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Saving Lives

'I needed to do this for my child because it's not their decision. She can't make achoice to do or not do what I put into my body so I needed to get better.'Sarah, recovering opioid addict
Services available for pregnant opioid addicts

Pregnancy can be a difficult situation for women battling addiction.

Many of these women are unaware of services in the community that are available to help them beat their drug and alcohol issues, while at the same time protecting the safety of their unborn child.

Magee-Womens Hospital of UPMC has expanded its Pregnancy Recovery Center program to five new locations, including one at the hospital's Womancare offices at Pullman Square Plaza in Butler.

Now the hospital's office at 200 Pullman Square Plaza will offer buprenorphine treatment — a program the hospital says is better for expectant mothers and their unborn children than methadone — as well as obstetrics and gynecological services.

The program uses buprenorphine — sold under the brand name Subutex — rather than methadone, a change the hospital says helps pregnant women recover faster and babies born with opioid exposure experience fewer side effects.

“Babies born to mothers on buprenorphine did better than babies born on methadone,” Dr. Michael England, medical director for the PRC said.

Opened in 2014 in Pittsburgh, the PRC provides treatment for pregnant women addicted to opioids and illicit drugs like heroin. In 2017, the program expanded to five satellite locations in Beaver, Butler, Clairton and Natrona Heights, with a traveling team of nurse managers, social workers, peer specialists and physicians.

7 percent of all babiesMagee's PRC program is one of 45 across the state offering addiction treatment services for pregnant women. The program currently includes 35 patients in Pittsburgh, with several in each of the satellite locations, according to Amy Charley, manager of public relations for UPMC and University of Pittsburgh Schools of the Health Sciences.“At Magee, we were seeing 7 percent of all babies born with opioid withdrawal,” she said. “So this program started to grow along with the epidemic.”England said the hospital recognized the issues of pregnancy and substance abuse, and resolved to be part of the solution.Patients have the choice of a methadone or buprenorphine program if they wish, but buprenorphine only requires weekly appointments, while methadone requires daily dosing, and according to England, “babies tend to have less chance of being born with withdrawal symptoms” with buprenorphine.He said 35 percent of babies in the program are born experiencing withdrawal symptoms, while buprenorphine programs outside of the PRC have a 45 percent chance, and on methadone, a 55 to 65 percent chance of the baby being born experiencing symptoms can occur.A key to those numbers is that the program not only provides for the medical care of mother and child, but also the mental and social aspects of recovery, England said.He said 55 percent of these patients also deal with mental health issues, which need to be addressed.“If we don't control that along with their substance issues it will never make it better,” he said. “This model was set up as a medical home model, with all care in one location. If we minimize patient travel that helps success.”Drug and alcohol counselors with the Ellen O'Brien Gaiser Center are on hand to speak to patients and address those needs, he said.Linda Franiewski, executive director of the Gaiser Center, said the center is often the first point of contact with people requesting services, and pregnant women and women with children are a “priority population.”“We try to get them into medical services ASAP,” she said.

Goal: Healthy babiesThe PRC program uses screenings that include an interview and drug tests to determine whether patients are eligible for the program, and treatment also includes behavioral counseling, clinic visits and consultations with social workers, in addition to routine prenatal checkups.“Behavioral health is a very important aspect of treatment,” England said. “Women in these situations tend to have a lot of ongoing issues — legal, housing, with their partners or their occupation — so we have social workers and service providers on hand to help provide those needed services.”Franiewski said once in the program, the center provides for patients' counseling needs to “guide these women into a safe place for them and their baby.”She said the center has also recognized the need in the community, which led to an expansion in August and the doubling of capacity at the women's center, which focuses on women seeking treatment, including those who are pregnant and already have children.“There is a huge need for women,” she said. “There has been an explosion of women seeking and needing treatment. It is a very devastating spot to be in.”While Franiewski declined to say how many referrals the center has been seeing lately, she said they “have exploded, big enough that we had to double our capacity.”England said people attempting to beat their addiction cold turkey will have the largest chance of relapse. With just counseling and no medical treatment, only about 10 to 20 percent will remain drug free; with medication alone, about only 40 percent will remain drug free; while combining counseling with medication shows a 60 to 80 percent success rate.“I have yet to meet a patient that did not want to have a healthy baby,” he said. “If we can get into good obstetric care we reduce risk of both mother and baby.”He said most of the expectant mothers dealing with opioid issues are no longer using to get high, but to manage withdrawal symptoms, and are putting themselves into risky situations to support that habit.England said this program is one way to break that cycle.He said that while no good long-term studies exist, short-term studies show this course of treatment is better at decreasing risks for both mother and child.

Negative stigmaWhile these services are available, England said the hospital is seeing a stagnant number of patients participating, partly because they may not know the services are available and partly because of the stigma associated with their situation.“The big issue is that negative stigma about substance abuse that we don't find with any other chronic illness,” he said.Franiewski said many of the women are “absolutely terrified and they feel so alone and don't know what to do” because they are “very harshly judged” for being an addict.“It is very unfortunate,” she said. “It is not something they set out to do.”England said addiction needs to be treated like other long-term illnesses. “Like diabetes, hypertension or asthma; we need to have a different perspective,” he said.England said many patients may not come in for treatment because they are afraid of legal ramifications. In Pennsylvania, he said, these types of programs are designed to offer treatment without involving the legal system.“We have to look at this as a chronic illness, not a criminal event for these patients,” he said. “Medical care shouldn't be a legal issue where people are afraid to seek care. Most patients can be good mothers, good parents if in recovery.”Franiewski said early recovery is a very difficult time, and with a new child there are added pressures that add to the risk of relapse.“But we see some really good things happening, women getting better, getting their children back, moving into a good lifestyle,” she said.England said those who are curious about the program should call the office and speak to a team member.“They will see we are not judgmental,” he said. “Our goal is to take care of these patients as we would any patient.”Six weeks after delivery, patients continue through treatment and follow-up appointments.Also offered by the hospital is the Women's Recovery Group, which treats women who are not pregnant with gynecological needs.Ruthane Durso, supervisor of Behavioral Health Services at the Butler Health System, said that while no specific programs exist in that health system for pregnant women, all available recovery programs can be utilized by that population of the community.