for Injury Prevention and Control, Atlanta, Ga, USA, 2008.
[14]
E. V. Nunes, M. M. Weissman, R. Goldstein et al., “Psychiatric disorders and impairment in the children of opiate addicts: prevalances and distribution by ethnicity,” American Journal on Addictions, vol. 9, no. 3, pp. 232–241, 2000.
[15]
Center on the Developing Child at Harvard University, The Foundations of Lifelong Health Are Built in Early Childhood, Center on the Developing Child at Harvard University, Harvard University, Boston, Mass, USA, 2010.
[16]
A. Garner, J. P. Shonkoff, B. S. Siegel, et al., “Early Childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health,” Pediatrics, vol. 129, pp. 224–231, 2012.
[17]
J. D. Lee, E. Grossman, D. Dirocco, and M. N. Gourevitch, “Home buprenorphine/naloxone induction in primary care,” Journal of General Internal Medicine, vol. 24, no. 2, pp. 226–232, 2009.
[18]
J. Mirlshari, A. Demirkol, M. Salsalsi, H. Rafiey, and J. Jahanbani, “Early Childhood experiences, Parenting and the process of drug dependency among young people in Tehran, Iran,” Drug and Alcohol Dependence, vol. 31, pp. 461–468, 2012.
[19]
K. A. Dolan, J. Shearer, M. MacDonald, R. P. Mattick, W. Hall, and A. D. Wodak, “A randomised controlled trial of methadone maintenance treatment versus wait list control in an Australian prison system,” Drug and Alcohol Dependence, vol. 72, no. 1, pp. 59–65, 2003.
[20]
R. P. Mattick, C. Breen, J. Kimber, and M. Davoli, “Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence,” Cochrane Database of Systematic Reviews, no. 3, Article ID CD002209, 2009.
[21]
W. W. Wechsberg, Methadone Maintenance Treatment in the U.S.: A Practical Question and Answer Guide, Springer, New York, NY, USA, 2002.
[22]
B. Fischer, M. F. Cruz, J. Patra, and J. Rehm, “Predictors of methadone maintenance treatment utilization in a multisite cohort of illicit opioid users (OPICAN),” Journal of Substance Abuse Treatment, vol. 34, no. 3, pp. 340–346, 2008.
[23]
B. A. Johansson, M. Berglund, and A. Lindgren, “Efficacy of maintenance treatment with methadone for opioid dependence: a meta-analytical study,” Nordic Journal of Psychiatry, vol. 61, no. 4, pp. 288–295, 2007.
[24]
H. D. Kleber, “Methadone maintenance 4 decades later: thousands of lives saved but still controversial,” Journal of the American Medical Association, vol. 300, no. 19, pp. 2303–2305, 2008.
[25]
L. A. Marsch, “The efficacy of methadone maintenance interventions in reducing illicit opiate use, HIV risk behavior and criminality: a meta-analysis,” Addiction, vol. 93, no. 4, pp. 515–532, 1998.
[26]
L. Pang, Y. Hao, G. Mi et al., “Effectiveness of first eight methadone maintenance treatment clinics in China,” AIDS, vol. 21, no. 8, pp. S103–S107, 2007.
[27]
J. Esteban, C. Gimeno, J. Barril, A. Aragonés, J. M. Climent, and M. De La Cruz Pellín, “Survival study of opioid addicts in relation to its adherence to methadone maintenance treatment,” Drug and Alcohol Dependence, vol. 70, no. 2, pp. 193–200, 2003.
[28]
A. Fugelstad, M. Stenbacka, A. Leifman, M. Nylander, and I. Thiblin, “Methadone maintenance treatment: the balance between life-saving treatment and fatal poisonings,” Addiction, vol. 102, no. 3, pp. 406–412, 2007.
[29]
A. Gibson, L. Degenhardt, R. P. Mattick, R. Ali, J. White, and S. O'Brien, “Exposure to opioid maintenance treatment reduces long-term mortality,” Addiction, vol. 103, no. 3, pp. 462–468, 2008.
[30]
P. Millson, L. Challacombe, P. J. Villeneuve et al., “Reduction in injection-related HIV risk after 6 months in a low-threshold methadone treatment program,” AIDS Education and Prevention, vol. 19, no. 2, pp. 124–136, 2007.
[31]
J. Chun, J. R. Guydish, E. Silber, and A. Gleghorn, “Drug treatment outcomes for persons on waiting lists,” American Journal of Drug and Alcohol Abuse, vol. 34, no. 5, pp. 526–533, 2008.
[32]
S. Schreiber, E. Peles, and M. Adelson, “Association between improvement in depression, reduced benzodiazepine (BDZ) abuse, and increased psychotropic medication use in methadone maintenance treatment (MMT) patients,” Drug and Alcohol Dependence, vol. 92, no. 1–3, pp. 79–85, 2008.
[33]
A. M. M. Burbridge, Evaluating methadone maintenance treatment outcomes in an Atlantic Canadian milieu [Doctoral dissertation], Psychology Department, University of New Brunswick, Fredericton, Canada, 2012.
[34]
G. P. McMillan, S. Lapham, and M. Lackey, “The effect of a jail methadone maintenance therapy (MMT) program on inmate recidivism,” Addiction, vol. 103, no. 12, pp. 2017–2023, 2008.
[35]
M. Teesson, J. Ross, S. Darke et al., “One year outcomes for heroin dependence: findings from the Australian Treatment Outcome Study (ATOS),” Drug and Alcohol Dependence, vol. 83, no. 2, pp. 174–180, 2006.
[36]
L. Amato, M. Davoli, C. A. Perucci, M. Ferri, F. Faggiano, and R. P. Mattick, “An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research,” Journal of Substance Abuse Treatment, vol. 28, no. 4, pp. 321–329, 2005.
[37]
M. Simpson and J. McNulty, “Different needs: women's drug use and treatment in the UK,” International Journal of Drug Policy, vol. 19, no. 2, pp. 169–175, 2008.
[38]
N. Poole and C. A. Dell, “Women and substance abuse,” Canadian Centre on Substance Abuse (CCSA) and British Columbia Centre of Excellence for Women’s Health, 2009, http://www.ccsa.ca/Eng/Pages/Home.aspx.
[39]
B. H. Bowie, “Interventions to improve interactions between drug abusing mothers and their drug exposed infants: a review of the research literature,” Journal of Addictions Nursing, vol. 15, pp. 153–161, 2005.
[40]
T. J. McMahon, J. D. Winkel, N. E. Suchman, and S. S. Luthar, “Drug dependence, parenting responsibilities, and treatment history: why doesn't mom go for help?” Drug and Alcohol Dependence, vol. 65, no. 2, pp. 105–114, 2002.
[41]
Center for Substance Abuse Research, Cesar Briefing Substance Abuse Treatment for Women and Children, University of Maryland, Baltimore, Md, USA, 2004.
[42]
A. Niccols, K. Milligan, W. Sword, L. Thabane, J. Henderson, and A. Smith, “Integrated programs for mothers with substance abuse issues and their children: a systematic review of studies on parenting outcomes,” Harm Reduction Journal, vol. 9, pp. 1–14, 2012.
[43]
A. Niccols, K. Milligan, A. Smith, W. Sword, L. Thabane, and J. Henderson, “Integrated programs for mothers with substance abuse issues and their children: a systematic review of studies on child outcomes,” Child Abuse & Neglect, vol. 36, pp. 308–322, 2012.
[44]
A. G. Tuckett, “Qualitative research sampling: the very real complexities,” Nurse Researcher, vol. 12, no. 1, pp. 47–61, 2004.
[45]
M. Patton, Qualitative Research and Evaluation Methods, Sage, Thousand Oak, Calif, USA, 3rd edition, 2002.
[46]
M. A. Jessup and C. D. Brindis, “Issues in reproductive health and empowerment in perinatal women with substance use disorders,” Journal of Addictions Nursing, vol. 16, pp. 97–105, 2005.
[47]
N. Poole, Evaluation Report of the Sheway Project for High-Risk Pregnant and Parenting Women, British Columbia Centre for Excellence for Women’s Health, 2000.
[48]
J. Trujois, N. Sinol, I. Iraurgi, et al., “Patient and clinician’s ratings of improvement in methadone-maintained patients: differing perspectives,” Harm Reduction Journal, no. 8, pp. 23–25, 2011.
[49]
Health Canada, “Best practices—early intervention, outreach and community linkages for women with substance use problems,” 2006, http://www.hc-sc.gc.ca/hlvs/pubs/adp-apd/early-intervention-precoce/index-eng.php.
[50]
P. H. Hughes, S. D. Coletti, R. L. Neri et al., “Retaining cocaine-abusing women in a therapeutic community: the effect of a child live-in program,” American Journal of Public Health, vol. 85, no. 8, pp. 1149–1152, 1995.
[51]
R. R. Szuster, L. L. Rich, A. Chung, and S. W. Bisconer, “Treatment retention in women's residential chemical dependency treatment: the effect of admission with children,” Substance Use and Misuse, vol. 31, no. 8, pp. 1001–1013, 1996.
[52]
L. C. Greaves, C. Varcoe, N. Poole, et al., “A motherhood issue: discourses on mothering under duress,” Cat. no SW21-99/2002E-IN, Status of Women Canada, Ottawa, Canada, 2002, http://dsp-psd.pwgsc.gc.ca/Collection/SW21-99-2002E.pdf.
[53]
C. E. Faupel and J. P. Hanke, “A comparative analysis of drug-using women with and without treatment histories in New York City,” International Journal of the Addictions, vol. 28, no. 3, pp. 233–248, 1993.
[54]
L. M. Lundgren, R. F. Schilling, T. Fitzgerald, K. Davis, and M. Amodeo, “Parental status of women injection drug users and entry to methadone maintenance,” Substance Use and Misuse, vol. 38, no. 8, pp. 1109–1131, 2003.
[55]
T. J. McMahon, J. D. Winkel, and B. J. Rounsaville, “Drug abuse and responsible fathering: a comparative study of men enrolled in methadone maintenance treatment,” Addiction, vol. 103, no. 2, pp. 269–283, 2008.
[56]
P. Radcliffe, “Substance-misusing women: stigma in the maternity setting,” British Journal of Midwifery, vol. 19, pp. 497–506, 2011.
[57]
A. Harrell, O. Mitchell, J. Merrill, and D. Marlowe, “Evaluation of Breaking the Cycle,” Urban Institute Justice Policy Centre, Washington, DC, USA, 2004, https://www.ncjrs.gov/pdffiles1/nij/grants/205002.pdf.
[58]
Advisory Council on the Misuse of Drugs, “Hidden harm: Responding to the needs of children of problem drug users,” 2003, http://www.drugmisuse.isdscotland.org/publications/local/hharm_full.pdf.
