CASE: A 22-year-old pregnant woman (18 weeks AOG) presented with 7 years of heavy intravenous heroin dependence on top of her daily methadone dose. She manifested with complicated pregnancy (bleeding and abdominal pain), heroin-related medical problems (abscesses, cellulitis), and severe craving as well as other psychosocial related issues namely homelessness, court case, poor family support, and unemployment.
When intoxicated, she describes her mood as “really good”. When she does not use, she craves for the drug, becomes very sick, sleepy, feels depressed, and has a large appetite. She has tried to quit on numerous occasions, even entering an inpatient treatment program at one point, but she always quickly begins using again. The patient used to work part-time as a secretary, but she lost her job as she was chronically late and, in fact, stole money in order to pay her dealer. She freely admits that she was trying to rob the grocery store to “pay off my debts.”
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