Compassion Delivers Treatment For Pregnant Women Using Opioids

Feb 01, 2020



Have you ever wondered why so many people get addicted to opioids, or how a pregnant woman could use, knowing she’s carrying an innocent life? Below, one recovering addict paints a vivid picture of what it looks and feels like to be addicted to opioids. Perhaps seeing opioid use disorder (OUD) from an addict’s lens will bring compassion to a disease that overwhelms families, communities, social service organizations, and the criminal justice system.

Unfortunately, this story is just one of many.

An Addict’s Purview

Behavioral pharmacologist Sam Snodgrass wrote an achingly transparent editorial (“What It Feels Like to Have an Opioid Addiction,” the Huffington Post, Aug. 16, 2017) describing his deadly dance with drugs. Starting at age 20, and for more than a decade, he used opioids like heroin without becoming addicted. He got his bachelor’s degree in psychology, master’s in experimental psychology, and doctorate in biopsychology. Then, while working under a fellowship at the University of Arkansas for Medical Sciences, he got hooked on methadone. He went from having it all to living on the streets. He finally got clean about 10 years ago, and now serves on the board of directors for Broken No More (broken-no-more.org).

“Because of my education and research, I understand the neurocircuitry, neuropharmacology, and behavioral aspects of opioid addiction,” Snodgrass said. “The continual intake of these opioids, day after day, year after year, alters the brain on a cellular, molecular basis.” He described the drug-focused mindset of an addict, which transfers hunger for food to hunger for the drug. “This craving that you feel is the brain’s mechanism that drives you to survive. Its purpose is to make everything else fall away and to force you to focus solely on acquiring what you have to have to live.”

While it may take a few days since the last meal for someone to feel like they’re starving, an addict feels the same overwhelming sensation much quicker. “Four to five hours after our last use, we begin to starve,” Snodgrass said. But the addict can’t just go to the grocery store. Snodgrass likens it to a famine or government control where there are no soup kitchens or food banks, and no one will give you anything to eat. But you’re starving, so you search out the black market or steal. “How much of who you are and what you are would you let go of to survive?”

Neonatal Abstinence Syndrome (NAS)

For pregnant women, substance use is a leading cause of maternal death, according to Centers for Medicare and Medicaid Services (CMS). “Pregnant and postpartum women who misuse substances are at high risk for poor maternal outcomes, including preterm labor and complications related to delivery; these problems are frequently exacerbated by malnourishment, interpersonal violence, and other health-related social needs.” (cms.gov)

Infants exposed to opioids before birth also face negative outcomes, with a higher risk of preterm delivery, low birth weight, and neonatal abstinence syndrome (NAS). Babies born with NAS are born addicted to drugs. “Neonatal abstinence syndrome is commonly seen in the kids whose mothers are dependent on drugs like opioids before or during pregnancy,” said Ragni Kapoor, a pediatrician with SSM Health in an interview with KRCG-TV (krcg.com) in Jefferson City, Mo. “The babies absorb the substances through the placenta.”

Kapoor said babies begin exhibiting NAS symptoms one to three days after birth. Symptoms include being hyperactive or jittery, feeding poorly, high-pitched cries, sweating, sucking, and diarrhea. Kapoor added the worst signs are respiratory issues like fast breathing. In some cases, the babies may have seizures. Initially, babies are treated without pharmaceuticals. Instead, they are kept in quiet, low-stimulus environments. In some cases, babies are weaned off the substance they are addicted to with decreased amounts of methadone.

Consequently, babies born with NAS have hospital stays in Missouri of nearly 17 days costing an average of $66,000, compared with about 2 days and $3,500 for babies without the condition.

The good news is these babies can recover. “This is nothing that can’t be corrected, that can’t be solved in the future,” Kapoor said. “I’ve followed these kids closely; they have done very well, and they are really happy toddlers now.”

Criminal Justice and Maternal OUD

In recent years, state legislatures have passed new laws or applied existing child endangerment laws to prosecute pregnant women for illicit drug use during pregnancy. However, the American Academy of Pediatrics (AAP) pushed back and wrote, “Punitive measures taken toward pregnant women, such as criminal prosecution and incarceration, have no proven benefits for infant health. The public must be assured of nonpunitive access to comprehensive care that meets the needs of the substance-abusing pregnant woman and her infant.” (aap.org)

Over the last decade-in-a-half, more than 20 national organizations have published statements against the prosecution and punishment of pregnant women who use illicit substances. But even with a strong consensus among the medical and public health communities, the number of states passing and considering criminal prosecution laws that target women with substance use disorders is increasing.

According to AAP, qualitative research shows that women who use drugs may avoid prenatal care for fear of being reported to the police and child protective services. The Child Abuse Protection and Treatment Act mandates states have “policies and procedures to address the needs of infants born with and identified as being affected by illegal substance abuse or withdrawal symptoms from prenatal drug exposure.”

States have differing interpretations of reporting requirements for in utero illicit substance exposure to child welfare systems. More than 25 percent of states currently have statutes that consider illicit substance use during pregnancy to be reportable as child abuse or neglect. (Guttmacher Institute: Substance Abuse During Pregnancy.) However, as maternal OUD rates increase, child welfare systems have not received substantial funding increases to handle today’s more robust caseloads. Jails and prisons are also overloaded. According to the Council of State Governments Justice Center, Missouri has the eighth highest incarceration rate in the country and the highest for women, who get caught in the recidivism trap for probation and parole violations due to drug use. The Council notes Missouri prisons are operating at 105 percent capacity. (csgjusticecenter.org)

An Alternative to Incarceration

Research shows babies born to women who receive medication- assisted treatment (MAT) during pregnancy fare better than those whose mothers receive no treatment (National Institutes of Health, nih.gov).

Methadone maintenance program is one form of MAT. Pregnant women have been shown to:

  • gain more weight
  • start prenatal care earlier
  • have better nutrition
  • have fewer instances of children released to foster care
  • more likely to attend a substance use treatment program

Methadone maintenance programs benefit pregnant women by reducing drug cravings, preventing withdrawal (which can sometimes cause the uterus to contract, which can induce labor prematurely or cause a miscarriage), and block the effects of opioids (samhsa.gov).

As the University of Pittsburg Center for Public Health Practice wrote in Changing the Culture: Women Impacted by the Opioid Crisis, “A cultural change of the attitude towards pregnant women with OUD is imperative in providing better care for them and their children. Focusing on legal protections instead of punitive actions will help these women receive better treatment.”

For local help and support, contact the Health Care Collaborative (HCC) of Rural Missouri at 660.259.2440, visit hccnetwork.org, or text “Live Well” to 72727 for clinic locations.

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Tonia Wright

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