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

The number of pregnant people or postpartum parents in the US who died of 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 using 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 New York State are trying to help.

“I’ve given Narcan to people in the same bag of diapers.”

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

Across the parking lot, Julia Reischel leads the Neonatal Abstinence Syndrome Program. The program offers recovery coaching, postpartum support and a “parent pantry”. The pantry stocks 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 right outside their door; it is accessible 24/7 and always filled with the drug that reverses the overdose. They also give out fentanyl test strips to anyone who wants them.

Reischel said they are working on building trust.

“We want to be there to give you what you need, with no strings attached, because there are so few programs with no strings attached,” Reischel said.

While 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 wean opioids during pregnancy, which experts say can be risky for both the fetus and the parent.

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

“I’ve given Narcan to people in the same bag of diapers…I hoped, prayed they wouldn’t need it,” Fairbairn said. “But you know, without security there’s a 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 equipment is a way to reduce harm, which gives autonomy and hope.

“I can help with the diapers and bottles and the formula and the baby clothes,” Fairbairn said. “Just try to bring people in a little bit, and also just illustrate to people in a material way that they matter and they’re good people.”

The program is funded by a larger federal grant, called the Rural Communities Opioid Response Program. It started in October 2020 and Reischel said it will end in September. She tells her team to let parents know that the program is ending. But she hopes they might find some money to keep it going.

“‘People who do drugs never end up with their babies.'”

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

Patrick said the biggest fear he hears from patients with substance use disorder is that of their children could be removedeven when they are actively seeking prenatal care and treatment.

He recalled a 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 says, ‘What do you mean?’ She says, ‘Well, people who do drugs never end up with their babies.’”

Patrick said the patient eventually found treatment and she and her baby are doing well. Having a substance use disorder does not automatically equate to child neglect or abuse, he added. Like any other chronic illness or mental illness, it is treatable.

Patrick said yes difficult for people with substance use disorder to get treatment in the U.S. in general. But he said it’s often even more difficult for pregnant patients. Patrick said this could contribute to the growth in overdoses.

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

“Pregnant women often face the added stigma of the quote, ‘How could you do this to your baby?'” Patrick said. “There is 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 are not always familiar with the treatment of opioid use disorders. And opioid practitioners are not always familiar with pregnancy care.

Patrick said there are also many misunderstandings about prescribing opioid drugs to pregnant patients. Some providers are afraid of causing opioid dependence and thus withdrawal in newborns.

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

“What I’m concerned about is the babies who are born very early, the babies with really complex birth defects,” Patrick said. “It’s not drug withdrawal. It’s not complicated to treat. It’s limited in time. It just happens for a while, and you treat it and then the baby goes home.”

Patrick worked for a year as a consultant to the federal government on this particular issue. The Biden Administration signaled a commitment to help pregnant people and postpartum parents with opioid use disorder, by tackling stigma and increasing access to drug treatment.