Detox and Pregnancy: WHAT YOU NEED TO KNOW

Do you…• Needtodrinkmoreorusemoredrugstogethighthanyouusedto?• Feelsickwhenyoutrytostopdrinkingorusingdrugs?• Usemorealcoholordrugsthanyoumeanto?• Wanttocutdown,buthaven’tbeenableto?• Spendalotoftimegettingalcoholordrugs?• Spendalotoftimerecoveringfromdrinkingorusing?• Missactivitieswithfamily,friends,orworksoyoucandrinkoruse?• Keepdrinkingorusingeventhoughitcausesproblems?

Ifyoudoanyofthesethings,youaredependent.

Detox and Pregnancy: WHAT YOU NEED TO KNOW

TABLE OF CONTENTS

DetoxWhatisdetox? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1HowlongwillIbeindetox? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Whatwillhappentomeduringdetox? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2WhatwillhappentomychildrenwhileIamindetox? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3HowwillIfeelduringdetox? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

PregnancyIjustfoundoutI’mpregnant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Whattoexpectduringpregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Warningsignstowatchoutfor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Caringformybabybeforebirth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Questions and Answers about OpioidsWhataremytreatmentoptions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12IsmethadonesafetotakewhenI’mpregnant? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14WhatwillhappentomybabyifI’monmethadone? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16WhatifIoverdoseonopioidsduringpregnancy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

After DetoxWhichtypeoftreatmentisrightforme? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18WherecanIfindtreatment? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20WhatifIstartusingagain? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Dealingwithfamilyandfriends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Resourcesforpregnantwomenandmothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Words to Know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Detox and Pregnancy: WHAT YOU NEED TO KNOW Thisbookisjustforpregnantwomenlikeyouwhoarestartingdetox.Gettingsoberisanimportantstepforyouandyourbaby.Thisbookwillanswersomeofyourquestionsaboutdetox.

What is detox?Detoxisaplaceforyoutogethelptosafelystopdrinkingorusingdrugs.Detoxstaffwillhelpyougetsober.Theywillalsohelpgetyoureadyfortreatmentandrecoveryafteryouleave.Theyaregoingtotakegoodcareofyouandyourbaby.

Ifyoudon’tfeelgoodunlessyouaredrinkingorusingdrugs,youare“dependent”onthem.Peoplewhoaredependentoftenneedtogotodetoxtosafelystopdrinkingorusingdrugs.

How long will I be in detox?Everypersonisdifferent.Thetimeyouneedindetoxdependsonalotofthings,including:

• Howsickyouget.Thedoctormaythinkthattherighttreatmentforyouisinahospitalsetting,whereyoucanreceiveobstetricalservicesinadditiontodetox.

• Whatdrugsyouwereusing.

• Ifyouhaveotherhealthormentalhealthproblems.

• Whattypeofinsuranceyouhave.

What will happen to me during detox?

• A doctor or nurse will give you a physical exam and ask about your alcohol and drug use.It’simportanttotellthedoctorornurseaboutallthedrugsyouaretaking,includingprescriptiondrugsandonesyoubuywithoutaprescriptionfromyourdoctor.Thiswillhelpyouandthedetoxstaffchosetreatmentthatisrightforyou.

• You will get medicine to help you feel better.Yourbodyisusedtotakingdrugs,anditfeelssickwithoutthem.Thesicknessyoufeeliscalledwithdrawal.Thedetoxstaffisheretohelpyoubemorecomfortableduringwithdrawal.Somewithdrawaleffectsareveryserious,butmostjustmakeyouuncomfortable–likefeelingitchy,dizzy,sicktoyourstomach.Youmayalsohavetroublesleeping.Withdrawalwillendoncetherearenomoredrugsoralcoholinyourbody.

• Your doctor may give you medicines to protect you and your baby from withdrawal.Thesemedicinescanmakeyoumorecomfortableandmakeitsaferforyourbaby.Forexample,youmaybegivenacetaminophen(Tylenol)forpain.Ifyouareatriskofhavingaseizure,yourdoctormaygiveyouLibriumorAtivan.

Noteveryonehasseriouswithdrawalsymptoms,butsomeseriouswithdrawalproblemscaninclude:• Seizures• Hallucinations(seeingandhearingthingsthatarenotthere)• Anxiety• Vomiting• Diarrhea• Pain• Pelvicpainand/orbleeding

Ifyouhaveanyoftheseproblems,telldetoxstaffrightaway.

Tell detox staff about all drugs you are taking. Taking certain medicines at the same time as some detox drugs can harm you and your baby.

It’simportanttogetcarefromadoctorwhenyouareinwithdrawalandpregnant.Withdrawalwithoutmedicalcareinadetoxcouldmakeitmorelikelythatyouwillhaveamiscarriageorstartlabor(givingbirth)toosoon.Amiscarriageiswhentheunbornbabydiesbeforeyoureachthe5thmonthofpregnancy.

Onceyouaredonewithwithdrawal,detoxstaffwillhelpyoumakearecoveryplanforwhenyouleavedetox.Thiswillhelpyoustaysober.

What will happen to my children while I am in detox?

InMassachusetts,goingtodetoxwhileyouarepregnantdoesnotmeanyourbabyorotherchildrenwillbetakenaway.

Thelawsaysdetoxstaffanddoctorsmustsendareport(calleda51A)totheDepartmentofChildrenandFamilies(DCF)if:

• Therearechildrenforwhomyouareresponsibleathomewhohavebeen,orareatriskofbeing,hurt(abused)orneglected.

ThelawdoesNOTsaydetoxstaffanddoctorshavetofilea51Abecauseawomanispregnantandisusingaddictivedrugs.

REMEMBER, EVERY FAMILY IS DIFFERENT. Make sure to talk with detox staff if you are worried about your children.

Ifyoutakemethadonethroughatreatmentprogramtotreatyouropioiddependence, seethespecialsectionaboutmethadoneandpregnancyonpage12.

Ifyoutakeopioids(likeheroin,OxyContin,orPercocet),seethespecialsectionabouttreatmentforopioidwithdrawalonpage13.

page 3page 2

page 5page 4

How will I feel during detox?Womenhavemanydifferentfeelingsduringdetox.

Youmayfeelstressedaboutnotdrinkingortakingdrugs.Youmightnotwanttobehereatall.Youmightbeafraidofwhathappensduringdetox.Youmightbeworriedaboutyourfamilyandwhatwillhappentothem.Youmightalsobefeelingexcitedandhopefulaboutchangingyourlife.

All these feelings and many more are normal to feel when you are in detox.

WHEN YOU ARE DEPENDENT ON DRUGS AND ALCOHOL, YOU ARE MORE LIKELY TO BE DEPRESSED. SOME SIGNS OF DEPRESSION INCLUDE:

• Asad,anxious,or“empty”moodthatdoesn’tgoaway• Lossofinterestinactivitiesyouusedtoenjoy,includingsex• Restlessness,irritability,beingmoody,orcryingtoomuch• Feelingguilty,worthless,helpless,and/orhopeless• Sleepingtoomuchortoolittle,wakingupearlyinthemorningand notbeingabletogobacktosleep

• Notbeinghungry,orbeingmorehungrythanusual• Losingweightorgainingweightwhenyouarenottryingto• Nothavingenoughenergy,feelingtiredor“sloweddown”• Thoughtsofdeathorsuicide(killingyourself)orsuicideattempts• Havingahardtimepayingattention,remembering,ormakingdecisions• Ongoingphysicalproblemsthatdon’tgetbetterwithtreatment,suchasheadaches

• Stomachproblemsandpainthatdoesn’tgoaway

Depressioncanhappeninrecovery,too.So,ifyouhavesomeormostofthesesigns,youmaybedepressed.It’simportanttoletyourdoctorordetoxstaffknowifyouthinkyouaredepressed.OryoucangethelpbycallingthestatewideEmergencyServicesProgram(ESP).Call877-382-1609,andenteryourzipcode.YouwillbegiventhenumberofthenearestESP.Orgotowww.masspartnership.comandclickonESPontheleftsideofthewebpageformoreinformation.

page 7page 6

Contacting your health insurance planManyhealthplansofferspecialcareforpregnantwomen.Theycanincludemedicalcareandotherservices.Somehealthplanswillhelpyougettoyourappointments(bypayingforabus ortaxi).Somewillcometothedetoxcentertoseeyou.

Mosthealthinsuranceplanshave2numberstocall.Makesureyoucontactboth:• Thebehavioralhealthplan(thepartofyourhealthinsuranceplanthatpaysfordetox)• Themedicalplan(theplanthatpaysforyourhealthcareduringpregnancy)

What if I don’t have insurance for care during my pregnancy? FindoutaboutHealthy Start.Thisisahealthinsuranceplanforpregnantwomenwhomeetcertainincomerequirements.Theprogramoffersprenatal(beforebirth)andpost-partum(afterbirth)care,counseling,andotherservices.Call1-888-665-9993tofindoutifyoucanuse theplanor1-800-841-2900tosignup.

When I was sent to detox, I was really worried about how I was going to pay for it. I talked to Linda, a detox counselor, and she helped me call my health insurance plan and gave them the information they needed. It really helped to have someone who knew all the right things to say to the insurance people.

-AnaDrug-free for 4 years

PREGNANCY

I just found out I’m pregnant Manywomenfindouttheyarepregnantwhentheycometodetox.Thisisbecauseallwomen takeapregnancytestwhentheystartdetox.

Ifyoujustfoundoutyouarepregnant,youmaynotknowhowlongyouhavebeenpregnant. Youcanfindouthowmanyweeksyouhavebeenpregnantbygettinganultrasound(also calledasonogram).Anultrasoundiseasyanddoesn’thurt.Theultrasoundwillletyouand yourdoctorseehowyourbabyisgrowing.Ifyoudon’thaveadoctorforyourpregnancy (calledanobstetricianorOB),thedetoxstaffmaybeabletohelpyoufindone.

Youmaynotknowwhatyouwanttodoaboutyourpregnancy.Thesearedifficultchoicestomake.Thefeelingsyouarehavingindetoxmaymakeitevenharderforyoutodecide.Ifyouwanttodiscussyourchoicesaboutthepregnancy,youcantalkwithyourdoctororcallacounselingagency,likePlannedParenthoodat1-800-258-4448;orKidsnetatMassachusettsSocietyforPreventionofCrueltytoChildren,1-800-277-5387whichprovides24houradaycounseling,www.mspcc.org/aol.

Baby Safe HavenEvenifyoucontinueyourpregnancy,youmaydecidethatyoudonotwanttokeepthebaby.Thereareanumberofoptionsyoumayconsider.Adoption

providesthemostdirectroutetoapermanenthomeforyourchild.Ifyouareunsure

aboutwhattodo,thereareresourcesthatcanhelp.Massachusettsalsohasa

programcalledBabySafeHaven.Thisprogramletsaparentgiveupanewbornbaby

(lessthan7daysold)withoutfacinganylegalcharges.Theparentmusttakethebaby

toahospital,policestation,ormannedfirestation.ThestaffwillthencontactDCF.

DCFwillplacethebabyinafosterorpre-adoptivehome.TheBabySafeHavenhotline

canbereached24hoursaday,7daysaweekat1-877-796-HOPE.Thishotlinewill

alsohelpyouunderstandyouroptions.

NOTE: You might not have this choice if you or your baby tests positive for illegal drugs when you give birth. In that case, the hospital is required to file a 51A.

page 9page 8

What to expect during pregnancy First trimester (0-12 weeks pregnant)

Inyourfirsttrimester,yourdoctorprobablywillnotbeabletohearyourbaby’sheartbeat.Thisisnormal.Youlikelywon’tfeelthebabymovingyet.Youmightfeeltiredandnauseous(feellikethrowingup).

Second trimester (13-27 weeks pregnant)

Sometimeatthebeginningofyoursecondtrimester,yourdoctormaybeabletohearthebaby’sheartbeat.Thistrimesteriswhenyoumightstarttofeelthebabymove.Tellthedetoxstaffifyoufeelyourbabymove.Yourbodywillstarttochangealotduringthistime.

Third Trimester (28 weeks pregnant to birth)

Thethirdtrimesterbeginsaround28weeks.

It’svery importantthatyouletyourprenatal(beforebirth)doctorknowyouareindetox. Thedoctorcanhelpmakesurethatyouandyourbabyarehealthy.Havingcontractions (atighteningofmusclesinyouruterus(womb))oryourwaterbreakingaresignsthatlabormightbe starting.Youneedtotellthedetoxstaffandgotothehospital.Ifyouareclosetoyourduedate,thedetoxstaffmightdecidethatit’sbestforyouandforthebabytofinishyourdetoxatthehospital.

Warning signs to watch out forThesearesignsthatyouoryourbabymightbesickorintrouble.Besuretotelldetox stafforcallyourdoctorifyou:

• Havefeltthebabymovebefore,butthemoving stopsanddoesnotstartagain.

• Haveanypain or vaginal bleeding(likeaperiodorheavier).

• Havecramps, contractions,oranypainyouhavenotfeltbefore.

• Havetovomit(throwup)andhavetroublekeepingfoodorliquidsinyourstomach. Ifyouarevomitingtoooften,youmightgetdehydrated(whenyourbodydoesn’t haveenoughwaterinit).

page 11page 10

Benefits to Quitting Smoking while Pregnant• Lowersyourriskofbleeding,improvingyourchanceofasafedelivery.

• Lesslikelytohaveyourbabyearly.

• Lesslikelytohaveababywhoissmall.Babieswhoaresmalloftenhavehealthproblemsandaremorelikelytogetsick.

• Increasestheamountofairyourbabywillget.

• Increasesthechancesyourbaby’slungswillworkwellafterbirth.

• Improveyourhealth.

CARING FOR YOUR BABY BEFORE BIRTH Contact a prenatal (before birth) doctor.It’sveryimportantthatyoumeetwithaprenataldoctor(calledanobstetricianorOB). Yourprenataldoctorwillworkwithyoutohelpkeepyouandyourbabyhealthy.

Manywomenfindithelpfulfordetoxstafftotalkwiththeirprenataldoctor.Youwillbe askedifyouwanttosignaformsayingit’sokayforthedetoxstafftogiveyourdoctor yourmedicalinformation.ThisformiscalledaRelease of Information .

Tokeepyouandyourbabyhealthy,besureto:

Remember — Your prenatal doctor needs to know what medicines you are taking at detox and what type of treatment you are doing. When you talk to your doctor, remember that you are the expert about you. Before your appointment, think ahead about what you want to know and what you want to ask. Take notes. Bring someone with you.

Ifyouaredependentonalcohol,it’sveryimportantthatyoutakethiamine(akindofvitaminBinprenatalvitamins).Alcoholcanmakeyourbodylowinthiamine.Lowthiaminecanleadtoproblemswithyourvision,notbeingabletorememberthings,andhallucinations(seeingthingsthataren’tthere).

Ifyousmokecigaretteswhileyouarepregnant,considercallingtheMassachusettsSmokersHelpline@1-800-QUIT-NOW(1-800-784-8669)forfreeinformationaboutquittingandtelephonecounseling.Enteringdetoxmeansyoumayberequiredbythefacilitytosmokelessoften.Thismaybeagoodtimetoconsidercuttingdownorquittingforgoodasitwillgreatlyimproveyourhealthandthatofyourbaby.

• Tellyourprenataldoctorthatyouare indetox

• Takeprenatalvitaminswithfolicacid• Quitsmoking(ifyousmoke)

• Tellyourdoctorwhattypeofmedicinesyouaretakingatdetoxand/orwhat typeoftreatmentyouaredoing

• Getenoughsleep

page 13page 12

QUESTIONS AND ANSWERS ABOUT OPIOIDS What are my treatment options?Therearespecialtreatmentsforpeoplewhouseopioids.Thesearecalledmedication-assistedtreatments.Medication-assistedtreatmentiswhenadoctorgivesyouadrug,usuallymethadone,butsometimesSubutex®,tohelpyousafelygetthroughwithdrawalandtostayoffillegalopioids.Medication-assistedtreatmentisrecommendedifyouaredependentonopioids.

Medication-assisted treatment is the best treatment for pregnant women who are dependent on opioids.

Opioid Treatment ProgramOnetypeofmedicationassistedtreatmentismethadonemaintenance.TheseprogramsarecalledOpioidTreatmentPrograms,andareoftenreferredtoasOTP’s.Methadonemaintenancestartsindetox.Duringdetox,youwillstarttotakemethadone.Onceyouarethroughdetoxandyourbodyisusedtomethadone,youwillgotoanOTPformethadonemaintenance.Methadonemaintenancetreatmentissaferforyouandforyourbabybecauseit:

• Getsridofcravingsforopioiddrugs

• Makesyoufeellesssickduringwithdrawal

• Cankeepwithdrawalfromstartingfor24hoursormore

• Blockstheeffectsofotheropioiddrugs

• Lowersyourriskofrelapse(takingdrugsagain)

Medically Supervised Withdrawal Medicallysupervisedwithdrawalisanothertypeofmedication-assistedtreatment.Inmedicallysupervisedwithdrawal,youstarttotakemethadoneduringdetox.ThenyougotoanOTPtocompletewithdrawal.Duringmedicallysupervisedwithdrawal,youtakesmallerandsmalleramountsofmethadoneuntilyourbodyisthroughwithdrawal.Theamountofmethadoneyoutakeandhowlongyoutakeitwilldependonwhatdrugsyouweretakingandforhowlong.

Methadone maintenance is recommended for pregnant women taking opioids. Butifyouchoosemedicallysupervisedwithdrawal,makesureyouknowthat:

• It’snotrecommendedinthefirst3monthsofyourpregnancy (yourfirsttrimester)becauseyoumighthaveamiscarriage.

• It’snotrecommendedinthelast3monthsofyourpregnancy (yourthirdtrimester)becauseyoucangointolabortoosoon.

• You are more likely to start using heroin and other opioids again, compared to people going through a methadone maintenance program.

IT’S IMPORTANT TO REMEMBER THAT ANY TREATMENT IS BETTER THAN NO TREATMENT. YOU AND YOUR DOCTOR NEED TO DECIDE WHAT TREATMENT IS BEST FOR YOU AND YOUR BABY.

Subutex(buprenorphine)isamedicationlikemethadone.Itcanalsoreducecraving,andloweryourriskofrelapse.SubutexissimilartoSuboxone®butismuchsaferforpregnantwomen.YoushouldNOTtakeSuboxonewhileyouarepregnant.AskmedicalstaffhereoratanOTPifyouwouldlikemoreinformationaboutSubutex.

page 15page 14

I was so scared when I started detox and found out I was pregnant. I didn’t know if I had made my baby sick. It really helped to talk to an OB outside of the detox center. She answered a lot of my questions and helped me focus on getting better.

-SarahDrug-free for 3 years

When you are in a medication-assisted treatment program, make sure that you have signed a Release of Information form. It’s important that your doctor and the program staff can tell Department of Children and Families (DCF) that you are in treatment, how often you go to treatment, and what drugs you are taking.

Is medication-assisted treatment safe when I’m pregnant? Manypregnantwomenhavesafelytakenmethadone.Methadonehasnotbeenshowntocausephysicalbirthproblems(defects).Butbabiescangothroughwithdrawalaftertheyareborn(calledneonatalwithdrawalsyndrome).Babiesusuallystartwithdrawalafewdaysafterbeingborn,butwithdrawalcouldstartaslateas4weeksafterbirth.Ababy’swithdrawalcanlastforweeks.Babiesgoingthroughwithdrawalmay:

Ifyourbabystartstoexperiencewithdrawalweeksafteryouleavethehospital,youmayseethesamesymptoms.Ifthishappens,letyourbaby’sdoctorknow.Yourbabyisnotindanger,butmayneedhelpgettingthroughthewithdrawalperiod.Sometimesthesesymptomslastforawhile.Whenthathappens,itiscalled“post-acutewithdrawalsyndrome”.

Subutexismedicationthatislikemethadone.Itissometimesusedinmedication-assistedtreatmentinsteadofmethadone.SomebabiesexposedtoSubutex(insteadofmethadone)mayexperiencewithdrawalforashorterperiodoftime,ortheirsymptomsmaynotbeasbad–butthisisnottrueforallbabiesexposedtoSubutex.IfyouareinterestedinSubutex,askmedicalstaffhereindetox.IfyougotoanOpioidTreatmentProgramafterdetox,youcanalsoaskaboutSubutexthere.

Andsomebabieswhosemotherssmokeduringpregnancyhavealongerperiodofwithdrawal,orhavemoreseveresymptoms.

Mostofthetime,beinginaquiet,comfortableplacewillmakeyourbabyfeelbetter.Ifyourbabyisreallysick,thedoctorcanprescribemedicinetohelp.Thedoctorwillalsogiveyouinformationonhowtomakeyourbabymorecomfortablewithoutmedicine.

Babiesborntomothersonmethadonearemuchhealthierthanbabiesborntowomenusingillegaldrugs.Whileit’snotknownforsurehowmethadonetreatmentmightaffectyourbabyinthefuture,yourbaby’shealthwillbemuchbetterthanifyouwerestillusingheroinorotheropioids.

Be fussy or restless • Not eat or sleep well • Have a fever • Vomit (throw-up) • Tremble or shake

Opioid maintenance and giving birth ItisimportanttotellyoudoctorsandnursesthatyouaretakingmethadoneorSubutex.ItisalsoimportanttogivethemthenameandphonenumberofyourOTPcounselor.Whenyouhaveoneofthesemedicationsinyourbody,yourdoctorwillneedtomanageyourpaindifferently.Thesemedicationsaffectthetypeandamountofpainmedicationyoutake.Therearedrugsforgivingbirththatyoucannottakewhenyouaretakingopioidmaintenancemedications.Ifyourdoctorsdon’tknowyouaretakingmethadoneorSubutex,theymightgiveyouadrugthatcanharmyouoryourbaby.Thereareothersafepainmedicationstheycangiveyou.

IfyouworryabouttellingyourdoctoryouaretakingmethadoneorSubutex,don’tforget–youaretheexpertaboutyou.Mostobstetriciansknowaboutopioidtreatment,butsomemayneedmoreinformation.It’sagoodideatohaveyourobstetriciantalkwithyourOpioidTreatmentProgram(OTP),especiallyifyourdoctorhasquestionsaboutmethadoneorSubutex.

What will happen to my baby if I’m on methadone or Subutex?Womenandtheirnewbabiesmaybetestedtoseeiftherearedrugsintheirsystemwhenthebabyisborn.Thisiscalledatoxicologyscreen.IfyouaretakingmethadoneorSubutex,itwillshowuponthetest.Thelawsaysyourdoctormustreportapositivetoxicologyscreenthatshowsdruguse,includingmethadone,totheDepartmentofChildrenandFamilies(DCF).Thisreportiscalleda51A.

DCFhasupto3daystodecideiftheyneedtofollowuponyourcase.DCFmaychoose nottoinvestigateyourcaseifall of these 3 things are true:

1. Theonlydrugfoundinyoursystemismethadone,buprenorphine(thedrugthatisthebasisforSubutex),oraprescribedmedicine(fromyourdoctor)thatisbeingtakentotreatamedicalproblem.

2. Thedrugfoundinyoursystemisapprovedbyadoctor,andthedoctorwhogaveyouthemedicineconfirmstoDCFthatitisbeingtakenaspartofatreatmentprogramtotreatamedicalproblem.

3. Therearenosignsofabuse,neglect,orrisktoyourbabyorotherchildrenathome.

page 17page 16

DCFhasbookletsdescribinghowtheyrespondtothese(andotherreports).Theseareavailableonline.Gotowww.mass.gov/dcf.OntheDCFpage,righthandside,clickon:ChildAbuseandNeglectPublications.DCFhasguidesinEnglish,Spanish,HaitianCreole,Portuguese,KhmerandRussian.Onthesamepage,lefthandside,clickonIntegrated Casework Practice Model(ICPM),andthenclickon ICPM fact sheet.IfyouwouldliketotalktoparentswhohavebeeninvolvedwithDCF,youcancontactParents Helping Parentsat1-800-632-8188,www.parentshelpingparents.org/ .

What if I overdose on opioids during pregnancy?AmedicinecalledNaloxone(oftenknownbythebrandname,Narcan)canstopanopioidoverdose.Naloxonecansaveaperson’slife,butitcanalsocauseseriouswithdrawal.Naloxonecancauseapregnantwomantohaveamiscarriageorgivebirthtoosoon.Naloxonecanalsocauseveryseriouswithdrawalinbabiesrightafterbirth,includingbeingstillborn(dead).

That’swhybeingintreatmentnowissuchagoodmove.

After DetoxWhenyoufinishgoingthroughdetox,youhavecompletedthefirststeptowardyourrecovery.Youhavechoicesaboutwhattodonext.Talkwithdetoxstaffaboutthedifferentchoicesyouhave.Therearedifferentwaysthatyoucancontinueyourtreatment.It’simportanttofindaprogramthatworksbestforyou.

•Aredetoxingfromdrugsthattakealongtimetogetoutofyoursystem(liketranquilizers,valium,Librium,Xanax,benzodiazepines).

•Needshort-termsupportforotherhealthproblems.

•Needmoretimetoplanyournextstepsfortreatment.

•Donothaveasafeplacetostay.

•Havefamilyandfriendsathomethatarenot,andwillnotbe,usingalcoholordrugs.Youhavestrongsupport.

•Cangettotreatmentappointmentsregularly(haveawaytogetthere, cangetoutofwork,orgetchildcare).

page 18

Transitional Outpatient Residential Rehab OpioidSupport Services Treatment Treatment Programs

•Live-in •Liveathome •Live-in Liveatresidentialrehab, •Short-term(30daysmax) •Counselingandeducation •Longterm(3-6months) transitionalsupport,orathome •Counselingandeducation Methadonemaintenancewith •Helpfindingemploymentandhousing counselingandeducation

This may be a good option if you: This may be a good option if you: This may be a good option if you: This may be a good option if you:

•Havefamilyandfriendsathomewhoareusingalcoholordrugs.Youwillneedalotofsupportinearlyrecovery.

•Feelunsureorshakyaboutbeingabletostopusingalcoholordrugs.Youworrythatyouwillstartusingagain(relapse).

•Havementalhealthconditionsthatmakeitdifficulttoplanandknowwhattodo.

•Donothaveasafeplacetostay.

•Aredetoxingfromopioids (likeheroinorPercocet).

•Plantodomethadone maintenanceorwant medicallysupervised withdrawal.

page 19

Talk with detox staff about your choices.Somehealthplansofferspecialprogramsandservicesforpregnantwomen.Theseservicescanhelpyoumakeappointmentswithyourdoctorandcounselor,andhelpyougettoappointmentsand12-stepmeetings.Tofindoutwhatservicesyourhealthplanhas,callthemandaskassoonasyoucan.Thephonenumberforyourplanisonyourinsurancecard.

Where can I find treatment? Bureau of Substance Abuse Services (BSAS)

BSAShasahelplinetofindtreatmentprograms.Thisisavailableonlineat www.helpline-online.organdbyphoneat1-800-327-5050 (TTY: 1-888-448-8321) .

Institute for Health and Recovery (IHR)

IHRisthemainplacetoapplyforresidentialtreatmentservicesforpregnantwomen. Call1-866-705-2807 or 1-617-661-3991 .

Alcoholics Anonymous (AA)

InEasternMassachusettscall1-617-426-9444 or www.aaemass.org InWesternMassachusetts,call1-413-532-2111 or www.westernmassaa.org

Foralistofmeetingsthroughoutthecountry,gotowww.aa.org

Narcotics Anonymous (NA)

E-mailinfo@newenglandna.orgorvisitwww.Newenglandna.orgorcall 1-866-624-3578 (1-866-NA HELP U)

Detoxstaffcanhelpyoufindfurthertreatment,too.

page 20

What if I start using again?Peoplewhoaredependentondrugsoralcoholcanbetreated,butnotcured.Sometimespeoplewillbegintousealcoholand/ordrugsagain.Thisiscalledarelapse.

Arelapseisseriousandcanbedangerous.Preventingrelapseisanimportantpartoftreatment.Whenarelapsehappens,peoplemightnotbelievethattheycanquitforgood.Manytimesfamilyandfriendswillbeangryandupset.

If you do relapse, it does not mean that you are not trying or you don’t want to be sober. Usually, it just means you don’t have the skills and support to stay in recovery.

Topreventrelapse,youneedto:

• Knowwhatsocialeventsmayhavepeopledrinkingand/orusingdrugs,andlearnhowto stayoutofthosesituations(calledtriggeringsituations)

• Findwaystodealwithhigh-riskortriggeringsituations

• Knowwhenyouarecravingtodrinkoruse,andfindwaystostaysoberuntilthecravinggoesaway

• Findagroupofhelpfulfamilymembersandfriendsthatsupportyourrecovery

• Understandwhyyouhaverelapsedinthepast,andtrytochangeorfixthoseproblemssoyoudon’trelapseagain

• Knowthatnomatterhowmanytimesyouhaverelapsed,youcanstaysober.Don’tgiveup.

Dealing with Family and FriendsPeoplewhoaredependentondrugsoralcoholoftenstopdoingthingstheyenjoy,likespendingtimewithfamilyandfriends.Usingdrugsandalcoholhurtsrelationships.

Everyonewillreactdifferentlytoyouandyouralcoholordruguse.Familymembersmaybeangry.Friendsmaynottrustyou.Theyareworriedaboutyourhealth.

Thegoodnewsismanyofyourrelationshipscanberepaired.Whenyouareinrecovery,youcanfindsupporttohelprebuildyourlife.Usuallyyourfamilyandfriendswillsupportyouingettinghelp.

page 21

ChildrenChildrenmaybeconfused,scared,andnervous.Sometimeswhenchildrenhaveaparentindetox,theydoworseinschoolandactout.Thegoodnewsisthatchildrencanalsogetbetterbyseeingyougetbetterandbytalkingtoacounselor. Manyfamiliesfeelhappierandcloserwheneveryoneisalcoholanddrugfree.

ARE YOU IN AN ABUSIVE RELATIONSHIP?Abusecanbephysical,financial,andemotional.Themainsignisfearofyourpartner.Someothersignsincludewhenyourpartneroradultyoulivewithis:• Hittingorthreateningtohityou• Threateningtotakeyourkidsaway,commitsuicide,ordamageyourhome• Forcingyoutohavesexordodrugs• Callingyounamesandputtingyoudown• Cuttingyouofffromfamilyandfriends• Notlettingyouhaveajoborabankaccount

Abuseoftengetsworseduringpregnancy.Italsomakesitmorelikelythatyouwilluse alcoholordrugsagain.Ifyouexperienceviolenceinyourrelationship,orifyouarescaredofsomeonebecomingviolent,nowisthetimetodosomethingaboutit.

Youcanaskdetoxstafftohelpyou.YoucanalsogethelpthroughSafelinkbycalling 1-877-785-2020 (TTY: 1-877-521-2601) .

page 22

RESOURCES FOR PREGNANT WOMEN AND MOTHERS Women and Infant Care (WIC)

WICprovidesvouchers(usedinplaceofmoney)forfood(likemilk,eggs,cereal,andinfantformula)forpregnantwomenandyoungchildren.WICisbasedonyourincome(howmuchmoneyyoumake)andifyouliveinMassachusetts.YouwillneedanIDtoproveyouridentity,likeadriver’slicenseorpassport.Togetmoreinformation,call1-800-WIC-1007(1-800-942-1007).

Child Care

Forinformationaboutchildcare,visitwww.mass.gov/eec.Linksforchildcareprograms,parentandfamilysupportprograms,andotherhelpfulresourcesarelistedontheleftsideofthiswebpage.

Parenting

TheChildren’sTrustFundofMassachusettskeepsalistofagenciesthatofferhelpwithparenting,includinghowtoparentbabiesandyoungchildren.Youcancheckthewebsitewww.mctf.orgorcall1-617-727-8957oremailinfo@mctf.state.ma.us

Early InterventionVeryyoungchildren(babiestoage3)cangetearlyintervention.Earlyinterventionserviceshelpbabiesandtoddlerswhotakealittlelongertodeveloporareatriskfordelays.Developmentdelaysarewhenachildislateinstartingtodevelopcertainskillsliketalkingorwalking.EarlyInterventionteamsworkwithfamiliestofigureoutwhatservicescanhelp,thenafterherbaby isborn,helpherlookintoearlyinterventionservices,atwww.massfamilyties.org .

Massachusetts Organization for Addiction Recovery (MOAR)

MOARisastatewideorganizationofindividuals,families,andfriendswhojointogethertoeducatethepublicaboutthevalueofrecovery.Visitwww.moar-recovery.orgorcall 1-617-423-6627 .

STAYING HOPEFUL

Detox staff are here to help you stay strong and build a new life. This is the start of your journey toward sobriety and recovery. You can stay healthy for yourself and your baby. Congratulations on taking the first brave step.

page 23

WORDS TO KNOWHere are some words that you will hear during detox, at the doctor’s office, or in treatment. If staff or your doctor use a word you don’t understand, ask them what it means.

Dependence:theneedaperson’sbodyandminddevelopswhenaddictedtoalcoholorotherdrugs.

Detoxification:thetimewhenapersonisgettingadrugand/oralcoholoutofhisorherbody.

Ectopic:anabnormal(notnormal)pregnancywherethebabydevelopsoutsideoftheuterus(womb),usuallyinthefallopiantubes.++

Embryo:thebeginningformofababy.Ababyiscalledanembryofromthemomentit’sconceived(whentheeggandspermmeet)totheendofmonth2ofapregnancy.*

Fetal Alcohol Syndrome (FAS):growth,mental,andphysicalproblemsthatmayoccurinababywhenthemotherdrinksalcoholduringpregnancy.++(AlsoincludesFetal Alcohol Spectrum Disorder (FASD) and Fetal Alcohol Effects (FAE))

Fetus:anothernamefortheunbornbabyfromtheendofweek8ofpregnancyuntilbirth.*

Gestation:thetimeperiodofpregnancy,whenthebabyisgrowing.*

Hepatitis:adiseaseoftheliverthatisspreadfrompersontoperson(likethroughsexorsharingneedles)orfromtakingsubstances(likealcoholanddrugs).

HIV (Human Immunodeficiency Virus):ThevirusthatcausesAIDS(AcquiredImmuneDeficiencySyndrome).PeopledieofAIDSbecausetheirbodiescan’tfighttheillnessestheydevelop.

Source:Heile’sNewburyDictionaryofAmericanEnglish(online)

Hyperemesis:extreme,non-stopnausea(feelinglikeyouneedtothrowup)andvomiting(throwingup)duringpregnancythatmayleadtodehydration(nothavingenoughwaterinyourbody).++

Methadone:aprescriptiondrugusedtotreatpeoplewhoaredependentonopioids.

Miscarriage:whenthefetusdiesbeforeyoureachweek20(5months)ofpregnancy.

Naloxone:adruggiventostopanopioidoverdose(alsoknownbythebrandnameNarcan).

page 24

Neonate:anewborn(ababylessthan28daysold).*

Obstetrician:Adoctorwhogivescaretoapregnantwomanandherbaby,includingwhensheisgivingbirthandthetimerightafterthebabyisborn.

Opioid:adrugmadefromopium(includesheroin,fentanyl,OxyContin,methadone,morphine,Percocet,andVicodin).

Over-the-counter:amedicineavailablewithoutaprescription.

Perinatal:happeningbefore,during,orafterthetimeofbirth(fromweek28ofpregnancythroughthe7daysafterthebabyisborn).*

Postnatal:happeningafterbirth.*

Prenatal:happeningbeforebirth.*

Prescription:amedicineorderedbyadoctor.

Preterm:laborthatbeginsbeforeweek37ofpregnancy(earlylabor).**

Release of Information:Aformthatapatientsigns,whichallowsonehealthcareprovider tosharethepatient’smedicalinformationwithanotherhealthcareprovider.

Substance use disorder (SUD):arangeofconditionsreferringtoalcohol,tobacco,andotherdruguse,includingsubstancedependence,abuse,andwithdrawal.+++

Subutex:aprescriptiondrugusedtotreatpeoplewhoaredependentonopioids.

Tolerance:thebody’sabilitytogetusedtohavingalcoholanddrugsinit,makingapersondrinkorusemoretogetaneffect.

Trimester:onethird(threemonths)oftheninemonthsofpregnancy

Ultrasound (also known as sonogram):theuseofsoundwaves(thatyoucan’thear)togetpicturesoforgans(likeyourstomachorheart)andstructuresinsidethebody(likeababy).Duringpregnancy,doctorsuseultrasoundtolookatthebaby.+

Withdrawal:thephysicalreactionabodyhaswhenapersonstopstakingdrugsoralcohol.

*FromTIP2Pregnant,SubstanceAbusingWomen+FromTIP45DetoxificationandSubstanceAbuseTreatment++fromMedline**NIHwebsite+++105CMR164definition

page 25

Where you can find treatment:

Bureau of Substance Abuse Services (BSAS) BSAShasahelplinetofindtreatmentprograms.Thisisavailableonlineat www.helpline-online.organdbyphoneat1-800-327-5050 (TTY: 1-888-448-8321) .

Institute for Health and Recovery (IHR) IHRisthemainplacetoapplyforresidentialtreatmentservicesforpregnantwomen. Call1-866-705-2807 or 1-617-661-3991 .

Massachusetts Smokers HelplineForfreeinformationaboutquittingsmokingandfreetelephonecounseling. 1-800-Quit-Now (1-800-784-8669)

Alcoholics Anonymous (AA) InEasternMassachusettscall1-617-426-9444 or www.aaemass.org InWesternMassachusetts,call1-413-532-2111 or www.westernmassaa.orgForalistofmeetingsthroughoutthecountry,gotowww.aa.org

Narcotics Anonymous (NA) E-mailinfo@newenglandna.orgorvisitwww.Newenglandna.orgorcall 1-866-624-3578 (1-866-NA HELP U)

SA3510Jun2011