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Pregnant and Addicted: Help Is Available

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For healthcare providers, one of the most important battles in the opioid epidemic is the struggle to overcome stigma, misconception and judgment.

Dr. Krisanna Deppen, an addiction and family medicine specialist with OhioHealth Family Medicine Grant, is no stranger to treating patients with addictions to opioids or other substances. She said a key part of her job is relaying to patients, colleagues and the public that there is no “typical” opiate user.

“I think anyone can be affected by the opioid epidemic, and I think there are a lot of stereotypes around what that looks like,” she said.

That battle is waging even within hospitals, where Deppen said caregivers can sometimes slip into the same thinking as those outside the profession.

“One of the biggest barriers within healthcare is how even we, as healthcare providers, still come with a lot of stigma and even discrimination as it relates to addiction and treatment,” she said. “If you had a heart attack and came into the emergency department, we wouldn’t tell you, ‘Gosh, you really need to see a nutritionist before we talk to you because you need to stop eating all those hamburgers. ’ We’re just going togive you a list of providers and you can follow up later.”

When people imagine a person with addiction, it’s unlikely that they think of pregnant women. But one of Deppen’s specialties is caring for women with addictions while pregnant, and that population alone is a reminder of how diverse the face of addiction can be.

“I do a lot of caring for pregnant women with addiction and I think there’s this idea that they’re young, minority, teenage moms, but it’s actually quite the opposite most of the time,” she said. “It’s women who have been moms before — they’re in their 30s, they’re usually white and they come from lots of different backgrounds.”

In Athens, Ohio, at OhioHealth Physician Group Heritage College Obstetrics & Gynecology, Dr. Jody Gerome said she and her colleagues have seen a significant increase in the number of women entering prenatal care while using or abusing opioids. They had to come up with a solution on the fly.

“We really weren’t sure what to do with it, but we identified this as a risk in our region,” she said.

Along with other doctors and hospitals, Gerome helped form a “collaborative approach” between caregivers in a five-county region that brought “likeminded people to the table who wanted to make a difference and make change.”

That collaboration is important, she said, because of how “complex” caregiving can be for a pregnant woman with an addiction.

“We have a wide range of different types of women we care for at our practice, but the majority of women we care for who suffer from addiction disorder also tend to have a lot of poverty associated with them,” she said. “Not only do they have an opiate addiction, but they lack resources for basic things … that you take for granted, like food on the table, transportation or a place to live.”

Deppen and Gerome both said the goal is to provide what each patient needs, rather than a onesize-fits-all approach.

Deppen has experience with women across the addiction spectrum. Some, she said, became addicted to pain medicine, while others started with heroin. She said 20 years ago about 5 percent of addicted pregnant women started by using heroin. In a recent study, she said, that number has risen to about 30 percent.

“The majority of people, by the time they get to me, are using heroin and injecting,” she said. “So that’s different — they’re not just misusing pills anymore, they’re misusing something different.”

And while it would seem that a pregnancy would provide more chances for addiction to be caught by healthcare providers, Deppen said the combination of addiction, outside stigma and the patient’s own guilt can mean they often avoid treatment.

“There are plenty of patients who show up without any prenatal care and have a baby in labor and delivery,” she said. “It’s a barrier to care, when they’re using. So sometimes they don’t get care. We have to make sure that when they reach out and get help — whether that’s in labor and delivery or in their office — that people know how to help that patient. We still want them getting care, regardless.”

That’s why Deppen and others, such as OhioHealth Senior Vice President and Chief Medical Officer Dr. Bruce Vanderhoff, are trying to eliminate that stigma at the healthcare level by introducing more addiction specialists and fewer barriers to treatment.

“There’s always this fear, especially in a health system, that we don’t want those patients,” Deppen said. “But the truth is, those patients are right here. Right now, we’re just not treating them. This gives us an opportunity to address those patients.”

And the ultimate goal, she said, should be the same for all doctors: to “bring hope to our patients.”

“Addiction is a chronic medical disease,” she said.

“People can get better; I think we forget that in the hospital. I try to remind my residents that healthy people don’t come to a hospital. Well-controlled diabetics don’t come to the hospital; people who are using their inhalers as prescribed don’t come to a hospital; and people who are in recovery from addiction also don’t come to a hospital.

“So we get a skewed view, and it’s important to remember that people do get better.”


Photography: Lorrie Cecil/ThisWeek News