New Hampshire health officials decided to prioritize a specific demographic this year when allocating scarce federal funds toward the opioid epidemic: pregnant and newly post-partum women.
The choice reflects stark statistics both in New Hampshire and across the country.
In recent years, the number of pregnant women struggling with opioid abuse has increased significantly. With that, the number of newborns experiencing symptoms of opioid withdrawal, a condition known as neonatal abstinence syndrome (NAS), has jumped.
One of the challenges in caring for this population is geography. Standard treatment involves regular doctor visits combined with regular doses of a medication, typically Suboxone or methadone, that blocks withdrawal symptoms, reducing risk of relapse or overdose. But access to clinics that offer this treatment can be limited, particularly in more rural areas.
So, federal funds in hand, a team from New Hampshire’s largest hospital, Dartmouth-Hitchcock Medical Center, is looking to replicate the success it’s had developing its own specialized practice in Lebanon. The team is working with seven maternity care practices across the state, helping them build similar programs.
Care for pregnant women struggling with opioid abuse revolves around their two distinct, but interconnected, medical needs: maternity care and addiction treatment.
But about five years ago, doctors at Dartmouth-Hitchcock realized there was a lack of coordination across departments, between physicians attending to the women's prenatal care and those focused on addiction.
“Often it was difficult for [the women] to attend multiple appointments,” said Julia Frew, a psychiatrist who now directs the center at DHMC devoted to this population. “They would either miss prenatal care appointments or, in some cases, miss addiction treatment appointments.”
Multiple appointments meant more transportation challenges for the women, more juggling of childcare and work schedules. So, Frew said, DHMC decided to integrate its work into one specialized program, called Moms in Recovery. Frew now serves as its medical director.
"Pregnancy is this time of really incredible motivation for change."
It’s a simple idea: Take the various medical services these women need and put them in one location; don’t have them travel to different departments, on different days. But the simple change has made a big difference.
Heather Carter has seen that difference firsthand. She lives in Lyme with her family and has struggled with addiction most of her life. When she first came to Dartmouth-Hitchcock’s program in Lebanon, she was about seven months pregnant. She’d been getting Suboxone treatment elsewhere, she said, but she needed more support. "Basically I saw a doctor once a month and got a prescription," she said.
As a mother grappling with addiction, Carter is not unique. But she is lucky. Lucky in that she has access, relatively nearby, to a program like Dartmouth-Hitchcock's.
Officials at the medical center and elsewhere say their program is working. The women are staying off drugs - and both the mothers and infants are healthier than those who don't have access to this kind of care.
That's in part because, alongside the medical appointments, Dartmouth-Hitchcock offers a number of additional services at their center. Those include peer recovery groups, recovery coaches, childcare, a food and diaper bank, and a children’s clothing swap.
Having all these resources in one place has been critical for Carter. She’s now been sober from all substances for almost a year, she said. It’s the first time since she began drinking at age 14.
“Pregnancy is this time of really incredible motivation for change," said Frew, with Dartmouth-Hitchcock. “Many people who have been struggling with substance abuse, and who haven’t previously sought treatment, will seek treatment during a pregnancy.”
The problem is, in some areas, options to get addiction treatment are incredibly limited.
Recognizing this, Frew’s team is working with seven maternity care practices across the state to build up their own, in-house addiction treatment programs.
One group they’re working with is Coos County Family Health in Berlin. Providers there have long offered a broad range of family medical care, including maternity care. But they decided recently to begin prescribing Suboxone as part of an addiction treatment program.
“We just feel like we have to step up because if we don’t, we’re not sure that anybody else in the community can do this work,” said CEO Ken Gordon.
"The future of our community is at stake, and that starts with the children."
Their program began in January. For now, it’s open to pregnant and post-partum women and their partners. They’re getting regular training and guidance from a team at Dartmouth-Hitchcock.
“I think it’s huge,” said the program's coordinator Autumn Croteau, speaking to the resource they’ll be able to provide to Berlin and surrounding communities. A lot of their patients are otherwise traveling up to two hours to get treatment, she said.
Across town, the manager of a local recovery center, Kelly Charron, said she was glad to hear the program was getting off the ground.
“It’s good they’re starting with pregnant women,” she said. “The future of our community is at stake, and that starts with the children."
