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SALT LAKE CITY — Between 2005 and 2014, nearly 26 percent of pregnancy-associated deaths were drug-induced, making opioid abuse the leading cause of death in new Utah moms and pregnant women, according to a University of Utah Health study published this month.
Researchers found that the postpartum period is "critical" time for women with substance abuse problems.
“Most women are able to stop using substances during their pregnancy, but in that postpartum period there's a perfect storm of (relapse),” said Marcela Smid, lead author of the study and assistant professor of maternal-fetal medicine at University of Utah Health.
That perfect storm of issues can include the struggle of having a newborn, partner-relationship strain, postpartum depression, sleep deprivation, loss of insurance providers or substance abuse treatment, Smid said.
Pregnancy-associated deaths are defined as the death of a woman during pregnancy or within one year from the end of the pregnancy, according to the study in the medical journal Obstetrics & Gynecology. The majority of drug-induced deaths were attributed to opioids, prescription opioids or misuse of multiple substances. Half the women in the study were known to have misused drugs, it noted.
The study found that the number of drug-induced deaths equal those from other leading causes like thromboembolic disease and car accidents combined. Eighty-nine percent of those deaths occurred during the postpartum period, with most in the late postpartum period — the time period between 43 days and a year after the end of the pregnancy.
Out of the all the drug-induced deaths, over half were accidental, 26 percent were intentional and 20 percent could not be determined. Smid said 9 percent of women had multiple substances in their system.
Pregnant Utah women insured by Medicaid also face "the highest rate of any state in the nation," as 42 percent are prescribed opioids, according to information cited in the study.
"The most common reasons for opioid prescriptions during pregnancy are back pain, abdominal pain, headache or migraine, joint pain or other pain diagnosis," the study states.
Fewer than half of the women received social work consultation or mental health services, despite most of them having a mental health condition or the fact that 1 in 5 of the women had a prior suicide attempt.
"No woman was documented as having been screened for drug use with a validated screening tool during prenatal, delivery or postpartum care," the study stated.
According to the study, none of them received pharmacotherapy for their opioid use disorder.
“Every provider needs to be screening all of their patients and not assuming they know what their patients are doing based on how they look, how much money they have or where they live,” Smid said.
It was also found that drug-induced deaths were irrespective of age, race, educational level, geographic location or number of prenatal visits.
"It speaks to the fact that we don’t have an epidemic, we have a pandemic," said Smid. "It’s not poor people, middle class, rich people — it's all people."
Jasmin Charles, clinical director of the Substance Use in Pregnancy Recovery Addiction Dependence Clinic at the University of Utah, said people wrongly assume a person with a substance abuse disorder comes from a lower-income class.
"It is an epidemic that affects every single walk of life. It's not related to race, or socioeconomic status. It affects everyone," Charles said.
Smid emphasized that substance abuse in pregnancy is a medical issue, but has historically been miscategorized as a social or criminal one.
Charles mirrored Smid’s statements on how substance abuse should be treated like a medical condition.
“It's a chronic disease, it's similar to diabetes or having high blood pressure,” Charles said. “It changes your brain.”
Charles, who opened the specialty prenatal clinic along with Smid, its medical director, said the idea of the clinic stemmed from seeing a need to manage the treatment of women with substance use disorders or dependency.
Charles said it takes a multidisciplinary team to provide great care and the clinic provides maternal-fetal medicine services, peer support, social workers and addiction consultants.
She said it's common to see women who are self-referrals visit the clinic for the first time, to handfuls of others who have been in treatment programs and referrals from the Salt Lake County Jail.
Christina Choate, Project ECHO senior program coordinator, is looking to spread awareness about substance abuse disorders to primary care providers, mental health professionals and clinicians in Utah.
Project ECHO is a free service that connects community health providers with University of Utah health specialists through interactive video conferencing technology and provides accessibility to health providers seeking to learn about specialty medicine.
“This is free for community providers and easily accessible so that we can meet them where they are,” Choate said. She said the sessions are collaborative and everyone who joins the call has a voice.
Choate said the Opioid, Addiction and Pain Echo is one of seven branches under the Project Echo umbrella. It was created as a spinoff of the project’s Behavioral Health Echo after it was decided that addiction medicine deserved its own branch due to the amount of discussion and questions the topic prompted. Questions the health community had about substance use disorder went beyond the nine weeks originally allotted and its own branch was created last summer.
It speaks to the fact that we don’t have an epidemic, we have a pandemic. It’s not poor people, middle class, rich people — it's all people.
Now, the program is a series that lasts a year, with two sessions occurring monthly that last an hour each. Its goal is to help providers manage patients with chronic pain and substance abuse issues.
“We wanted to tackle substance use disorders and also pain management and how the two intersect,” Choate said.
Choate said opioid use in pregnant women and new moms has been a topic of discussion the last two years in Project Echo and has been discussed in the pregnancy care, behavioral health and opioid, addiction and pain management branches.
Smid said women might be reluctant to seek help due to the lack of accessibility to get treatment, the stigma associated with substance abuse or fear of the consequences from the Division of Child and Family Services.
"None of the women in our study were actually in treatment or were receiving medications, which is shown to improve outcomes," said Smid.
Smid said the best outcomes are associated with mothers getting treated for their addiction. She recommends that women looking for treatment talk to their doctors to to find a treatment program.
- National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
- Statewide/Salt Lake County Crisis Line: 801-587-3000
- Utah County Crisis Line: 801-691-5433
- Wasatch Mental Health Crisis Line: 801-373-7393
- Trevor Project Hotline for LGBTQ teens: 1-866-488-7386
- NAMI Utah: namiut.org
- County Crisis Lines: https://www.namiut.org/families-caregivers/suicide-prevention
- Utah Chapter-American Foundation for Suicide Prevention: afsputah.com
- Suicide Prevention Lifeline: www.suicidepreventionlifeline.org