March 30, 2023 – for Executive Director of an Addiction Clinic in Chapel Hill, NCMany of her patients delay seeking addiction treatment because they fear a reaction. They fear that their children will be taken away or jailed and left in an unsafe environment if they test positive for drugs.
Jones, who runs UNC Horizons, a facility to treat pregnant women and their babies, said she has seen several cases where these fears have been realized. Recently, one of her patients survived becoming pregnant, but when her newborn baby tested positive for the drugs, child protective services intervened. The woman desperately wanted help to kick her addiction, but she was worried she might not be able to care for her child.
“We were able to advocate for her to allow her child access to treatment, but often these families are 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 people show a similar pattern of addiction. A recent article published in jama found that among pregnant and postpartum people, drug overdose deaths increased by 81% between 2017 and 2020. Recent reports have also revealed that Meternal death is increasing in the United States and the number of overdoses is partly driving this increase.
Pregnant people also face additional barriers to healthcare. For starters, punishing drug use has become more common in recent years due to the opioid epidemic. States like California and about a dozen others now have laws on the books that classify drug use as child abuse and many parents could lose custody of their children, according to an article JAMA Pediatrics,
They may also be sent to emergency rooms or areas far away,couldn’t believe it when he said,Jones said, “I am sad to withdraw.” As of October 2022 reports From the White House Office of National Drug Control Policy, pregnant people are 17% less likely than the general public to be admitted to a treatment center and when admitted are often met with disdain.
Jones said many women are treated so poorly in the health care system that they go for treatment once and never go back. While we are seeing a greater understanding of addiction as a medical condition within many populations, the same understanding has not extended to people who are pregnant. “It takes a lot of courage to walk into a treatment center and say you need help and if there is no kind response these women get scared and walk away,” she said.
Only 19% of treatment facilities in the US treat pregnant people, and that number has been declining in recent years, according to a study. reports of the American Counseling Association. The decline is due to poor funding and the pandemic, when social distancing forced many facilities to reduce housing numbers. It has also become more difficult to work with well-trained counselors in these treatment centers as people are leaving and not entering the profession. All of this has resulted in a shortage of care for those who need it most, he said. Emily Bruzeliusan epidemiologist at Columbia University in New York Which studies how the opioid crisis has affected the well-being of children.
“Nobody starts using opioids when they’re pregnant. It’s people who have an opioid use disorder who may or may not have access to treatment and the social support they need to get through it.” is needed,” Bruzelius said.
Furthermore, the postpartum period can be even more dangerous for many people who have been able to remain drug-free during pregnancy. Bruzelius’ research shows that the highest number of opioid-related deaths occur after childbirth. A study published in February 2021 women’s health magazine found that the risk of overdose was highest after 7 to 12 months of pregnancy.
“Pregnancy can be a motivating time for women to seek help, but the risk of recurrence is higher in the postpartum period as time goes on. “They don’t have the same tolerance as before,” Bruzelius said.
The postpartum period is already at a critical point due to the risk of postpartum depression and the general lack of postpartum health care. While pregnant people may see their midwife weekly, most see their doctor only once after giving birth. And for the most at-risk populations, it’s not enough, Bruzelius said. “There are so many stresses that come with having a new baby, and stress is not conducive to drug cessation.”
But when people get the help they need, research Shown that it works. patients treated with methadone and buprenorphine (two drugs commonly used to treat heroin addiction) are much less likely to die from a reports 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 negatively affect fetal development,” he said. MD, director of the National Institute on Drug Abuse,
In some cases, when pregnant people take these drugs, their babies may be born with N.Ainda AAbstinence Ssyndrome (NAS), caused by withdrawal from drugs exposed to them in the womb. This result is more pronounced when using methadone. buprenorphine, Volkow said one of the treatment recommendations is breastfeeding, because if the mother is taking these drugs, breastfeeding may reduce some of the withdrawal symptoms in the child.
While there are not enough facilities available for pregnant people to meet the current need, there are examples of treatment centers that are flourishing. For example, UNC Horizons, a state-of-the-art facility, not only helps pregnant people recover from addictions, but also treats the underlying trauma that causes them to relapse.
Other treatment facilities, such as the Hope Clinic at Massachusetts General Hospital in Boston, provide addiction and psychiatric care during pregnancy and early postpartum, when people are most vulnerable to dying.
According to Volkow, we cannot expect pregnant people to be helped if their basic needs are not met. They need to be able to trust that the people engaged in health care have their and their children’s well-being in mind.
Volkow said that instead of treating these people like criminals, we need to understand that this is a medical condition and without treatment many women will die.
At the most basic level, Volkow said, these people should be able to bring their children in for treatment. In some cases, they may need transportation, financial assistance in finding a safe place to live, and proper nutrition.
“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.
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