This essay is about hope, healing, and recovery regarding women impacted by the opioid epidemic. It is not about blame, shame, or placing guilt on anyone or any system such as the pharmaceutical companies that created the drug, physicians who prescribed opioids for pain, drug cartels, or the person that finds herself enslaved to opioids. My goal is that you increase your knowledge in understanding the complexity of the opioid crisis, reflect upon other women’s journeys that have risen from the ashes, and become empowered to begin the journey towards recovery.
I was introduced to the negative impact of long-term opioid dependence when I was a young girl. My mother was diagnosed with Lupus, an autoimmune disease that causes chronic pain in 1976. After multiple tests- many invasive, and extensive hospitalizations it was eventually managed with morphine. For most of my childhood my mother was on morphine injections every few hours and then when her body rejected it intravenously, she began to take it orally. From a child’s perspective, I knew my mother was not herself when she was medicated with morphine. I knew there was something “not right” with the medication that was kept in a locked basement.
My mother was born in 1950 into a family with many secrets. These secrets my mother never shared with me. I am assuming she did not want to relive the horror she witnessed and experienced as a child and adolescent, least of all share them with her children. Her mission was to protect and love her children from the emotional pain she experienced. I do know however, shared from some of her seven siblings, that her father had an alcohol use disorder, there was intimate partner violence, and emotional and physical abuse. In addition, her mother was a tireless nurse, head of the union in a city hospital and her eight children were often left to themselves by necessity.
My mother, being one of the oldest and a girl, cared for her younger siblings. My mother was susceptible to having a dependence on opioids. She experienced childhood trauma and had a familial history of an alcohol use disorder. Childhood experiences, both positive and negative, have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. As such, early experiences are an important public health issue. Much of the foundational research in this area has been referred to as Adverse Childhood Experiences (ACEs). ACEs have been linked to risky health behaviors, chronic health conditions, and early death.
My childhood and adolescent upbringing are mostly filled with love and acceptance. I am one of the fortunate people who had a mother who loved and cherished me. She believed that I could and would accomplish anything and supported me through it all. She never raised her voice to me or insulted me. Actually, I never heard her use an unkind word towards anyone. She had the uncanny ability to accept all people and often would say, “If you don’t have anything nice to say, don’t say it.” She was also incredibly bright, intuitive, and sometimes too sensitive when someone emotionally hurt her. She was loyal, faithful, and thoughtful so she expected the same from others. When my mother became dependent on morphine and then fourteen years later on prescription opioids, these qualities were hidden. Rather instead, what was paramount, were fear, anxiety, anger, irritability, and sometimes a lack of joy. What I would later learn as a researcher and clinician is that opioids create a numbing effect, and later a false belief that it is the only coping mechanism to daily function. The use of opioids long-term can shift how we think of our capabilities, efficacy, and determination. It can cause disempowerment.
According to the American Psychiatric Association, opioid use disorder (OUD) is defined by the standard DSM-5 diagnosis as a problematic pattern of opioid use leading to clinically significant impairment or distress, occurring within a 12-month period. The incidence of pregnant and postpartum women with an opioid use disorder is increasing at an alarming rate. According to a recent CDC report, the number of pregnant women with opioid use disorder have quadrupled since 1999. Between 1999 and 2015, the rate of deaths from prescription opioid overdoses and heroin use increased twofold more often in women than men. A recent study in Massachusetts regarding fatal and nonfatal overdoses among pregnant and postpartum women demonstrated there was a decline of overdose rates during pregnancy and peak in the 7-12 months postpartum period. This has led to devastating consequences, including overdose fatalities, more newborns exposed to opioids in utero and experiencing neonatal abstinence syndrome, and mothers and children separated, sometimes permanently, through the child welfare and criminal justice systems.
Positive Coping and Recovery
It is my hope that women of childbearing age become more informed about their health and body and have tools to negotiate a complex system. With increased knowledge and understanding about the system, women will be emboldened and empowered to advocate for themselves and their children. In summary, the importance of understanding substance use disorders is essential in beginning the road to recovery. Addiction is a disease in which both the woman and her family suffer from the consequences of drug abuse and it is not intentional or deliberate behavior. To address the feelings of shame, guilt, fear, and despair it is important to reach out for help and support during the stressful time of pregnancy. Pregnancy is an opportunity to develop trustworthy and mutually supportive networks. It is the start of learning to find comfort in close, healthy relationships without the use of substances as a protective factor. The participants in the qualitative health study I conducted shared their knowledge based on their lived experience: Increase awareness and education about the potential of prescription opioid use disorder, have honest and directive communication between yourself and your health care providers, learn alternative methods for coping with pain, stress, trauma histories, and mental illness, listen to your body, and advocate and request formal information, such as informational literature to obtain comprehensive information regarding neonatal opioid exposure.
Where does self-determination originate? Is it something you can simply conjure at your beckoning? How do you find the strength to tell yourself “you can do it!”? How do you take the first step to will yourself not to give up, to take a risk, to face the risk of failing? According to the psychological theory self-determination theory we need another person in this equation. We need support. We need connections. Some of us are fortunate to have a parent, partner, close friend, or even a child to encourage, support, and believe in us. If you are isolated and do not have any human connections, reach out to a health care provider or peer support who you find trustworthy.
Have you ever found yourself in the position as feeling less than? Not fully human? Incapable of change? These are lies that maybe you heard as a child? Perhaps they are lies that you are telling yourself. What are your dreams? What brings you peace? What makes you smile inside? This is where you can begin. Imagine yourself fulfilling your dream, finding peace, smiling again. Now write it down. Congratulations you have just began your healing journey, your recovery from substances that are blockading your growth.
Dr. Howard is an Assistant Professor at the Phyllis & Harvey Sandler School of Social Work at Florida Atlantic University. http://cdsi.fau.edu/ssw/people/heather-howard