Scenario

A 23 year old woman presented, stating she was pregnant and requesting methadone treatment. She reported having used heroin since the age of 13. She had been on buprenorphine for six months but had dropped out two months earlier. She was started on methadone and confirmed to be 20 weeks pregnant. In addition to heroin, she reported smoking cigarettes and cannabis.

She lived with her partner of five months, who was also on methadone. Medically, she had asthma and was hepatitis C positive. She rarely accessed health care. This was her second pregnancy. Her first child had been born one year earlier. During that pregnancy she was homeless and using heroin regularly. Her daughter was born at 36 weeks and weighed 2800 g. The child was removed at birth and remains in care.

Treatment comprised daily supervised methadone, weekly review by a nurse and medical practitioner, drug testing of urine, and assistance to attend antenatal care. Her methadone dose was increased to 50 mg/day by the time of delivery. Urine tests showed only methadone.

A baby weighing 3100 g was delivered at full term and did not need treatment for neonatal abstinence syndrome. After discharge, mother and baby continued to receive support and supervision from multiple services.