March 30, 2023 – For Hendrée Jones, PhDexecutive director of an addiction clinic in Chapel Hill, North Carolina, too many of his patients wait to enter drug treatment because they are afraid of a backlash. They fear that their children will be taken away or imprisoned and left in an unsafe environment if they test positive for drugs.

Jones, who runs UNC Horizons, an addiction treatment center for Pregnant Women and their children, said he’s seen a number of cases where those fears have come to fruition. More recently, one of his patients survived her pregnancy, but when her newborn baby tested positive for drugs, child protection became involved. The woman desperately wanted help for her addiction, but it was feared she could not take care of herself. Babe.

“We were able to advocate for her so she could bring her child to the treatment center, but too often these families end up separated,” Jones said.

The introduction of fentanyl into the drug supply has led to an increase in overdose deaths in the general population, and pregnant Women show the same addiction patterns. A recent article published in JAMA found that among pregnant and postpartum women, drug overdose deaths increased by 81% from 2017 to 2020. Recent reports have also shown that mmaternal mortality is on the rise in the United States and overdose rates are partly responsible for this increase.

Pregnant women also face additional barriers to care. For starters, penalizing them for drug use has become more common in recent years due to the opioid epidemic. According to an article by JAMA Pediatrics.

They may also be turned away from emergency rooms or are‘I didn’t believe when they say they‘re in withdrawal pain, Jones said. According to an October 2022 report from the White House Office of National Drug Control Policy, pregnant women are 17% less likely to be accepted into a treatment facility than the general public and when accepted, they are often met with disdain .

Many women are treated so poorly in health care facilities that they go there once for treatment and never return, Jones said. While we are seeing a greater understanding of addiction as a medical condition within many populations, this same understanding has not been extended to pregnant women. “It takes a lot of courage to walk into a treatment center and say you need help and when there’s no compassionate response these women get scared and leave,” she said.

In the United States, only about 19% of treatment centers treat pregnant women, and in recent years that number has fallen, according to a report of the American Counseling Association. The decline is due to insufficient funding and the pandemic, when social distancing forced many establishments to reduce the number of accommodations. Staffing these treatment centers with properly trained counselors has also become more difficult because people are leaving the profession rather than entering it. All of this has resulted in a lack of care for those who need it most, said Emilie Bruzeliusepidemiologist at Columbia University in New York who studies the impact of the opioid crisis on the well-being of children.

“Nobody starts using opioids when she’s pregnant. These are people who have opioid use disorders and may or may not have access to treatment and the social support they need to recover,” Bruzelius said.

Additionally, for many people who are able to stay drug-free during pregnancy, the postpartum period can become even more dangerous. Bruzelius’ research shows that the greatest number of opioid-related deaths occur after the birth of a child. A February 2021 study published in the Women’s Health Journal found that the risk of overdose was highest 7 to 12 months after pregnancy.

“Pregnancy can be a motivating time for women to seek help, but over time the risk of relapse is higher in the postpartum period, and if women have successfully stopped using drugs during pregnancy, their risk of overdose becomes even higher because they don’t have the same tolerance they had before,” Bruzelius said.

The postpartum period is already at a critical point due to the risk of postpartum depression and a general lack of postpartum health care. While pregnant women may see their obstetrician weekly, most only have one visit to their doctor after giving birth. And for the population most at risk, that’s just not enough, Bruzelius said. “There are so many stressors that come with a new baby, and stress is not conducive to quitting drug use.”

Yet when people are able to get the help they need, research showed that it worked. Patients treated with methadone and buprenorphine (two drugs widely used for the treatment of heroin addiction) are much less likely to die, according to a report of the American College of Obstetricians and Gynecologists.

“There is clear evidence that these drugs help women have better outcomes, and there is no evidence that they negatively impact fetal development,” said Nora D. VolkowMD, Director of the National Institute on Drug Abuse.

In some cases, when pregnant women use these drugs, their babies may be born with nneonatal Aabstinence ssyndrome (NAS), caused by withdrawal from the drugs they are exposed to in the womb. This result is more pronounced with the use of methadone buprenorphine. Volkaw said one of the treatment recommendations is to breastfeed because if the mother is taking these drugs, breastfeeding can help ease some of the withdrawal symptoms in the baby.

Although there are not enough facilities available for pregnant women to meet current needs, there are examples of treatment centers that are doing it well. UNC Horizons, a state-of-the-art facility, for example, not only helps drug-addicted pregnant women, but also treats the underlying trauma that causes them to relapse.

Other treatment centers, such as the Hope Clinic at Massachusetts General Hospital in Boston, provide addiction and psychiatric care throughout pregnancy and into the early postpartum period, when people are most likely to die.

According to Volkaw, we cannot expect pregnant women to get help if their basic needs are not being met. They need to be able to trust that members of the health system have their well-being and that of their children in mind.

Rather than treating these people as criminals, we need to understand that this is a medical condition and without treatment many women will die, Volkaw said.

At the most basic level, Volkaw said, these people need to be able to take their children with them for treatment. In some cases, they may need transportation, financial assistance to find a safe place to live, and adequate food.

“These are basic needs and if they are not met it becomes very difficult for women to stay on treatment whether they are pregnant or not,” she said.