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Stigma, barriers to care put pregnant people, new parents with opioid use disorder at risk

Julia Reischel looks through a chart showing how much Narcan her team has distributed in the past few weeks. Reischel runs the Neonatal Abstinence Syndrome program at Margaretville Hospital.
Phoebe Taylor-Vuolo
Julia Reischel looks through a chart showing how much Narcan her team has distributed in the past few weeks. Reischel runs the Neonatal Abstinence Syndrome program at Margaretville Hospital.

The number of pregnant people or postpartum parents in the U.S. who died from an opioid overdose grew by 81% in the past six years, according to a recent study. It's a significant increase compared to other people who use opioids.

Stigma, barriers to care, and a lack of resources put pregnant people and new parents with opioid use disorder at risk. But some local organizations in upstate New York are trying to help.

“I have given Narcan to people in the same bag with diapers.”

At Margaretville Hospital in Delaware County, patients can get immediate access to buprenorphine, a medication that treats opioid use disorder by relieving cravings and withdrawal symptoms.

Across the parking lot, Julia Reischel runs the Neonatal Abstinence Syndrome program. The program offers recovery coaching, postpartum support, and a “parent pantry”. The pantry has supplies such as self-care products for new parents, formula, diapers, and condoms.

As a harm reduction program, they also want to help people who use drugs stay safe. There’s a Narcan distribution box just outside their door; it’s accessible 24/7 and always stocked with the overdose-reversing drug. They also give out fentanyl test strips to anyone who wants them.

Phoebe Taylor-Vuolo
Reischel holds a dose of Narcan, a drug which reverses opioid overdoses. A box outside is regularly stocked with the drug.

Reischel said they’re working to build trust.

“We want to be there giving you what you need, with no strings attached, because so few programs don't have strings attached,” Reischel said.

Even though the gold standard for opioid use disorder treatment is medication, Reischel said pregnant patients often have to fight to access it.

She has worked with women who were forced to go through opioid withdrawal while pregnant, which experts say can be risky for the fetus, as well as the parent.

Jaine Fairbairn, the program’s wellness coordinator, said the focus is on making sure people are safe. Being in recovery is not a requirement to get diapers, formula, or postpartum support.

“I have given Narcan to people in the same bag with diapers… hoped, prayed that they're not going to need it," Fairbairn said. "But, you know, in the absence of safety is real danger.”

Fairbairn said many of the parents she works with are terrified of losing custody of their child, especially if they are actively using drugs. She said offering baby supplies is one way to reduce harm, giving some autonomy and hope.

“I can help with the diapers and bottles and the formula and the baby clothes,” Fairbairn said. “Just try to kind of draw people in, and also just illustrate for people in a material way that they matter and they are good people.”

The program is funded through a larger federal grant, called theRural Communities Opioids Response Program. It started in October 2020, and Reischel said it’s set to end in September. She is telling her team to let parents know the program is ending. But she hopes they might find some funding to keep it going.

Phoebe Taylor-Vuolo
The program offers diapers, as well as bottles, formula, and self-care products for parents.

“‘People who use drugs never end up with their babies.’”

Stephen Patrick directs Vanderbilt University’s Center for Child Health Policy in Nashville, Tennessee. He also runs the university’s treatment program for pregnant women with opioid use disorder.

Patrick said the biggest fear he hears from patients with substance use disorder is that their children could be taken away, even when they’re actively seeking prenatal care and treatment.

He recalled one patient’s experience during her first ultrasound.

“She was in her ultrasound and the sonographer said to her, ‘Have you found a family for your baby yet?’" Patrick said. "And she goes, ‘What do you mean?’ She goes, ‘Well, people who use drugs never end up with their babies.’”

Patrick said the patient ultimately found treatment, and she and her baby are thriving. Having substance use disorder doesn’t automatically equate to child neglect or abuse, he added. Like any other chronic illness or mental health issue, it’s treatable.

Patrick said it’s difficult for people with substance use disorder to get into treatment in general in the U.S. But he said it’s often even harder for pregnant patients. Patrick said that could be contributing to the growth in overdose rates.

In 2019, Patrick, along with some colleagues, conducted a "secret shopper" study. They found participants posing as pregnant women were 17% less likely to get an appointment at the outpatient buprenorphine treatment clinics they called, compared to non-pregnant women.

“Oftentimes, what pregnant women face is the added stigma of quote, ‘How could you do this to your baby?’" Patrick said. "There's a special level of stigma that pregnant women face."

Part of the problem, he said, is a gap in knowledge and training. Obstetricians and gynecologists aren’t always familiar with opioid use disorder treatment. And opioid treatment providers aren’t always familiar with pregnancy care.

Patrick said there’s also a lot of misunderstanding about prescribing medications for opioid use disorder to pregnant patients. Some providers are afraid of causing opioid dependence, and therefore withdrawal, in newborns.

But Patrick argues neonatal opioid withdrawal is treatable and temporary, and prescribing medications for treatment to pregnant patients improves outcomes and reduces the risk of premature birth.

“What I'm worried about are the babies born very preterm, the babies with really complex birth defects," Patrick said. "It's not drug withdrawal. It's not complicated to treat. It’s time limited. It only happens for a period of time, and you treat it and then the baby goes home."

Patrick worked for a year advising the federal government on this particular issue. The Biden administration has signaled a commitment to helping pregnant people and postpartum parents with opioid use disorder, by addressing stigma and increasing access to medication treatment.