Lisa Pulley's fourth daughter was born last week. She put the first three up for adoption long ago because she couldn't - really, wouldn't - stop using crack cocaine and heroin long enough to focus on them. n The eighth-grade dropout has never held a job. She has been too busy selling sex for drugs, living on the street so she could afford drugs. There was no room in her life for children.
But this time, Pulley swears, she is ready. This time, she keeps telling herself, will be different. This time, she wants to keep the baby.
When the 37-year-old became pregnant, she enrolled in an intensive drug treatment program in Baltimore, through which she has been getting methadone to help fight against her drug cravings.
In 40 years as a treatment for heroin addiction, methadone - a synthetic opiate that satisfies the addict's physical hunger for the illicit drug - remains the gold standard. But its effects on children born to women who take it still are not fully understood. The U.S. Food and Drug Administration has not approved its use in pregnant women, and about half of the babies will suffer a potentially harmful withdrawal after birth.
Still, addiction researchers say such babies are much better off than those whose mothers continue to shoot heroin. The greatest danger to the fetus of a heroin addict comes from the withdrawal the mother constantly cycles through as she searches for her next hit. And those who are prostituting themselves to procure the drug risk contracting new infections, being raped or even killed in the process.
Yet the women still are taking a narcotic, at a time when many expectant mothers worry about having a sip of wine or drinking a cup of coffee.
"Most people, when you say 'methadone and pregnancy,' it's like, 'Oh my God, what are you doing?' " said Vickie L. Walters, program director at the Center for Addiction and Pregnancy at Johns Hopkins Bayview Medical Center.
"The ideal would be that she use nothing, that nothing gets into her system. But that's not the norm and that's the exception," she said. "It's better to have them on a safe, legal medication."
Dr. Christopher Welsh, an addictions psychiatrist at the University of Maryland Medical Center who treats pregnant women regularly, said "pregnancy just goes better" when addicts are on methadone. On methadone, they are not high, as the long-acting drug allows them a feeling of stability.
