When Amanda, 28, found out that she was pregnant with her second child, she was in the middle of the COVID-19 pandemic and struggling with opioid use disorder.<\/p>\n\n\n
\u201cI was pretty heavy into my drug use,\u201d said Amanda, whose last name is being withheld due to patient confidentiality. \u201cI had given up hope and was figuring out a way to use drugs and get away with the consequences. But it doesn\u2019t work like that.\u201d<\/p>\n\n\n
Now, however, Amanda is feeling \u201creally good.\u201d That\u2019s because she is in a clinical trial for pregnant women run by the Yale School of Medicine<\/a>, through which she receives medication-assisted treatment (MAT) for her opioid use disorder (OUD). Amanda\u2019s OB-GYN is among a group of physicians at 12 clinics in Connecticut and Massachusetts who are training with Yale to offer OB-GYN care and treatment for substance use disorder under one roof to pregnant patients.<\/p>\n\n\n The study comes as the COVID-19 pandemic exacerbates the struggle for women like Amanda, whose disorder began when she first tried heroin at the age of 18. \u201cPregnant women with a history of substance use disorder have not been able to go to groups and turn to the people they rely on to help them,\u201d said\u00a0Dr. Ariadna Forray,<\/a>\u00a0associate professor of psychiatry at the Yale School of Medicine and director of the\u00a0Center for Wellbeing of Women and Mothers.<\/a>\u00a0\u201cThose connections aren\u2019t there, and so we are seeing an increase in substance use.\u201d<\/p>\n\n\n Forray, who is involved with the study, pointed out that pregnant patients do not get the same access to OUD treatment simply because they\u2019re pregnant. \u201cA lot of providers do not feel comfortable treating pregnant patients, and there\u2019s currently no established model of care for opiate use disorder in prenatal clinics.\u201d<\/p>\n\n\n Data<\/a> from the Centers for Disease Control and Prevention show that the number of women with OUD at labor and delivery more than quadrupled from 1999 to 2014 nationwide. Connecticut data was not included in the report.<\/p>\n\n\n In Connecticut, data<\/a> show that drug overdose deaths overall surged 14.3%, at 1,372 deaths, in 2020, compared with overdose deaths statewide in 2019. The state Department of Public Health\u2014based on data from the Office of the Chief Medical Examiner\u2014reported 250 confirmed overdose deaths as of mid-March 2021, with 255 pending cases. Women made up a quarter of the 6,531 overdose deaths from 2015-2020, state data<\/a> show.<\/p>\n\n\n The American College of Obstetricians and Gynecologists and the American Society of Addiction Medicine both support MAT as the gold standard for opioid use disorder treatment during pregnancy.<\/p>\n\n\n In MAT, monitored doses of methadone or buprenorphine are administered to prevent withdrawal symptoms that could devastate the fetus. Yet, pregnant women are hitting a barrier when accessing MAT because of the nuanced care they require. \u201cAt least 90 percent of patients with OUD who are interested in receiving buprenorphine for medication-assisted therapy can obtain a prescription if they are not pregnant, compared to less than 75% of pregnant patients,\u201d Forray said.<\/p>\n\n\n The\u00a0Opioid Operational Command Center\u00a0reported that from January to September 2020, deaths related to opioid use increased by 16 percent among non-Hispanic whites and 13 percent among non-Hispanic Blacks \u2014 while Latinos saw an increase of 27.3 percent.<\/p>\n\n\n A nationwide study led by Princeton University researchers, published April 2021 in JAMA<\/a>, found that the COVID-19 pandemic limited access to buprenorphine, which may have contributed to the increase in opioid overdose deaths.<\/p>\n\n\n The Yale study, which is funded by the nonprofit\u00a0Patient-Centered Outcomes Research Institute,<\/a>\u00a0tracks two ways of providing MAT treatment to women before and after the birth of their child. Amanda is in the Collaborative Care (CC) model, where a recovery coach becomes a one-on-one source of support through the pregnancy and three months postpartum. The other program, called Extension for Community Healthcare Outcomes (ECHO), uses video training and mentoring to help clinicians treat pregnant women with OUD. Yale hopes to enroll 480 women\u2014currently, there are 30\u2014half at CC clinics and half at ECHO clinics.<\/p>\n\n\n \u201cThe medicated assisted treatment takes away the withdrawal and cravings,\u201d Amanda said. \u201cMy recovery coach understands me and is real with me. If I ever did have a slip up, it\u2019s something that I wouldn\u2019t have to hide from her or feel ashamed of because she\u2019s constantly letting me know that slipping up is also part of recovery.\u201d<\/p>\n\n\n In Connecticut, there is an effort to get people with OUD in MAT programs.<\/p>\n\n\n Medicaid \/ HUSKY Health is actively pursuing the enrollment of MAT providers. Beacon Health Options, Medicaid\u2019s behavioral health administration services contractor, saw a 66% increase in the number of provider locations since 2017. Medicaid data also show that in 2020, 73.8% of 36,007 members received MAT, compared with 68.8% of 37,679 members in 2017.<\/p>\n\n\n But during Amanda\u2019s first pregnancy, not only did she not receive MAT at her OB-GYN clinic, she said she felt \u201csuper, super ashamed\u201d during visits.<\/p>\n\n\n \u201cI was struggling with addiction, and I didn\u2019t know that they were drug-testing me,\u201d Amanda recalled. \u201cI was obviously having dirty urines because I was using, but they never confronted me, like, \u2018Hey, we know you\u2019re struggling.\u2019 Once I had the baby, DCF [the Department of Children and Families] was at the hospital, and I was like, oh, wow. They opened an investigation, and I was able to clean it for a little bit.\u201d<\/p>\n\n\n This time around, Amanda refers to her pregnancy \u201cas amazing\u201d all because of the Yale study. \u201cThey\u2019re getting my doctors more involved, almost like trying to get rid of the stigma around addiction and pregnancy and telling them that it\u2019s OK to talk to me about it.\u201d<\/p>\n\n\n OB-GYNs say they require training on best practices in OUD treatment since pregnant women with OUD need nuanced medical care.<\/p>\n\n\n\n Dr. Amy Snyder, an OB-GYN at Coastal OB-GYN & Midwifery in New London, said it is necessary to get more OB-GYNs comfortable with treating pregnant patients with OUD because ultimately, patients and communities are better off. \u201cStudies like this push us in the right direction,\u201d said Snyder, who is a participating physician in the trial.<\/p>\n\n\n Amanda just celebrated being \u201csix months clean\u201d and marked the milestone by saving toward buying a house instead of spending \u201cevery dollar on drugs.\u201d More important, her 3-year-old son\u2019s \u201chappiness is through the roof. My partner\u2019s happy. This is a redemption pregnancy.\u201d<\/p>\n\n\n Without MAT provided by her OB-GYN, combined with the support from her recovery coach, none of this would have been possible, Amanda said. \u201cAddiction doesn\u2019t happen overnight, and neither does recovery,\u201d she pointed out. \u201cBecause honestly, I would rather be doing what I\u2019m doing with the help of methadone than to be back on the streets using drugs.\u201d<\/p>\n\n\n To find out more about the Project Smart trial,\u00a0contact Amanda Mele at (609) 618-0523 or\u00a0<\/em>amanda.mele@yale.edu<\/em><\/a><\/p>\n\n\n Cover Photo: Dr. Heather Lipkind and Dr. Ariadna Forray discuss the clinical trial.<\/p>\n\n\n Publisher\u2019s Note:\u00a0CTLN<\/a>\u00a0and\u00a0c-hit.org<\/a>\u00a0collaborate to best serve the Connecticut Hispanic, Latino community.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" When Amanda, 28, found out that she was pregnant with her second child, she was in the middle of the 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