Roxie had a toxic relationship with fentanyl. The need for the opioids woke her up in the morning and put her to bed at night. She’d tried unsuccessfully for years to kick the habit. It had devastated her relationships with her family and caused her to lose her job.
She resorted to crime to get money and that landed her in jail for a time. Now, she was out and back to her old habits, looking for drugs. However, to make matters worse, she was pregnant, again.
Her mom had her other children. Roxie was in no condition to care for herself, much less for children. Going to a doctor was out of the question. Roxie didn’t want to hear or see the judgment from the nurses when she explained using drugs and getting pregnant.
“I didn’t plan to get pregnant,” she told The Final Call. Maybe her mom would care for this baby too when it came. At least that’s what she hoped as she nodded off into another fentanyl-induced stupor.
Roxie is among the growing numbers of pregnant drug users at risk for overdose deaths. The number of drug overdose deaths rose dramatically between January to June 2018 and July to December 2021 among 10- to 44-year-old girls and women who were pregnant or pregnant within the previous 12 months, according to a new study by researchers at the National Institute on Drug Abuse (NIDA).
This rise is not news as it parallels the unrelenting rise in the country’s drug-related deaths since the start of the 1990s opioid epidemic. The opioid crisis in America is out of control. More people are dying from drug overdoses now than traffic deaths or suicides.
This rapid increase in overdose deaths since 2010 can be directly attributed to opioids––drugs that include both prescription painkillers like fentanyl, oxycodone, hydrocodone, codeine, and morphine as well as illegal narcotics like heroin.
The NIDA researchers examined 17,000 deaths, including women who were pregnant or had been pregnant in the previous 12 months. The team published its findings in the journal JAMA Psychiatry. Among pregnant and postpartum women aged 35 to 44, they found that the ratio of overdose deaths more than tripled.
Wilson Compton, deputy director of the National Institute on Drug Abuse and co-author of the report, pointed out that the data also indicated a significant spike in overdose deaths among Black women who are pregnant or just gave birth, which corresponds with the general rise in maternal mortality rates in this population.
Researchers attribute this rise in overdose deaths to many external factors, including social isolation due to the coronavirus pandemic and lack of access to adequate prenatal and postpartum care in the United States. They also found that while substance abuse treatment may be available to pregnant women, significant barriers—such as penalization, stigma, discrimination, and limited socioeconomic resources—may obstruct their path to care.
“The stigma and punitive policies that burden pregnant women with substance use disorders increase overdose risk by making it harder to access life-saving treatment and resources,” said Nora Volkow, M.D., NIDA director and senior author on the study. “Reducing barriers and the stigma that surrounds addiction can open the door for pregnant individuals to seek and receive evidence-based treatment and social support to sustain their health as well as their child’s health.”
Most overdose deaths linked to pregnancy involved opioids, particularly fentanyl. The majority of these deaths, the researchers discovered, happened outside of medical facilities, indicating the need for improved support for individuals with substance use disorders both before and during pregnancy.
This requires devising strategies to encourage expectant mothers to seek treatment without judgment as well as legal repercussions. It also requires education about available treatment alternatives.
Dr. Khalillah Ali works in an Arizona hospital with diverse patients. “One of my patients this week was a pregnant woman with a history of alcoholism and drug abuse. She wants treatment and has found a facility. The goal is to keep her engaged with treatment. It can be easy for some patients to get frustrated or depressed with their life based on their drug abuse.
The drugs provide a sense of comfort in spite of how destructive they are. Many women have lost custody of their children due to drugs and they think having another baby will be one they can keep.”
Pregnant women have reason for concern seeking drug treatment. Several states have laws that criminalize women and mandate reporting from professionals. In some states, there are mandates for automatic reporting of child abuse and neglect in cases involving newborns exposed to certain substances, including opioids.
“Knowing you could possibly be arrested for getting pregnancy or post-partum care will keep some women from getting services,” Roxie told The Final Call. “It’s hard enough to get the strength and courage to change your life. Having people make you feel like a criminal makes matters worse.”
The American College of Obstetricians and Gynecologists and the Substance Abuse and Mental Health Services Administration recommend methadone or buprenorphine as current treatment for opioid use disorders throughout pregnancy and the postpartum period.
“It is one of the few public health problems that is getting worse instead of better,” explained Dr. Debra Houry, director of the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control, at a Senate hearing. She stated the causes of the crisis are twofold.
“The opioid epidemic in the U.S. is fundamentally tied to two primary issues. The first issue was the significant rise in opioid analgesic prescriptions that began in the mid-to-late 1990s.
Not only did the volume of opioids prescribed increase, but well-intentioned healthcare providers began to prescribe opioids to treat pain in ways that we now know are high-risk and have been associated with opioid abuse, addiction, and overdose, such as prescribing at high doses and for longer durations,” Dr. Houry said.
“The second issue is a lack of health system and healthcare provider capacity to identify and engage individuals and provide them with high-quality, evidence-based opioid addiction treatment, in particular the full spectrum of medication-assisted treatment (MAT).
It is well-documented that the majority of people with opioid addiction in the U.S. do not receive treatment, and even among those who do, many do not receive evidence-based care.”
