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Opiate addiction in Athens County has grown more prevalent over the years, and healthcare providers have taken it on in full force. While the abused substance varies (heroin or prescription painkillers like Vicodin, Oxycontin, Demerol or Morphine), the protocols are much the same. But what happens when a patient becomes pregnant and is suddenly considered two patients? It gets more complicated, say health professionals. It also opens the door to a new possibility.

Much of the focus statewide has been on addressing a baby’s needs after birth. But in Athens, health providers around the county have been developing a system of coordinated care that addresses the mother’s needs before the baby is born.

Providers in his or her area of expertise — whether it be in prenatal medicine, psychology, counseling, group therapy or another support — team up for the sake of one patient (or in this case, two). Records are shared, recommendations are reinforced. Everyone is on the same page, and sometimes, in the same office. The ultimate goal? A healthy baby and a clean mom.

“It’s been recognized by the state that we do something different here,” said Dr. Melinda Ford, a family practice doctor with a certification to treat addiction. She’s one of just a few in the county. “Being a smaller town, we all know each other and know how to get a hold of each other. We really work well together.”

Health professionals have noticed, at least anecdotally, many of their moms are better off after going through the program. The number of patients who stay in treatment at Health Recovery Services, another partner, exceed the non-pregnant population (90 percent versus about 50 percent). Over time, they say they’ll have more data to support their claims.

Not only have their efforts turned heads at the state-level, it’s also a model the governor wants to replicate. In August, Gov. John Kasich announced he’s setting aside around $4 million in grants, administered by the Office of Health Transformation, to support two or three pilot programs around the state that will develop an integrated maternal care practice model. The program is intended to identify best-practices for obstetrical services relating to medicated-assisted treatment during and after delivery. It’s called the Maternal Opiate Medical Support program, or M.O.M.S.

The state’s motives are of course two-fold. Officials want healthier citizens and reduced costs. The most common condition associated with babies born to opiate-addicted moms is Neonatal Abstinence Syndrome, when babies suffer from withdrawal after birth. Other conditions include respiratory complications, low birth weight, feeding difficulties and seizures. In 2011, treating newborns with NAS resulted in more than $70 million in health care expenses, according the Ohio Hospital Association.

Representatives from Athens County will be applying to this program with hopes of expanding the services offered locally.

Homegrown help

Cultivated over years, River Rose has developed what they call an “open atmosphere” that results in many high-risk mothers feeling comfortable enough to talk about their habits. They do, for the most part. Those who don’t openly share their history of drug use are usually identified through the toxicology screening that’s used on all patients.

“Our goal isn’t to take their baby away,” said Pam Born, nurse manager at River Rose, adding that’s a common fear, although not entirely unfounded. “Our goal is to help them achieve an environment for their baby where they can keep them at home safe.”

“We don’t point the finger at mom,” she continued. “Nobody woke up one day and said, ‘Hey, I want to be an addict. A lot of it starts innocently enough.”

About two years ago, River Rose started a partnership with Dr. Ford. When the OB-GYNs got an addicted patient, they were sent to Ford. When one of Ford’s addicted patients became pregnant, she sent them to River Rose.

But with the overall need in the community and the 10 to 12 percent of River Rose’s pregnant patients needing addiction services (most of which are related to opiates), Ford’s caseload quickly maxed out. Due to federal regulations, Ford is limited to 100 patients.

“I’m sitting at 96 patients right now (about 30 are currently pregnant), and I have five applications on my desk, all of whom are pregnant,” she said. “Who loses out in that math?”

Typically, the applicants who answer the phone first are the ones admitted into her program. Because of the demand, River Rose expanded its program with Health Recovery Services. Now, HRS staff regularly works out of River Rose.

Medicated-assisted treatment has proven the most effective route to recovery, explained Dr. Gay, executive director of HRS. Suboxone is the drug of choice for non-pregnant patients. It contains an extra ingredient that automatically puts the patient in withdrawal if it’s injected rather than taken as directed.

Pregnant patients are given a different drug that contains only the intended active agent of suboxone, also known as buprenorphine. It’s important that expectant mothers be medicated because withdrawal can be dangerous to a baby in utero.

In addition to medication, moms are given counseling and mentoring.

“We work on getting them to make the changes they need to make in their lives so they don’t continue to use after the baby is born,” Gay said. “We also spend a lot of time dealing with issues of being a mom. Once they get stable, most want to be good moms.”

What will the future hold?

The coordinated effort continues to expand. Holzer Clinics in Athens and Gallipolis have recognized the problem and are also working with HRS to address it.

Debbie Cox, a nurse, has outgrown the space where she hosts a therapeutic community she’s developed to satisfy her moms’ “craving for community.”

Cox works with Medicaid-eligible pregnant women — not just those who are recovering from addiction — through a program called Pathways, which is lead by Integrated Professionals for Appalachian Children. It’s partly supported through Ohio University’s Heritage College of Osteopathic Medicine and Project LAUNCH. The purpose of Pathways is to connect the moms with the services they need and to provide support. Cox said she’s seen improvements in her moms but wants to do more.

“My dream is to apply for Kasich’s money to get funding for an inpatient rehabilitation center of some sort in our county,” she said, adding that because so few specialists are in Athens, many have to travel outside the county to get the treatment they need.

“We’re already successful,” she added. “Let’s make it bigger.”