ADDICTED AND PREGNANT

By John Giordano, Doctor of Humane Letters, MAC, CAP

Sarah wasn’t like most girls when she was growing up in a middleclass home located in  suburbia USA. She was a bit shy and didn’t have a vast group of friends, but she had talent. Sarah was a gifted soccer player and A+ student who was never one to sit back on her laurels. She methodically worked her gifts and honed her skills. College recruiters took notice of the high school student athlete, which led to a full four-year scholarship at a reputable university thousands of miles from her home.

In her first year at college, Sarah was living her dream. She excelled in both athletics and academics. On campus, she met a young man and fell in love. Everything seemed to be going her way until the end of her freshman year when she experienced a sports injury that required a procedure. Sarah left the hospital in a soft leg cast and a 30-day supply of opioid painkillers. Her life was forever changed.

Like so many others before her who had a similar experience, Sarah became addicted. As you have probably already surmised, her grades dropped like a rock and her performance on the soccer field lacked the panache that got her there in the first place. Her coach gave Sarah every opportunity, but eventually had to cut her in favor of a disciplined young girl who was less of a liability.

Without her scholarship, Sarah and her now addicted boyfriend were forced to leave campus life for a rundown apartment in a questionable area of town. They both worked menial jobs to raise enough money to by drugs and pay rent.

And then the unthinkable happened; Sarah became pregnant. She panicked and wanted so desperately to get off drugs during her pregnancy, and did have some success early on, but eventually succumbed to the seduction of these highly addictive and deadly opiates.

At her doctor’s recommendation, Sarah switched over to Buprenorphine, often referred to by its brand name Suboxone/ Subutex, the popular FDA approved Medication-Assisted Treatment opioid. Consequently, her baby was born addicted to opioids and spent his first days on earth suffering through painful drug withdrawal.

No one knows what the full long-term effects of Neonatal Abstinence Syndrome (NAS) – when a baby withdraws for a drug he or she is exposed to in the womb – are on a child born addicted. There have been a few studies that reveal these babies could have long term behavioral problems in their future. Are they more prone to addiction? That story has yet to be told, but if I were a betting man I’d have to say yes.

By the way, Sarah is not a single person but rather a composite character of several women I’ve treated over the years, whose real-life experiences I’ve portrayed here as a  single person. I chose this approach because it allows me to show you the breath of this complicated issue and the real consequences of being addicted and pregnant.

I don’t think that it comes as any great big surprise to anyone that the number of addicted expecting mothers is growing exponentially.  Every year for the past twenty-years the number of addicts and avoidable deaths due to drug overdose has exceeded the year before. Why would the number of addicted expecting mothers be any different?

However, current national statistics on addicted expecting mothers and NAS are hard to  come by. It is as if they cease to exist after 2014. Babies born addicted to opioids or some other narcotic is one of those ugly statistics that no one wants to talk about, especially manufacturers, distributors and prescribers of opioid painkillers. It just seems as though every article I found online was a reference to a report published in the CDC’s Morbidity and Mortality Weekly Report 2015. It was the first state-based analysis of women with opioid use disorder during pregnancy and appears to be the last.

Every 15 minutes, 1 baby is born suffering from opiate withdrawal

The article titled, “The Number of Women with Opioid Use Disorder (OUD) at Labor and Delivery Quadrupled from 1999-2014” shows increases in all states studied. The study goes on to say that, “OUD during pregnancy has been associated with a range of negative health outcomes for both mothers and their babies, including maternal death, preterm birth, stillbirth, and neonatal abstinence syndrome (NAS).” What researchers found is that nationally, the prevalence rate of OUD at labor and delivery increased from 1.5 per 1,000 delivery hospitalizations in 1999 to 6.5 in 2014. Every 15 minutes, 1 baby is born suffering from opiate withdrawal or roughly 35,000 babies per year.

Please keep in mind that these stats are nearly five-years old and are almost certainly on the rise. Also, in the last five years there are far more women using MAT drugs such as Buprenorphine (Suboxone/Subutex) and Methadone than in the years prior. The question that still remains – and no one seems to be able to or wants answered – is by how much.

However, statistics only tell part of the story – a somewhat sanitized version at that. What the numbers cannot tell you is the amount of pain and suffering people go through in these situations. It affects everyone involved including the mother, father and their extended families across the U.S.

Unfortunately, there is no national uniform standard of care for expecting mothers suffering from opioid use disorder. In a way, it is a blessing because the Federal Government has been so inept at curbing the drug epidemic that one could only imagine the damage they would do if they tossed their hat into this arena. That being said, the decision on how to address this issue rests in the states.

But there is also another reason. Addiction treatment experts can’t agree on the best  modality. Some believe abstinence is the way to go while others are convinced Medication Assisted Treatment, like what Sarah received, is the right choice. They say that detox and abstinence could pose a health risk to the mother and unborn child while the experts in the abstinence camp believe the risk is minimal and well worth it when compared to the known risks to the fetus during pregnancy and bringing a baby into this world addicted to narcotics. Oddly, there are no statistics on babies being born to mothers using Buprenorphine (Suboxone/Subutex) and Methadone; which makes me wonder why. I don’t see a meeting of the minds on this issue any time in the near or distant future.

So, after taking all of this into consideration, it’s no wonder states have such varied approaches to this issue that tend to lean more towards ideological tenets rather than science. More importantly, the impact their policies have on expecting mothers suffering from opioid use disorder can be devastating. Stephen Patrick, a Neonatologist and assistant professor at Vanderbilt University School of Medicine in Nashville said, “Oftentimes what I  see is that we treat pregnant women even worse than we treat the general population with opioid use disorder. We should be offering them more compassion.”

Many states require doctors to report cases where newborns experience withdrawal symptoms (NAS) directly to child-welfare agencies. Others require notice of expecting mothers with OUD be sent to the appropriate agencies. Some states have gone as far as to criminalize pregnant substance abusers. They incarcerate the mother under various charges such as aggravated assault, fetus assault and so on. There are instances where a controlled environment such as jail can protect the unborn baby, such as a suicidal mother to be or an addict with a raging out of control addiction. However, a blanked policy of jailing an addicted mother, especially after she has given birth, as punishment for her  addiction is straight out of the dark ages.

Although well intended, many of these policies have led expecting mothers down a dark path. They fear they’ll go to jail and their child will be taken away from them – and in many cases they are. As a consequence, these expecting mothers, who are often poor and don’t have health insurance, never receive the prenatal care they and their baby so desperately need.

Additionally, these women are failed by the system. Even though they are granted temporary Medicaid health insurance, finding an OB-GYN who works with expecting mothers who are still abusing opioids or in a MAT program can be daunting. According to the Substance Abuse and Mental Health Administration, less than 25% of the addiction treatment centers have services tailored specifically for pregnant or postpartum women.

This disturbing cycle is indigenous to our drug epidemic and will only be eradicated when the amount of opioids in our society has been drastically reduced. I have said before and believe it is worth repeating here, that if we are to be successful at ending this epidemic, it  is imperative that we have a better understanding of its reality. We must think of this epidemic, not as a monolithic entity, but rather a group of sub-epidemics like expecting mothers with opioid use disorder (OUD). There is no one modality that is going to help all  of these people and make this epidemic go away; but rather a collection of best practices focused individually on the various sub-epidemics within.

John Giordano is the founder of ‘Life Enhancement Aftercare & Chronic Relapse Recovery Center,’ an Addiction Treatment Consultant, President and Founder of the National Institute for Holistic Addiction Studies, Chaplain of the North Miami Police Department and is the Second Vice President of the Greater North Miami Beach Chamber of Commerce. He is on the editorial board of the highly respected scientific Journal of Reward Deficiency Syndrome (JRDS) and has contributed to over 65 papers published in peer-reviewed scientific and medical journals. For the latest development in cutting-edge addiction treatment, check out his websites: www.PreventAddictionRelapse.com www.HolisticAddictionInfo.com