March 30, 2023 – For Hendree Jones, PhDManaging Director of an addiction clinic in Chapel Hill, NCtoo lots of their patients wait to hunt addiction treatment because they’re afraid of negative reactions. They are afraid that in the event that they test positive for drugs, their children will likely be taken away from them or they will likely be sent to jail, leaving them in an unsafe environment.
Jones, who runs UNC Horizons, a drug treatment facility for pregnant women and their children, said she has seen quite a few cases where those fears have been realized. Most recently, certainly one of her patients survived pregnancy, but when her newborn tested positive for drugs, child welfare services stepped in. The woman was desperate for help along with her addiction, but there have been concerns she won’t have the opportunity to take care of her baby.
“We were able to advocate for her so she could take her child with her to the treatment facility, but all too often these families end up separated,” Jones said.
The introduction of fentanyl into the drug trade has led to a rise in overdose deaths throughout the population, and pregnant women show the identical addiction patterns. A recent article in JAMA found that drug overdose deaths amongst pregnant women and after childbirth increased by 81% from 2017 to 2020. Recent reports have also shown that MMaternal mortality is on the rise within the United States, and overdose rates are partly the explanation for this increase.
Pregnant women also face additional barriers to care. First, lately, resulting from the opioid epidemic, it has change into more common to punish them for his or her drug use. States like California and nearly a dozen others now have laws that classify drug use as child abuse and may end up in many parents losing custody of their children, in response to an article in JAMA Pediatrics.
You can also be turned away from emergency rooms or't believed after they say that they'They are in pain from withdrawal, Jones said. According to an October 2022 study report According to the White House Office of National Drug Control Policy, pregnant women are 17 percent less prone to be admitted to a treatment facility than the final population, and after they are admitted, they often face disrespect.
Many women are treated so poorly in health care facilities that they go to treatment once and never return, Jones said. While we're seeing a greater understanding of addiction as a disease in lots of populations, that understanding isn't there yet amongst pregnant women. “It takes a lot of courage to go to a treatment facility and say you need help, and when there's no compassionate response, these women get scared and walk away,” she said.
Only about 19 percent of treatment facilities within the United States treat pregnant women, and lately that number has been declining, in response to a report by the American Counseling Association. The decline is resulting from poor funding and the pandemic, when social distancing forced many facilities to cut back residential care. Staffing these treatment centers with properly trained counselors has also change into tougher as people drop out of the occupation relatively than enter it. All of this has led to an absence of care for many who need it most, said Emilie BruzeliusEpidemiologist at Columbia University in New York which examines the impact of the opioid crisis on child welfare.
“Nobody starts taking opioids when they're pregnant. It's people who suffer from opioid use disorder who then may not have access to treatment and social supports they need to overcome it,” Bruzelius said.
In addition, for many ladies who can remain drug-free while pregnant, the postpartum period may be much more dangerous. Bruzelius' research shows that the majority deaths from opioids occur after the birth of a baby. A February 2021 study published within the Journal of Women's Health found that the danger of overdose is highest 7 to 12 months after pregnancy.
“Pregnancy can be a reason for women to seek help, but over time, in the postpartum period, the risk of relapse increases. And if women have managed to stop using drugs during pregnancy, the risk of overdose increases even further because they no longer develop the same tolerance as before,” says Bruzelius.
The postpartum period is already at a critical point resulting from the danger of postnatal depression and a general lack of postnatal health care. While pregnant women see their obstetrician weekly, most see their doctor just once after giving birth. And for probably the most vulnerable population, that's just not enough, Bruzelius said. “A new baby brings so many stressors, and stress is not conducive to stopping drug use.”
However, if people get the assistance they need, Research has shown that it really works. Patients treated with methadone and Buprenorphin (two drugs commonly used to treat heroin addiction) die much less often, in response to a report from the American College of Obstetricians and Gynecologists.
“There is clear evidence that these drugs help women achieve better outcomes, and there is no evidence that they have a negative impact on fetal development,” said Nora D. VolkowMD, Director of the National Institute on Drug Abuse.
In some cases, when pregnant women take these medications, their babies could also be born with nNewborn Aabstinence Sdreams (NAS) brought on by withdrawal from drugs to which they were exposed within the womb. This result’s more pronounced with the usage of methadone than BuprenorphinVolkaw said certainly one of the treatment recommendations is breastfeeding because if the mother is taking these medications, breastfeeding may help ease among the withdrawal symptoms in the newborn.
While there aren't enough facilities available to pregnant women to fulfill current needs, there are examples of treatment centers which might be doing it right. For example, UNC Horizons, a state-of-the-art facility, not only helps pregnant women with addiction issues, but additionally treats the underlying trauma that results in relapse.
Other treatment facilities, resembling the Hope Clinic at Massachusetts General Hospital in Boston, provide addiction and psychiatric care while pregnant and within the early postpartum period, when the danger of death is best.
According to Volkaw, we cannot expect pregnant women to receive help if their basic needs are usually not met. They must have the opportunity to trust that health care employees have their best interests and people of their children in mind.
Instead of treating these people like criminals, we’d like to know that this can be a disease and that many ladies will die without treatment, Volkaw said.
Fundamentally, Volkaw said, these people must have the opportunity to bring their children with them for treatment. In some cases, they need transportation, financial help find protected accommodation and adequate nutrition.
“These are basic needs and if they are not met, it will be very difficult for women to continue treatment, whether they are pregnant or not,” she said.