UK College of Nursing, UK HealthCare Program Helps Pregnant Women Through Opioid Crisis

This article appeared in the Kentucky Herald-Leader on September 1, 2017.

By Linda Blackford

For much of her life, April Osborne has struggled with the illness of addiction, an inexorable pull that dragged her across state lines, and in and out of courtrooms, custody hearings and jail cells, always heeding the siren call of alcohol, pills or, in the end, heroin. She wasn’t sure she’d ever get clean or live with her children again. 

“I didn’t see a way out,” Osborne said. 

Then, she said, divine Providence stood her in front of a Kentucky drug court judge, who sent her in 2016 to Chrysalis House, a treatment center for women in Lexington. Osborne was a month or two pregnant, strung out and desperate. She didn’t want her baby born with the same cravings she felt. Within a month, Chrysalis House moved her to a new program started by the University of Kentucky aimed at women just like her.

Now, in 2017, Osborne sits inside the University of Kentucky Polk Dalton Clinic on Elm Tree Lane, cuddling with Jameson Helton, her cherubic 15-month-old boy. The clinic is their home away from home, and a good part of the reason that mother and son can sit together, happy and healthy, and return home to Osborne’s three other children who have been returned to her.

“They saved my life,” she said. “If it wasn’t for this program, my babies wouldn’t be with their momma.”

“They” is the PATHways (Perinatal Assistance and Treatment Home ) program, which is aimed at one small corner of the opioid epidemic that is devastating Kentucky and so many other states. 

Back in 2014, UK obstetrician Agatha Critchfield was like many doctors, “stunned” by the breadth of the drug abuse problem, particularly among her patients who could not get help for their addictions and gave birth to babies who suffered in turn with what’s known as neonatal abstinence syndrome. Babies and mothers were leaving the hospital, sometimes together, sometimes separated by child protective services, with no real help for a problem that touched every part of their lives.

So far this year, 1,355 babies in Kentucky have been born with NAS, which usually requires medication to wean babies off the opioids in their system, according to state officials. That’s up a whopping 375 percent since 2007, making Kentucky first in the nation for perinatal opioid dependence.

Treating the whole person

To help tackle the problem, Critchfield and Kristin Ashford, a nursing professor and researcher, mapped out a far-reaching plan for a small group of pregnant women who started coming to the Polk Dalton Clinic. The women were given substantial intake exams for both physical and mental issues, including past trauma and abuse. They talked to each other in group therapy sessions, worked with counselors and listened to social workers who helped them with food and shelter, and sat through educational sessions with nurses on childbirth, breast feeding, and care for a newborn baby. 

“We really try to treat them like a pregnant mom because they haven’t been treated that way ever, and it’s important that they feel welcomed here,” said Nancy Jennings, the program’s nurse facilitator at Polk Dalton.

They also are given medication-assisted drug treatment, the evidence-based therapy used to help patients addicted to opioids . Most patients are given a prescription for buprenorphine, commonly known as Suboxone or Subutex, which is a maintenance therapy to wean people from opioid addictions. Although medication-assisted treatment was initially controversial in medical circles because it uses controlled substances that can be abused, it’s now recognized as a therapy that can be used in conjunction with other methods, such as 12-step programs like Narcotics Anonymous, to help people in recovery.

“The medication helps you become stable so you’re not having cravings, so you can work on psychosocial therapy and group counseling,” said Mike Kindred, a doctor of addiction medicine who assists the program. “You have to treat the whole person.”

When the mothers arrive at UK Hospital to deliver, they find more support from people like Dianne Frankenburger, the childbirth education coordinator at UK HealthCare, and Lori Shook, a neonatologist at Kentucky Children’s Hospital. When there is room, the coordinators like to give the moms and babies time to stay together in a hospital room for up to five days, which helps them bond and appears to improve any withdrawal symptoms in babies.

So far, the preliminary results are impressive. 

As of spring 2017, more than 150 women have received treatment through PATHways. Of those, 77 percent were admitted to labor and delivery without any illicit drugs in their system. For every time a mother attended a group session in the program, she was almost 15 percent more likely to have a negative drug test and 50 percent less likely to relapse once the baby was born. 

Often, babies born to moms on medication-assisted therapy show some symptoms of withdrawal. Nationally, the average is between 40 and 58 percent of babies, but in PATHways it’s only about 30 percent. 

“There’s nothing like seeing a woman come in here and get started and have a hard time even focusing in group to seeing the change and the difference you see just in every part of them in being a new mom,” Jennings said. “They’re really invested in what we teach them … They’ve never really had anybody to give them information like we give them, it’s very empowering.”

Beyond birth

The program, though, soon became a victim of its own success, Jennings said. It was originally designed to end at about six weeks postpartum, but many moms still felt fragile and didn’t want to be cut loose. Plus, she said, the staff couldn’t find places they wanted to refer the moms to for continuing treatment. So the program morphed into something called “Beyond Birth,” and expanded to a two-year experience. 

“When the baby’s two-year birthday comes around, we hope to have people weaned completely down and off the medication, or if that’s not something we’ve been able to do, then find them some place to go next,” Jennings said. “It’s sort of like a family we’ve built here … Besides, you get to see the babies and that’s the best part. There’s nothing better than seeing babies with moms and babies who look healthy and moms that are doing the things they need to do. It’s awesome.”

Beyond Birth focuses on sustained recovery with the help of Kindred and Jason Joy, the group’s lead counselor. At some point, they would like to have as many as 200 patients, although they may need more space for that many people. Expansion also depends on more funding from state and private sources. 

Officials also are keeping a close eye on proposed changes to Medicaid, which covers costs for many of the women in the program. Currently, there are 30 pregnant women in PATHways and 55 in Beyond Birth.

As patients become healthier, the extended program allows them to help mentor other patients, said Joy. Service is a key piece of maintaining sobriety in most recovery programs, and some patients may even get certification as peer support specialists. 

Joy hopes to help find employment in that field for some of the program’s graduates, including April Osborne. 

“To have the opportunity to have a career in that would be amazing,” said Osborne, who now lives with her children and works as a janitor at Proof Fitness. She’s engaged to Jameson’s father, Brandon Helton, who is also in recovery.

“Proof Fitness has been my family, they gave me something I would not have had without them,” she said. “But at the same time, I scrub toilets for a living ...To have the opportunity to have a career in that (peer counseling) would be amazing.”

She looked to other sober women to give her hope last year and now hopes other women will look to her. 

“If women need to call me, that helps me get through my days, too,” she said, “knowing that I helped somebody.”