Megan knew her baby girl was going through withdrawal, because everything about her was tight. This was a feeling she recognized. “That’s what it’s like,” she explains. “You’re not yourself.” She holds up her fists to demonstrate. The baby wouldn’t stop crying. She couldn’t get comfortable. For almost the entire nine months of her pregnancy, Megan had been on buprenorphine (brand name Suboxone) to treat opioid dependency. Stephanie Bobby, the nurse in charge of the Pregnancy Recovery Center (PRC), warned Megan that withdrawal was a possibility. The chances were one in three, although Megan never thought it would happen to her child.
She was scared and didn’t want it to be true, but Megan knew she had to do what was best for her baby. The nurses at Magee Women’s Hospital in Pittsburgh, where the PRC is housed in the basement, treated her baby for withdrawal, or neonatal abstinence syndrome (NAS), for 17 days.
Megan, who talks quickly and seems capable of getting anything done, stayed on buprenorphine for the next two years. When she and her husband — also treated with buprenorphine for opioid addiction — started talking about having a second child, the thought of putting another baby through withdrawal was unbearable. Megan wouldn’t even consider getting pregnant until she’d slowly weaned herself off the buprenorphine.
When Bobby found out Megan was completely off buprenorphine, she asked her to interview for the peer navigator position the PRC was creating with grant money. As a peer navigator, she’d guide PRC patients using her firsthand experience with the recovery process. She knew what they’d be going through. The PRC maintains that medication-assisted treatment (MAT), such as buprenorphine, can be a long-term solution for addiction, and the hospital does not propagate abstinence, yet they wouldn’t hire Megan if she was still taking the medication.
This is a confusing contradiction that raises the question: Does being “clean” require abstinence?
There are two simple and contradictory answers.
One, yes. Twelve-step programs such as Alcoholics Anonymous and Narcotics Anonymous work on the basis of complete abstinence. For example, no marijuana in AA. They aren’t going to kick you out (because according to one of their traditions, “the only requirement for membership is the desire to stop drinking [using]”), but if you tell people you’re smoking marijuana, someone is probably going to tell you that you aren’t “sober.”