Deadly cocktail

Stephanie lay in the Salt Lake County jail bunk bed and thought, “Everything would be better if I just died.”

She was a burden to everyone she knew, and no one could trust her. She’d pawned her mom’s wedding ring, stolen her sister’s jewelry. There was nothing she wouldn’t do—or steal—to stave off the desperation, the seizures, and overwhelming sickness that assaulted her body every time she was “jonesing” for heroin.  (Stephanie requested anonymity to share her story).

Sexually molested and raped as a child, she’d started using drugs when she was 13, while growing up in Springville and Provo. It wasn’t until she went to prison for drug-related crimes that she decided rather than dying, she wanted to change. “Me going to prison is what saved my life,” says the 37-year-old. She took up healthy habits, running every day in the women’s circular yard.

But paroling from prison was one thing, transitioning back into society another. After a stint in the Orange Street halfway house for women, she lived in a tiny apartment with only a blanket and pillow—no food, no TV, or phone—while working as a server in a Mexican restaurant. She met her subsequent husband on TRAX. He was working on his recovery from addiction using Suboxone (buprenorphine/naloxone), medication used in opioid replacement therapy. The couple relapsed and lived off scamming cash from stores with discarded receipts.

Two more stints in prison and Stephanie and her partner couldn’t figure out how to turn their lives around. They would buy Suboxone from a dealer on the street, but when she found herself pregnant, she was terrified the state would take her baby away. Her doctor told her to aggressively taper the medication, but that only led to her craving heroin.

Marcela Smid, University of Utah Health

Stephanie called Marcela Smid, M.D., the medical director of University of Utah Health’s Substance Use in Pregnancy Recovery Addiction Dependence (SUPeRAD), a specialty prenatal clinic for women with substance use issues. “I need to get off this,” she told Smid.

“Don’t do anything,” Smid pleaded with her. “Stay on it. You’re stable on the medication and that is the most important thing you can do for you and your baby.”

Fast forward 18 months and Stephanie has now been on the same dose of Suboxone for three years. Her one-year old scampers around the living room of her sparsely decorated Sandy home, while her husband is at work. “It’s sad,” she says. “There’s not a lot of help,” for pregnant women who are frightened of relapsing if they go off the treatment medication.

While many providers and patients may view methadone or buprenorphine, two types of medications used to treat people with opioid use disorder, as a drug they need to be weaned off, Smid vehemently disagrees. Treating mothers helps to stabilize them and leads to the best outcomes for mother and infant.

“Addiction has been constructed as a social problem,” Smid says. “Medicine is catching up that it’s truly a life-threatening, chronic medical condition.”

The cost of that mistaken perception is evident in a study that Smid has just published entitled, Pregnancy-Associated Death in Utah: Contribution of Drug-Induced Deaths. It highlights the unrecognized price Utah’s mothers are paying in the midst of the state’s opioid epidemic. Mothers who have a history of substance use disorders often relapse in the first year after childbirth. In total 35 Utah women fatally overdosed on drugs (74% were from opioids), between 2005 and 2014, making drug-induced deaths the top cause of pregnancy-associated deaths in the state. The vast majority (80%) of deaths occurred in the late postpartum period, between 43 days and one year after the birth, after most women have had their one postpartum check.

Utah has long been in the grip of an opioid epidemic, from 2013 to 2015 ranking seventh in the U.S. for overdose deaths. It also has the highest rate of any state in the nation, at 42 percent, of pregnant women insured by Medicaid prescribed opioids, according to 2007 data.

If more postpartum women are not to be lost to drugs, Smid urges that deep changes need to be wrought in terms of both public perception and treatment. “We have a huge problem,” Smid says. “Our moms are dying in Utah, a state which says it values family above all else.”

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