The opioid crisis in America is so severe that it was declared a public health emergency by the U.S. Department of Health and Human Services last year. As of March 2018, more than 115 people die each day from an opioid overdose. But there's another sobering statistic that isn't discussed quite as often: The number of people with opioid addictions who are giving birth has quadrupled over the past 15 years.
Why is this happening?
The short answer is, of course, the opioid crisis has continued to surge each year.
"In the 1970s, opioids were not a popular pain treatment," Dr. Sameer Awsare, physician and associate executive director of The Permanente Medical Group, tells SheKnows. "Doctors were taught to prescribe opioids in very low doses unless a person was nearing death."
But doctors' attitudes about opioids began to shift in the 1980s. Awsare explains that two brief articles published in medical journals — one was a letter to the editor and the other was a study of just 38 people — formed "the foundation of the belief that opioids had a low potential for addiction."
The effects of this faulty foundation were far-reaching. Awsare tells SheKnows that by the 1990s, it was believed that opioids had low potential for addiction and that pain was being undertreated. And so doctors prescribed opioids liberally, thus laying the foundation for an addiction crisis.
Dr. David Garry, director of maternal fetal-medicine at Stony Brook Medicine Department of Obstetrics, Gynecology and Reproductive Medicine, tells SheKnows the vast majority of opioid addictions begin with a prescription. When the prescription runs out and doctors will no longer refill it, both men and women who have developed an addiction will seek it out in other ways, first buying the pills and eventually turning to heroin when cost becomes a concern.
"The difference between men and women, of course, is that women with addictions become pregnant," Garry says. "And just because they became pregnant doesn’t mean they can automatically just stop."
How does it affect a woman's pregnancy & birth?
For pregnant people who have become addicted to heroin, it's important to note that dealers often lace the drug with other drugs, such as cocaine, PCP and methamphetamines, Garry explains. But the most potent drug that's mixed with heroin is fentanyl, which is a huge part of the reason opioid-related deaths have spiked recently.
Today, opioid overdoses are one of the leading causes of what's called "pregnancy-associated maternal mortality" — a term that refers to the deaths of pregnant people that aren't related to the pregnancy itself (other examples are car accidents, homicides and suicides).
When a person with an opioid addiction gives birth, their baby will withdraw. "They’ve been exposed to opioids because the drugs cross the placenta," Garry explains. "The newborns have a similar opioid level as their mothers."
The babies' withdrawal is first treated by limiting the stimulation around them — for example, babies going through withdrawals are kept in darker, quieter areas than other newborns, Garry says. Next, doctors observe factors such as their movements, how they cry and how they feed in order to reach a score that determines whether the baby needs morphine, he adds. If that's the case, small drops of morphine are administered.
When it comes to long-term effects, it depends on the extent of the mother's opioid use. Garry says that if a person was on prescription opioids without any other drugs mixed in and they haven't gone through withdrawals, "the long term outcome appears to not be that different than a pregnancy that was unexposed to opioids."
Unfortunately, it's a different story if heroin and repetitive withdrawals were involved. "If a woman is using heroin and she uses and withdraws repeatedly, the fetus is withdrawing with the mother," Garry explains. "We think that repetitive withdrawal may have long-term implications for developmental delays."
What are the solutions?
First and foremost, Garry emphasizes the importance of not overprescribing opioids because it can easily lead to the slippery slope of addiction. He tells SheKnows it's crucial for physicians to be educated about the issue and know how to verbally screen patients before prescribing opioids.
For people who have opioid addictions, it's incredibly important to recognize it's an illness and treat it as such. "One of the main things is recognizing that addiction is a disease and punishments are not an effective means of treating that disease," Dr. Deborah Ansley, physician and medical director for the Early Start Program in The Permanente Medical Group, tells SheKnows. “The best thing you can do is provide nonjudgmental support and easy access to supportive programs."
Ansley also says it's important for pregnant people and new parents to be able to seek treatment without fear of immediately having their baby taken away. "California is the only state where it's not legal for children’s services to take away a child from a mother for a positive drug test alone," she says. "While a positive drug test does lead to further assessment of the safety of the home situation for the baby, the test alone does not mandate removal of the child from the parent and the home."
This tactic means the pregnant individuals may be more likely to seek treatment. Unsurprisingly, Ansley says when states punish people for drug use during pregnancy, they will opt out of prenatal care for fear of drug detection and subsequent punishment. "Not only can this lead to worse outcomes for the mothers and the babies, but it also doesn’t help her to get treatment for her drug-use disorder," Ansley tells SheKnows.
As the insight from these doctors shows, it's crucial to treat opioid addiction for what it is — an illness, not a character flaw or a sign of weakness. Breaking down the stigma surrounding drug addiction will benefit both the mothers and their children and increase the chances they'll live happy, healthy lives together.