Drug of Choice
The opioid epidemic sweeping the country over the past few years has shown its impact in the increased number of women and newborns being cared for through The University of New Mexico Hospital’s Milagro clinic. But it’s the growing popularity of a different type of drug that Milagro medical director Dr. Lawrence Leeman worries may catch medical providers flat-footed.
“A large number are using speed, amphetamines right now as a secondary drug,” said Leeman, who oversees medical services at Milagro. The clinic, which assists and supports pregnant women struggling with addiction, got its start in 1989. Since then, providers have had to continually adapt to changes in the drug scene.
“If you had to ask me with a crystal ball what’s going to be happening with substance abuse and pregnancy, it’s that we will start seeing a downtrend in the opioid use and we will continue to see an uptrend in the amphetamine use,” Leeman said. “We are seeing a fair amount of use coming from the rural and reservation areas with amphetamines. Sometimes people just use what’s available. In Albuquerque, heroin and other opiates are easily available, but in some other areas they may not be available or more expensive.”
A shift in the drug of choice will drive a major shift in the way care is provided. Doctors and nurses all over the country have been working to model their care for opioid addiction, but Leeman explained that model won’t work for amphetamine use.
“The women that are using opiates are in some ways easier to care for because we have medication-assisted treatment,” Leeman said. Once on medication those women can adjust to a life without substances. The same isn’t true for other drug users.
“When you have been using amphetamines regularly and you quit using them, it’s not a pretty sight,” Leeman said. “The person is exhausted, they very often get very depressed – they are what we call anhedonic, meaning they don’t get any pleasure out of anything.“
Caring for the babies has also changed over the years Leeman said, “The pharmacological treatment is only part of the treatment.What we are learning more and more is that through the optimal use of non-pharmacological treatment, we can decrease the number of babies that need to use medications for neonatal opioid withdrawal syndrome. Newborns can then go home earlier.”
Doctors and nurses focus on skin-to-skin contact with the birth mother, breastfeeding when possible, keeping the postpartum room calm and quiet and letting the mother and baby stay together.
“A lot of it is actually what mothers have been doing for ages, learning how to soothe their babies,” Leeman said.
The babies can be hard to soothe. Some have substance withdrawal seizures, struggle to gain weight and are very fussy. Leeman and the providers at UNM’s Mother Baby Unit and other newborn units focus on making the babies as comfortable as possible and teaching their mothers to do the same. That’s why it’s also important that the mother be healthy.
But that can be just as difficult. “Many of the moms have polysubstance abuse, including alcohol, nicotine, tobacco – stimulants,” Leeman said.
Leeman stresses that judgment is not a service you will find at Milagro. The clinic is run on understanding and support, “I see some really sad situations, women who are sex trafficked or abused when they are 3,4,5 and are in families where everyone is using and there is not a model on how you cope with life, other than drugs.”
A harm-reduction service model has proven effective. Leeman and Milagro providers are working to train rural hospitals and clinics to provide care to newborns and women in their facilities and have expanded to four Albuquerque clinics to serve women throughout the community.
Milagro has served more than 2,000 women since opening its doors. Leeman says it’s not just about helping them during pregnancy, it’s about a continuum of care.
“Do you decide you’re successful when the baby comes out?” he asks. “When the baby goes home? When the baby goes to school? The unfortunate nature of opioid addiction is that it’s a chronic recurring problem. Fortunately, we have a sister program here called FOCUS at UNM. Focus takes care of babies and families up to the point where the youngest child is three years of age. We work it out that the mothers can transition into FOCUS and continue their medication-assisted treatment and the babies get increased developmental care and screening.”