Since the late 1980s, policymakers have debated the question of how society should deal with the problem of women’s substance use during pregnancy. Prosecutors in many states have attempted to rely on a host of criminal laws already on the books to attack prenatal substance use.

Fortunately, many states, such as Kentucky, have placed a priority on making drug treatment more readily available to pregnant women.

Providing effective treatment for pregnant and postpartum women makes sense from both a public health and a financial standpoint. Studies show that women who complete treatment programs have a lower risk of relapse.

Local Efforts

Bluegrass Pregnancy and Addiction Network (BPAN), a new program at Bluegrass.org (Bluegrass), incorporates a multidisciplinary approach to provide addiction treatment during pregnancy and postpartum months.

Women who are pregnant or mothers with children up to two years can be referred to the network. Mothers experiencing addiction with children older than two years of age can find treatment through a continuum of addiction treatment programs offered by Bluegrass.

According to Chief Clinical Officer at Bluegrass.org, Don Rogers, the goal is to ensure all pregnant women and their families receive treatment for addiction with as few barriers and delays as possible. Ensuring they receive treatment for opioid use disorder before, during and after pregnancy is critical to improving their health and that of their infants.

Medication Assisted Treatment

Utilizing Medication Assisted Treatment (MAT) with pregnant women is an innovative approach. While methadone has been an accepted treatment for opioid addiction during pregnancy since the 1970s, it wasn’t until 1998 that the National Institutes of Health consensus panel recommended methadone maintenance as the standard of care for pregnant women with opioid addiction.

MAT combines Food and Drug Administration-approved drugs with behavioral interventions, such as counseling.

Bluegrass.org has the longest running MAT treatment facility in Kentucky serving patients since 1975. The combined successful history of the MAT program and the integrated care through the Bluegrass Pregnancy and Addiction Network means substantially reduced fluctuations in maternal serum opioid levels, protecting a fetus from repeated withdrawal episodes.

According to Rogers, one important goal of BPAN is to develop a program that can be replicated by other community mental health centers and substance use treatment facilities in Kentucky.

Rogers said, “As a nonprofit organization, Bluegrass accepted the challenge of building a successful pregnancy and addiction program with the mission to share the program practices to serve more women in Kentucky.”

Filling a Need

BPAN was created in response to the opioid epidemic in Kentucky. Rogers said, “The population of pregnant and postpartum women experiencing addiction is considered high risk. The impact is two-fold because dependence on substance can have damaging effects on both mother and infant.”

According to the Annual Report from the Public Health Neonatal Abstinence Syndrome Reporting Registry, the number of infants born in Kentucky and reported as having Neonatal Abstinence Syndrome (NAS) has climbed steadily since 2001, when 67 cases of NAS were reported statewide. In 2013, nearly 1,000 cases of NAS were reported in Kentucky, and the incidence continues to rise. Early identification, treatment and supports, including MAT, can improve outcomes for mother and infant.

The mission of BPAN is to decrease the number of infants admitted to the Neonatal Intensive Care Unit for NAS Symptoms. If infants need admission to intensive care, the goal is to reduce their length of stay. Through early identification, treatment and supports, the cycle of addiction stops and is not passed from mother to infant.

Persistent Stigma

A stigma around MAT and pregnancy persists that is not based in medical science. For too long, substance use disorders have been viewed as personal failings, when in fact they are chronic, relapsing diseases—similar to cancer or diabetes—that require ongoing treatment. Women struggling with these conditions need compassion and understanding, as well as immediate access to treatment and support services.

The stigma associated with the co-occurring conditions of pregnancy and addiction is a significant deterrent to accessing treatment. Rogers said, “Kentucky hospitals are seeing women arrive to deliver their babies having received no substance use treatment during the course of their pregnancy.”

Rogers continued, “Because of these factors, BPAN seeks community partners to build a system of successful treatment. We work with obstetric, pediatric and primary care physicians, hospitals, local health departments, Department of Community Based Services, local housing authorities, community educational services and childcare providers.”

Proven Results

BPAN has enrolled 76 pregnant and parenting women since beginning in June 2016. As of today, 21 women have delivered while receiving services. Only two NICU admissions were directly related to NAS symptoms.

When hospital stay and NICU admissions are reduced, the stigma surrounding addiction decreases. In turn, the mother’s health and well-being are stabilized. According to Rogers, improving the mother’s health has a direct impact on the development of the child and in breaking the cycle of addiction.

Improving the mother’s health has a direct impact on the development of the child and in breaking the cycle of addiction. 

Not only does this program provide reputable MAT, it also provides wraparound services and case management to further provide support with transportation, housing, medical, dental and childcare needs to address issues that typically serve as barriers to accessing treatment.

Meet Christina Coyle, a Bluegrass Pregnancy and Addiction Network graduate

We spoke to Christina Coyle, a graduate of Bluegrass Pregnancy and Addiction Network (BPAN), to learn about her time in the program. Below are the highlights. 

Medical News: Why did you use the Bluegrass Pregnancy and Addiction Network?

Christina Coyle: In December of 2015 I spent seven days in jail. When I got I out, I went straight to my dealer and got high. Soon after, I realized I was pregnant. Months passed, I felt powerless and I realized I lost my power of choice. I got up to a gram of heroin a day. I woke up one morning broke, sick, and tired. I knew in that instant, if I did not get clean I was going to lose my baby. I went to detox at the Schwartz Center, a 28-day residential program at Bluegrass.org. I was diagnosed with PTSD and depression.

Also, I was put on methadone, a form of Medication Assisted Treatment (MAT). At the Narcotics Addiction Program (NAP), where I received MAT, I saw a therapist and psychiatrist. At NAP, I became a part of a program called Bluegrass Pregnancy and Addiction Network. It is a program that helps mothers and pregnant women and is located in the same building as the NAP clinic. I started working with a case manager and a peer support specialist who have helped me change my life. I have not had an illicit drug screen the whole time I have been in recovery.

MN: How did this program change your life?

CC: This program has changed my life in many ways. I am the mother that my son needs me to be. He was born with little to no withdrawal symptoms. We left the hospital after six days. He spent no time in the NICU. I go to two MAT support groups a week.

Also, I am working on completing my GED. I completed the Adult Peer Support Specialist Training and passed the certification test. Now, I help other pregnant and young mothers in BPAN.

I went from a powerless little girl, with no purpose in the world, to a self-sufficient, independent mother with all the purpose in the world. My son will never have to grow up in a home where drugs and alcohol are used.