By Katie Spence
Joanne Harrison Clough, a single mother, and attorney raising her granddaughter, said that when her daughter, Emily, was pregnant, she sought in-person treatments for opioid addiction. However, no one was willing to accept her as a patient.
“She had a terrible time when she was pregnant,” said Clough. “We tried to get her in in-patient rehab, and no one would take her because she was 21 weeks pregnant, high-risk pregnancy. They would not take her.
“And they said, ‘Well, she could go into early labor, or she could die.’ So, she used to sit in my house, and we’d call eight hours a day to rehabs and get turned down. Two phones, two of us, eight hours a day for two weeks, and she would just sob, ‘Mommy, nobody thinks I’m worth helping. Nobody even thinks I’m worth helping.’”
Emily died of fentanyl poisoning in December 2016, leaving behind her 9-month-old daughter.
Fatal overdoses are now a leading cause of death for pregnant women in America, according to the Centers for Medicare and Medicaid Services (CMS). And CMS reports that those deaths are driven by a lack of access to health care during pregnancy and postpartum and a lack of treatment programs for women who are addicted to opioids.
“Many treatment programs do not accept pregnant clients and/or Medicaid beneficiaries. Maternity care providers often do not have the needed experience with substance use disorders to make evidence-based recommendations for treating OUD [opioid use disorder] in pregnancy,” CMS states.
In 2019, CMS’ Maternal Opioid Misuse (MOM) Model reported that women struggling with opioid addiction are “especially engaged with the healthcare system” when they’re pregnant, and by failing to offer effective treatment options for addiction during pregnancy, a “critical opportunity” is missed.
Officials in Montgomery County, Ohio, the nation’s previous opioid overdose epicenter, have developed a program to effectively treat pregnant women struggling with addiction.
Effectively Treating Addiction
In the late 1990s, pharmaceutical companies told the medical community that opioid pain relievers wouldn’t result in addiction, according to the U.S. Department of Health and Human Services (HHS). That assurance led healthcare providers to prescribe opioids at increasing rates.
Fast forward to today, and opioid abuse is officially a public health emergency, having been declared such by HHS in 2017. Despite that declaration six years ago, more than 130 Americans are still dying daily from opioid-related drug overdoses.
For pregnant women, addiction is even more complicated—she can’t simply stop taking drugs. If she did, it could harm her unborn child, according to Teresa Russell, the director of criminal justice outreach in Dayton, Ohio
Russell works between the county jail and community health and treatment facilities to find the right help for women.
“We have pregnant females enter the jail facility that test positive for opioids. When that happens, we just want to work to make sure that they’re started on medication-assisted treatment to prevent withdrawal, and we always begin education on treatment options and maintenance as needed for stability throughout the pregnancy,” Russell told The Epoch Times.
For treatment, either buprenorphine or methadone is used for pregnant women as Russell said the studies show they’re “safe and effective.”
Russell added that a crucial aspect of her work is making sure that when an expectant mother is released from jail, she has a place in a community facility to continue her opioid addiction treatment. “One of the most important things for us, if we have a woman in custody with those needs, is that we have a discharge plan in place that creates a warm handoff to a community-based provider upon release.”
Russell works in Montgomery County, Ohio. From 2011 to 2017, it had the highest unintentional drug overdose death rates in Ohio, with deaths increasing from 130 in 2011 to 566 in 2017, according to Montgomery County’s Community Overdose Action Team. Additionally, in 2017, Montgomery County was named the “overdose capital of the United States.”
That spurred Montgomery officials, and the community, to action.
“That’s when we had a lot of national news and a lot of highlights put on our county,” Russell said.
“Our county’s drug-free coalition, our community overdose team, families of addicts, and just concerned neighbors and friends, and people, just started getting together and saying, ‘What are we going to do about this?’”
Russell said that during that first year of the community and officials coming together to implement a plan of attack for addiction and substance abuse, overdose deaths decreased by half in 2018.
“Can increasing opioid abuse be reversed? Absolutely. I know it can because we’ve done it,” Russell said. “In that first year … we dropped those overdose death numbers from 566 to 280.”
Specifically, Russell said that in Montgomery County, outpatient addiction services and mental health programs partnered with private physicians or a hospital network, and funding for treatment facilities and programs was increased.
“We’ve had this hospital who started this division within the hospital named Promise to Hope,” Russell said. “Promise to Hope has been around for quite a long time, but more funding was provided to it when we started to see the opioid crisis.
“That program was developed comprehensively to provide medication-assisted treatment and withdrawal treatment to women and infants exposed to opioids. It works with everybody—in the criminal justice system or not.”
Russell explained that if a pregnant woman in the community is struggling with addiction and her physician isn’t trained to handle that, there’s an in-place network to partner with another physician with the necessary medical training.
“We have multiple providers and options for pregnant women in our community,” Russell said. “Most of which work very closely with our major hospital network to ensure that appropriate care is provided. Lack of treatment options is definitely not something we experience here.”
Addressing Mental Health
In addition to treating drug addiction, Russell said Montgomery County had to recognize that drugs are only part of the problem.
“For a really long time, we probably didn’t do a great job treating mental health and addiction co-occurring,” Russell said. “But I definitely think that dual diagnosis is more common now than it was when I first came into criminal justice services six years ago.
Russell said she’s currently seeing more pregnant women addicted to opioids than she was 10, or even five years ago. Now, there’s also the recognition that women abusing opioids are often self-medicating an underlying mental health need.
As a result, Montgomery County is addressing the mental health aspect simultaneously with addiction.
“Previously, if you came into the jail or you went into a correctional setting, or even if you showed up for treatment if addiction was assessed to be the issue, that’s what was put down as a primary need and what was worked on first,” Russell said.
“Now it’s a lot more thorough. If someone comes into jail, we look at mental health and addiction. You know, up front. … A lot of the clinicians have said it’s kind of the chicken or the egg. Which one comes first? Do you clean someone up from addiction to work on mental health? Or do you start addressing mental health to help the addiction issues? So, we do a much better job now than we did I know when I first came into service six years ago, just looking at things co-occurring, and treating them that way instead of one at a time.”
Increasing Treatment Options
In recognition of the lack of treatment options for pregnant women struggling with addiction and substance abuse, in 2021 the Substance Abuse and Mental Health Services Administration (SAMHSA) distributed $3.6 million to four grantees in a state pilot program to treat pregnant and postpartum women.. The distribution was the first of its three-year award cycle, which will total $10.8 million in the end.
SAMHSA states about the program, “The funds support family-based services for pregnant and postpartum women with substance use disorders, emphasizing treatment of opioid use disorders; help state substance abuse agencies address the continuum of care, including services provided in nonresidential-based settings; and promote a coordinated, effective, and efficient system by encouraging new approaches and models of service delivery.”
Additionally, CMS’ MOM program is working with eight states to address the “lack of access to comprehensive services during pregnancy and the postpartum period” for women struggling with substance abuse. The eight states involved in the program are Indiana, Maryland, Texas, Maine, Tennessee, Colorado, New Hampshire, and West Virginia.
Still, Russell stated about addressing the rising opioid crisis, “The issue can’t just fall on law enforcement. It can’t fall on local addiction and mental health boards or public health departments in general.
“Your schools have to be involved. Your churches have to be involved. Everybody has to come together and do the work to break the stigma related to addiction and mental health and start passing out resources. You know, the more people talk about it, the less stigma attached to it, the more people will utilize the resources that are available in the community.”
For Help
SAMHSA National Helpline
1-800-662-HELP (4357)
Samhsa.gov
