Pregnancy, addiction create tough choices
Jennifer Kostoff had been in a heroin rehabilitation program for a little more than a week when a routine blood screen showed she was pregnant. Caregivers told her she would have to leave. She could be a liability.
The inpatient center near her Granite City, Illinois, home had prescribed her Suboxone — a drug often used to control cravings and drug withdrawal symptoms — but said last September that it could harm her unborn child. Kostoff worried that withdrawal wouldn’t be safe for the baby, either. And would seeking treatment elsewhere lead her to trouble with law enforcement or losing custody of her baby?
“Most people think, ‘How could you not stop with a baby in your belly?’ ” Kostoff said. “But the physical cravings, the mental cravings, they take over despite what’s going on with your body.”
As the nation’s opioid crisis has deepened, the number of drug treatment centers for pregnant women has grown. But experts and advocates say there aren’t enough services for pregnant women to meet the demand, and many don’t offer the drugs doctors would normally use to treat addiction because they are concerned about the effects they might have on a fetus. And some laws requiring that babies going through withdrawal be removed from their mother’s care can be a deterrent to seeking help, they said.
Nineteen states have either created or funded drug treatment programs for pregnant women; 24 states and the District of Columbia consider drug use during pregnancy to be child abuse under civil child-welfare statutes, according to the Guttmacher Institute, a reproductive rights research and advocacy organization.
Less than a quarter of the nation’s substance abuse treatment centers offer services tailored to pregnant or postpartum women, according to the most recent survey from the Substance Abuse and Mental Health Administration. Of those centers, a fraction offer recovery drugs to reduce cravings and withdrawal symptoms. Experts say that quitting drug use without the use of such medications has a higher incidence of relapse and can be stressful on a fetus.
“Oftentimes what I see is that we treat pregnant women even worse than we treat the general population with opioid use disorder,” said Stephen Patrick, a neonatologist and assistant professor at Vanderbilt University School of Medicine in Nashville. “We should be offering them more compassion.”
But some doctors and caregivers are wary of pregnant women receiving opioid addiction treatment drugs, which have potential for abuse.
And child-welfare advocates and law enforcement officers are reeling from cases in which parents seem to choose drugs over their young children.
In April, a mother who was abusing pills and heroin in Utah crushed Suboxone pills and rubbed them onto her newborn daughter’s gums while nurses were out of the room, hoping to mask the child’s symptoms of drug withdrawal. She and the baby’s father were later arrested.