The standard approach to treating pregnant woman with substance abuse disorder is to wean them off of street drugs through methadone.
In fact, medically supervised withdrawal is not recommended for expectant mothers.
But Memorial Healthcare System officials said they have found success with its newest program that bucks the trend. At Memorial, women who present to its Mothers in Recovery program go through a full detox from opiates instead of maintaining on methadone.
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“We do the detox regardless of which point in pregnancy [the mom is],” said Tammy Tucker, associate administrator at the Florida-based health system, who heads up its opioid-focused programs.
The recommendations to use medication-assisted therapy for pregnant women who suffer from addiction is rooted in an older case study where two women lost their babies while going through detox—though research since has questioned if detox was the cause. According to the Substance Abuse and Mental Health Services Administration, discontinuing pharmacotherapy is associated with high rates of return to substance use poorer fetal health and is not the recommended course of treatment.
But when a woman with substance abuse disorder learns she’s pregnant, knowing that she’s responsible for two leaves can be a powerful motivator to get clean, Tucker said told FierceHealthcare in an interview.
“This is a great time for moms—a lot of times, people that have substance abuse disorder aren’t necessarily motivated to change," Tucker said. "But at a significant event in their lives, that’s usually when someone might be motivated.”
Their efforts to address the problem of opioid addiction among new mothers comes as the issue has taken on a new urgency in light of alarming statistics from the Centers for Disease Control and Prevention. The CDC reported last week that a record 72,300 people died in 2017 from opioid and synthetic drug overdoses.
The process
The detox is a fairly slow process, and typically takes about six weeks, Tucker said.
Enrolling in the program connects the participating women to comprehensive prenatal care to ensure the baby is healthy, and also allows the program’s team to identify their other needs, such as housing or food insecurity.
They then connect the women with community organizations that may address those concerns too, Tucker said.
The program, which launched in 2015, has treated 109 women as of July 31. Of the 87 children born so far—some of the mothers have yet to give birth—80, or 92%, were born without neonatal abstinence syndrome because of the detox.
Babies with NAS are at risk for low birth weight, respiratory and feeding problems and seizures, and the growing number of infants with the condition has become a substantial burden for hospitals, according to the Centers for Disease Control and Prevention.
Of the babies born with NAS at Memorial, the detox led to shorter stays in the neonatal intensive care unit, Tucker said. The average length of stay for babies born in the program was 10 days, while most babies born with the syndrome may stay in the NICU for between 16 and 21 days.
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After the baby is born, Memorial conducts follow-ups at three-month, six-month and year intervals to check on both the child’s condition and see if the mother has sustained her recovery. Of the mothers who have gone through the program so far, 90% were clean at three months, 66% were clean at six months and 56% were clean one year after detox.
“One of the arguments for maintaining them on methadone is detox and relapse is going to be a high-risk problem,” Tucker said.
To mitigate that concern and to improve the long-term recovery stats, Tucker said that Memorial has begun to screen mothers after birth for risk of relapse and those that are at high risk are offered buprenorphine as maintenance drug once the baby is born.
This offers an option for mothers who need additional help in dealing with their addiction while improving the baby’s health, she said.
“We really try to give these babies the opportunity to be born drug-free,” she said.