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Saskia de Melker
Saskia de Melker
The risk for overdose from opioid painkillers and heroin among women, including pregnant women, has skyrocketed, which means a growing number of babies are born dependent on opioids. NewsHour Weekend Special correspondent Alison Stewart reports on the challenges for pregnant women struggling with addiction.
In many ways Sheena is a typical 30-year-old North Carolina mom — she spends a good part of her day shuttling around her two boys, 5-year-old Kiefer to kindergarten
I love you!
and 18-month-old Rohan to day care.
But another part of Sheena's routine is going to the Horizons clinic at the University of North Carolina, in Chapel Hill for a urine drug test.
Hey Sheena, what's going on?
Coming to pee!
How many times do you have to go get drug tested?
Right now, it's three times a week.
So this is just part of your life as a mom. You go take a drug test, and you pick up your son.
And that's just the way life is right now.
Sheena is recovering from an 11-year addiction to opioids that included painkillers and heroin. We agreed not to use her last name. She now attends classes and therapy sessions that help her stay clean, and her daily regimen includes taking medication to prevent withdrawal.
If I were to not take it, it starts to quickly increase in getting worse — the withdrawal symptoms.
She says her older brother introduced her to opioids when she was 17.
He had gotten some pain pills, painkillers, from our grandfather and I loved the way it made me feel. I was happy. The time flew by.
In her early 20's, Sheena says she stopped using opioids when she met her boyfriend. At 24, she became pregnant. And during a difficult childbirth she was given intravenous Fentanyl, an opioid painkiller, by a doctor who didn't know about her addiction.
Discharged with a prescription for another opioid painkiller, Percocet, she relapsed. Sheena continued using opioids for the next three and a half years. Even when she and her boyfriend found out she was pregnant again.
So, you were actively addicted when you became pregnant with your second son?
Did you use while you were pregnant?
Every day. Just to get out of bed I had to have opiates. I was just in a place of complete self-hate. I hated myself.
Almost five months pregnant, Sheena went to see Elisabeth Johnson at Horizons, which used to treat mostly cocaine abuse in pregnant women. Now, it's almost all opioid abuse.
Were you taking prescription pills? (patient nods) Yeah. Were you buying them mostly?
And sometimes I was using heroin, because it was cheaper.
Johnson previously worked for a pain clinic, and has seen first-hand the effects of powerful opioids like Oxycodone. They have been increasingly prescribed over the past 15 years as doctors began treating pain more aggressively.
Is it quite simply easier to get opioids now than it used to be?
I think that it is in that they have been prescribed so often.
There is plenty of evidence in the literature that women are far more likely than men to
be given prescriptions for opioids for chronic pain conditions. So I do think that a lot of
it starts in a very well-meaning primary care office, or pain provider's office.
Each year between 2008 and 2012, on average, more than one-quarter of reproductive age women with private insurance — and more than one-third of those enrolled in Medicaid — filled a prescription for opioid painkillers.
In 2014, 4. 8 million women reported nonmedical or illicit use of prescription opioids.
And the number of pregnant women receiving treatment for opioid abuse more than doubled between 2000 and 2012.
April, who lives in Tennessee, is one of those women. She didn't want us to use her last name or show her face to protect her family's privacy.
When you're an addict, all you can think about is getting that drug, getting that medicine, getting that relief.
What began with a legitimate prescription for pain following a car accident quickly slipped into abuse.
I knew I had crossed the line when I started running out of them a couple days before my prescription was supposed to be gone. Then I found ways to get them without a prescription.
Did you go doctor shopping at all?
If I didn't have a doctor, and I had a pain flare-up, I would go to an ER. I accrued tens of thousands of dollars in bills.
Eventually, when April tried to get more painkillers, a doctor checked a state database that tracks prescription use and confronted her. She got into treatment.
Now, at 32, she's pregnant and attends a clinic for pregnant opioid users. Doctor Jessica Young started it four years ago at Vanderbilt University Medical Center. Young estimates two-thirds of her patients are like April, whose addiction started with a prescription for pain.
When you have a woman come in who is addicted to an opioid and is pregnant, what kind of questions do they usually have for you?
One of the first things is, "What will happen to my baby?" And they are so afraid of Baby having any problems after delivery. And they want to know that they are doing whatever they can to get treatment in a safe way, in the safest way possible for Baby.
Infants exposed to an opioid taken by their mothers during pregnancy can be become dependent on the drug in utero, and be born going through withdrawal. The condition is called Neonatal Abstinence Syndrome, or N-A-S.
Doctor Stephen Patrick is one of the top N-A-S researchers and works in Vanderbilt's Neonatal Intensive Care Unit, or NICU.
We began to see more and more infants with Neonatal Abstinence Syndrome in our NICU and began to wonder, "Is this becoming a problem everywhere?"
In a study published last year, Patrick found a nearly fivefold increase between 2000 and 2012 in the number of babies born withdrawing from opioids.
Here in Tennessee and in the surrounding states, we have a rate that's about three times the national average, about 16.1 per thousand births, compared to the national average, which is about 5.8 per thousand births.
Why is that?
It's linked pretty heavily to prescribing, to opioid prescribing. We know that about 80 percent of the cases of Neonatal Abstinence Syndrome in Tennessee, you know, have a prescription written for an opioid.
Are people writing more prescriptions in Tennessee than other parts of the country?
Yes. Tennessee has the second-highest rate of opioid prescribing in the U.S.
At East Tennessee Children's Hospital, nurse Heather Mishlick takes care of these newborns.
Typically, N-A-S babies come in and they're screaming uncontrollably. Their temperatures are high; their extremities are really stiff.
I'm going to pick him up.
N-A-S babies need a lot of skin to skin contact to be soothed and are kept in dimly lit rooms to prevent overstimulation.
That's not always enough. Sometimes N-A-S babies must be given a low dosage of an opioid like morphine to wean them off the drug.
And what we do is we control the symptoms. We make the infant more comfortable and we do reduce the risk of having complications like seizures, and we slowly decrease that dose over a period of time.
Their mothers are put on a similar treatment while pregnant. It's called "maintenance therapy" — a consistent dose of a safer opioid like the medication Suboxone. Doctor Young says those medications keep a mom stable.
Maintenance therapy is a lot about harm reduction. And the misconception is that it's substituting one drug for another. But if maintenance therapy is done appropriately, moms aren't getting high from the medication, they're functioning normally.
Newborns of women in opioid maintenance therapy can still go through withdrawal. But Dr. Young emphasizes that if an addicted mother-to-be tries to quit opioids cold turkey that can jeopardize the pregnancy.
It can cause miscarriage. It can cause preterm labor. We don't want moms delivering early because of all the complications that that can cause.
April has been on Suboxone throughout her pregnancy.
It's a Catch-22 all the way. You can't get off of it, or then the baby will die. But, if you stay on it, the baby could go through withdrawal. It's just scary, not to mention that the laws that are coming out that are criminalizing women for when their babies are born, going through withdrawals.
If a baby in Tennessee is born dependent on drugs the mother can be charged with aggravated assault unless she can prove she is actively seeking treatment.
Tennessee has brought charges against at least 28 women under the new law. Sponsors of the law say it's not meant to penalize women but to get them into treatment and protect the welfare of their babies.
Dr. Young believes the law discourages women from getting treatment.
What many of my patients tell me is that they spent many weeks and months trying to wean themselves or taper themselves off of these drugs at home without any medical intervention because they were afraid of whatever possible legal repercussions there could be.
There are so few programs like the ones at Vanderbilt and UNC that offer treatment and prenatal care to pregnant addicts so the women often end up on waiting lists.
With addiction down there though, they really don't understand. There's no rehabs, there's no places like this.
At the University of North Carolina Horizon's clinic, Elisabeth Johnson says on average her patients drive an hour, mostly from rural communities. Logistics are compounded by shame and stigma, which Johnson says, are hurdles for getting pregnant opioid addicts into treatment.
After several months of maintenance therapy with the medication Suboxone, Sheena had her second son, Rohan. He was born with N-A-S and hospitalized for three weeks.
He sounded like he was in pain. What was really hard was knowing what he was going through, 'cause I felt it before. He was sick. He was withdrawing off the medicine I was taking.
There's not enough research to know if there are any long term effects of N-A-S on a child.
Do you want to get out the blueberries or the carrots?
Sheena says the Horizons program saved her life and her sons. Their father was not as fortunate. He died of an overdose last year. After nearly two years in recovery, Sheena looks forward to a day when she will no longer need to take a medication to feel normal.
I look around me and I'm just so grateful, you know. I've come so tremendously far.
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Melanie Saltzman reports, shoots and produces stories for PBS NewsHour Weekend on a wide range of issues including public health, the environment and international affairs. In 2017 she produced two stories for NewsHour’s “America Addicted” series on the opioid epidemic, traveled to the Marshall Islands to report on climate change, and went to Kenya and Tanzania to focus on solutions-based reporting. Melanie holds a BA from New York University and an MA in Journalism from Northwestern University, where she was a McCormick National Security Fellow. In 2010, she was awarded a Fulbright scholarship in Berlin, Germany.
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