Opiate-addicted Parents in Methadone Treatment: Long-term Recovery, Health and Family Relationships

LrgWord_FamilyI recently came across this 10 year follow-up of parents in methadone treatment and their children from 2011.

Here’s a review of their outcomes.

First, here’s their definition of recovery:

Recovery status was based on recent drug use, history of drug problems, and history of incarceration. Long-term recovery was defined as no recent drug use (self-report or urinalysis [UA]) and no drug problems or incarcerations for at least 10 years (LHC data). Moderate recovery was defined as no recent drug use and no history of drug problems or incarcerations in the past 5 years.

Here are the outcomes for their definition of recovery:

Of the 144 parents in the original study, 34 (24%) had died. Nineteen (13.2%) appeared to meet our criteria for recovery for at least 10 years. Another 14 (9.7%) met these criteria for 5 to 10 years. Ten (7%) could not be characterized on recovery because they could not be located or contacted. The remaining 46% of the original sample did not meet our criteria for recovery because they experienced continuous or intermittent drug use or incarceration.

If that definition of recovery is a little too muddy for you, here’s some of the data on drug use.

Of the parents who reported no drug problems in the past 10 years (n = 37), over a third (n = 16) self-reported using illegal drugs in the previous 30 days and did not consider this a problem. Forty-nine percent of parents interviewed reported some illegal drug use in the past 30 days

Did they stay in treatment over the 10 years?

Forty-one percent of the parents reported participating in some form of drug treatment every year, and 32% were in methadone treatment every year. Methadone treatment was intermittent for 43% of the sample.

What about criminal justice involvement?

Arrests and convictions were common (90% had some WA state criminal record in the past 10 years), and periods of incarceration over the last 10 years were reported by 54% of parents interviewed, compared to a lifetime prevalence rate of arrests in the United States of 3%.

Mortality?

Mortality among the addicted parents was high. Thirty-two (25%) of the 130 families experienced the death of the addicted parent, and in 2 cases both parents had died before the long-term follow-up interview (34 deaths total). For comparison, mortality in the general population of Washington State was 7.5% 25in 2005 and 14.8% among heroin users in the Seattle metropolitan area.

Mental health?

Mental health was also compromised. Forty-eight percent met DSM III criteria for a major depressive disorder in the last 10 years. . . .  Twenty-one percent felt their mental health was not good every day (mean days = 12.47, SD = 11.53). This is a high compared to the general population in Washington (mean days of mentally unhealthy days = 3.3).

Employment?

Unemployment was common. At the time of the interview, 52% reported no employment in the past year (55% of women and 40% of men, NS), compared to the unemployment rate for Washington State, which was 5.5% in 2005.29 Forty-one respondents (35 women, 6 men, NS) reported no time in the past 10 years in which they were employed more than 30 hrs/week for at least 9 months.

Stable housing?

Thirty-six percent reported at least one year in which they did not have a regular place to live. There were no differences by gender. Four parents reported being homeless during the entire 10-year period and were homeless at the time of the long-term follow-up interview. Parents in long-term recovery were less likely to report homelessness (5.3%) compared to those in shorter term recovery (35.7%) or those still using (44.8%, X2 = 10.0, p = .007).

The experience of the kids?

Overall, however, this study fills an important gap in the literature by providing a window into the lives of parents struggling with drug addiction. Our study shows similar negative long-term outcomes for opiate-addicted parents in methadone treatment as other studies have found for more general populations of drug addicts and methadone clients.

. . .

Very few of the children were doing well at the long-term follow-up. As previously reported,9 only 24% of the children met criteria for functional resilience by being constructively engaged in school or work, not having abused drugs, and avoiding criminal charges in the last 5 years.

Keep in mind that this is the treatment frequently referred to as the “most effective” treatment. You should ask, “Compared to what? And, as for what outcome measure?”

Further,  recent media coverage of the issue paints anyone who raises these kinds of questions as out-dated, moralistic, simple-minded and one-wayers. Some coverage comes close to implying that anyone who questions ORT is enabling overdose deaths.

I’m not saying a reasonable person could not reach a different position than I have. But, I have a hard time understanding how a reasonable person could be so certain that they try to dismiss, censor and discredit others by questioning their ethics, intelligence and motives.

3 Comments

Filed under Uncategorized

3 responses to “Opiate-addicted Parents in Methadone Treatment: Long-term Recovery, Health and Family Relationships

  1. Cheryl Kupras

    I am wondering what contributed to the deaths? Age? Other long term chronic conditions like HCV and HIV? Murder? Suicide? Perhaps this study points to the better need for services for persons with multiple comorbidities. And the intermittent treatment with Methadone-why? Their choice? Kicked out of the clinic for having symptoms of the disease? Funding issues?

    • The link to the full paper is in the post, but here’s what it said about causes of death.

      Overdoses accounted for about a third of the causes of death in our sample (n = 11). Other causes of deaths included 3 cases of hepatitis, 1 AIDS, and 1 malnutrition, which may also be due to drug use. There were 2 deaths due to accident, 4 due to cancer of various forms, and 4 due to some form of heart problem. Four deaths were due to other causes (kidney failure, stroke, and respiratory problems). Death certificates could not be obtained for 4 of the deceased participants (2 confirmed with public records and 2 confirmed by close relatives).

      If your interested in the subject here’s another post.
      It didn’t give any more information on retention. However, problems with retention have been found in other studies.

  2. Having worked in a methadone clinic, for two years as their sole “drug free” counselor, I found that the clinic served society, more than it did those dependent on opiates. Arguably, these people were not committing the same number of crimes to obtain the heroin that had started them down this path, however, I didn’t get many takers when I proposed discontinuing their methadone and participating in “abstinence based” recovery. But than, why would they. They knew that the acute withdrawals, from years of opiate use, would result in weeks of acute withdrawal followed by a year or more of anhedonia or post acute withdrawal syndrome.
    Rather than focus on methadone, Jason, how about if we look at the studies out of France from 1994 and the studies that have been done, more recently, here in the U.S.
    We started using buprenorphine in 2004 in our full service outpatient addiction treatment program with the wave of pain pill dependent patients that gradually turned into a tsunami of heroin addicts as the DEA cracked down on accessibility. We have found that patient stabilized on buprenorphine, are universally relieved to be off of that roller coaster of increasing tolerance and decreasing funds to meet the Mu and kappa receptor’s demands. We spend a significant amount of time educating the family and the patient regarding the nature, scope, downsides and individuation of each patient’s treatment plan. Some, come to us with a strong history of chronic pain and years of high power opiate use, while others have a shorter history that involves, mostly, using opiates to achieve that sense of euphoria that opiates provide by firmly placing the user in the “here and now”. If you are old enough, you remember a book by Richard Alpert (Harvard Psychologist) and later know as Baba Ram Dass. His book BE HERE NOW, sold millions of copies and did a great job of describing that place that we all seek but with no map as to how to acquire it.
    This is important, only from the perspective that it is human nature to pursue this state and, for some people, opiates take them there and make the journey back, excruciating and long-lived. Buprenorphine allows the patient to return to a state of brain chemistry normalcy while the treatment team begins the process of introducing the potentials of a life of recovery. The same thing that I went through in 1980. However, without the bupe, they can think of only one thing and that is a return to the here and now. The opiate will call and call until the right moment hits and a relapse returns. With bupe, the siren’s call is silenced. Simultaneously, the bupe provides, for the chronic pain patient, anti-inflammatory and anti-cortisol properties. Cortisol is a stress hormone that is the source of much disease. More importantly, the bupe doesn’t create any tolerance, is virtually impossible to overdose on and provides a ceiling effect that allows for no high. I hear the nay-sayers rant about how it is a narcotic but it is a very different narcotic. It is a partial agonist and a partial antagonist on those receptor sites. The bottom line is the President of the United States has even weighed in on how the addiction treatment industry has been stuck in a decades old committment to abstinence only. Having been one of those, whose eyes were opened, he is right. We need to embrace science and remember that the Big Book is no more a book of medical science than is the Bible. AA saved my life. So did buprenorphine 25 years later. There are counselors and program directors around the country, who are experiencing a battle with chronic pain and opiate dependence. Most are too afraid to use buprenorphine because they will be fired by their inpatient program employer. So, they sneak in shame to their physician’s office or dealer and try to continue to “carry the message” while still dependent on opiates. Let’s give them the message that someone can be in recovery and be on buprenorphine, just like someone can be in recovery and take anti-depressants or antabuse or insulin. It is time for our industry to return to a place when we welcome the hopeless instead of intensifying their shame and fear.