The short answer
The DSD has a community-based substance abuse programme. Ante-natal clinics often also have methadone withdrawal programmes.
The whole question
I have been addicted to heroin for a number of years but now I am pregnant. I know that quitting cold turkey is dangerous for my baby so I am desperate to find a health care provider in Cape Town that will help me receive the safest treatment for my baby. The father is not in the picture, so I am alone and still need to work.
I heard that a methadone programme is the most common form of treatment for expectant mothers but I don't know where to go or who to speak to. I'm terrified that my baby is going to suffer withdrawal when he's born and I'm prepared to do whatever I have to do to prevent that. I just don't know where to turn.
The long answer
The World Health Organisation defines detoxification as a withdrawal process that is carried out in a safe and effective manner, minimising the withdrawal symptoms, and supporting the person physically and mentally through the process.
The two treatment methods for pregnant women addicted to heroin are methadone maintenance and methadone withdrawal. Methadone withdrawal involves using tapering doses of heroin or methadone (which is also an opiod) to create a smooth transition from heroin use to a drug-free state. Methadone maintenance involves replacing heroin with methadone doses over an indefinitely extended period.
In state hospitals in South Africa, the standard treatment is methadone withdrawal, largely due to methadone maintenance being more expensive than withdrawal. But a major concern worldwide with methadone maintenance is that there is a high risk of the baby showing signs of opioid withdrawal (Neonatal Abstinence Syndrome or NAS) at birth, as it would if it was born to a heroin-addicted mother, which would mean that the baby would need withdrawal treatment itself. NAS symptoms include excessive crying, high-pitched cry, irritability, seizures and gastrointestinal problems, among others.
A Cape Town study in 2018 showed that the babies of six mothers who were on methadone withdrawal treatment had no signs of opioid withdrawal (NAS) and did not require help to breathe (resuscitation). This was seen as a major advantage of methadone detoxification/withdrawal as opposed to methadone maintenance.
But methadone alone, whether given as detoxification or maintenance, will not change any underlying psychosocial problems or address behaviour changes. For that, you also need psychological and social help to address the problem on all fronts.
Perhaps your first step in seeking help should be to contact the Department of Social Development (DSD) to have an assessment done by a trained health care worker or social worker, to plan a course of action. You can contact the DSD on this hotline from 7am to 7pm: 0800 220 250.
The address of the provincial DSD offices is Union House, 14 Queen Victoria Street, Cape Town, 8001 Telephone: 021 483 5045.
The DSD has a substance abuse programme that can be community-based, where you would be required to attend sessions but could continue working, or in-patient where you would stay in a rehabilitation centre, depending on the assessment. You can have an assessment done at any DSD local office or at a community centre that provides substance use disorders services.
You could also phone the DSD Metro North for information. It has treatment centres in Atlantis, Bellville, Cape Town, Delft, Goodwood, Langa and Milnerton, at 021 483 7689.
You could also ask the ante-natal clinic in your nearest hospital for information and assistance to get onto the methadone withdrawal programme. Social workers who work in the Neonatal and Obstetric departments will do an assessment and help to refer you to a detoxification programme.
The City of Cape Town has a 24/7 toll-free alcohol and drug helpline on 0800 4357 4 8 (0800 HELP 4 U).
Wishing you the best,
Answered on June 30, 2021, 1:56 p.m.
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