PREGNANT AND STRUGGLING WITH ADDICTION

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Every day in the United States a parent loses a child to meth and other addictive substances. For a majority of people; it would be unimaginable for someone to intentionally cause harm to the life of a child. While we recognize that America is fighting an epidemic of untold proportions; we seldom discuss the dirty little secret of addiction and pregnancy.

Being addicted and pregnant has become a reality for many women. Unfortunately, as the nation’s opioid crisis has risen, the demand on the treatment facilities for treating expectant mothers has also climbed. The treatment centers and physicians are struggling to keep up with the growing demand for services. Physicians and treatment facilities are also struggling to provide adequate treatment for both the expecting mother and simultaneously protecting the developing baby.

THE DIRTY LITTLE SECRET

The legal system has become a problem for the unborn child. While they advocate for the apprehension of children from mothers of addiction; the system is driving away those who should be seeking treatment during pregnancy. The system has insisted that children of addiction be apprehended to protect them and to provide treatment during an extensive chemical withdrawal period.

The threat of a child being apprehended is a deterrent for a number of pregnant mothers seeking treatment. It is not only preventing mothers from seeking treatment for their addiction, but it is preventing them from seeking medical care during their pregnancy. Have we forgotten that addiction is a disease? Why are we, as a society, threatening to apprehend a child from a mother who is struggling with a chronic illness? Have we lost our humanity?Why are we placing mothers and children into a legal system for achronic illness?

The dirty little secret of drug addiction and pregnancy is the fuel that drives many addicts away from seeking care. Moreover, it is also the legal statute that frightens many well intended mothersfrom seeking treatment. Did you know that 24 states and the Districtof Columbia consider the use of illegal substances to be a violation of a child’s rights? In fact, if found abusing drugs during pregnancy, these same jurisdictions would consider this to be a blatant act of child abuse. Meanwhile, there are only a mere 19 states thathave created or funded drug treatment facilities. Treatment centers designed to care and manage expectant mothers account for less than a quarter of the nation’s treatment centers.

“Oftentimes what I see is that we treat pregnant women even worse than we treat the general population with opioid use disorder,” said Stephen Patrick, a neonatologist and assistant professor atVanderbilt University School of Medicine in Nashville. “We shouldbe offering them more compassion.”

THE AVOIDANCE OF CARE

The legal system is causing a number of pregnant mothers to avoidcare. While seeking care for the addiction is one side of the coin, on the flip side is the developing baby. The baby’s inability to receivecare and be monitored throughout the process of development could increase the odds that the baby may be born with additionalhealth defects. We already know that the probability of a baby beingborn with birth defects increases the longer a mother uses. Yet, we place mothers at odds with seeking treatment because of fear ofapprehension and the legal repercussions. What are we trying toconvey to mothers who are struggling with addiction? That you are less of a person because you have an addiction?

Obviously, not every addict is interested in the well-being and safety of their child. Arguably, nor are all non-users of addictive substances interested in the well-being and safety of their children. Frustratingly, we label expectant mothers as child abusers long before the child is even born. Upon the day that the child is expected the be delivered; we have social service workers ready to apprehend the child and take the child into custody.

The child and mother are often not even provided a moment to bond. The mother, who has been struggling with a severe chronic illness, is now struggling with the same illness, as well as the emotional despair of loss.

As a clinician, I used to ask myself how could a mother knowinglyuse chemicals while pregnant, but I have realized that this is notalways a clear cut and dry issue. For some addicts, the addiction is to mask an internal psychological struggle that they have fought throughout their precious lives. For other addicts, the addiction

is to mask the scars of an abusive spouse or environment. Yet for others, they may have begun using due to inability to afford an opioid once prescribed by their physician. As many have discovered, the cost of opioids are not only increasing, but arebecoming more difficult to receive in times of medical need. While we also realize that there are many who have chosen to use due to a selfish journey to feel high and free of this life, the truth is, addictsare all struggling, but our society rather label them as criminals than individuals with a severe chronic illness. Likewise, as a clinician, I have never met an addict who was not presenting with a comorbid issue.

THE RESEARCH

The research concerning addictive mothers remains hopeful. According to a recent research study: “Perinatal substance use: a prospective evaluation of abstinence and relapse” found that83 percent of pregnant mothers who were using a variety ofsubstances were capable of ceasing use of the substance during pregnancy.

Further research suggests that mothers struggling with addiction are more likely to stay clean if they are allowed to interact and care for their babies. The forcible removal of a child from its mother will 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 UniversitySchool 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 thoughthey are granted temporary Medicaid health insurance, finding anOB-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 specificallyfor 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 itsreality. 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.

By Dr. Asa Don Brown, Ph.D., C.C.C., D.N.C.C.M., F.A.A.E.T.S.

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