Comment; I’m all for getting innocent babies the protection that they need from their mothers in the throes of addiction

Gray, Jessica, MD; Saia, Kelley, MD; Walley, Alexander Y., MD, MSc

doi: 10.1097/ADM.0000000000000468
Case Report:

Background: Opioid agonist treatment (OAT) in pregnancy reduces overdose risk, drug use, increases prenatal care engagement, and improves birth outcomes. Yet many pregnant women lack access to adequate treatment. OAT, while incarcerated, reduces subsequent overdose risk, improves continuation to treatment on release, and reduces recidivism. Yet most correction facilities do not follow evidence-based guidelines for treatment, resulting in destabilization and overdose. This case is unique in illustrating 1 example of a patient who is justice-involved during pregnancy and the postpartum period, and highlighting an area of advocacy that is under-reported in the medical literature.

Case Presentation: A 28-year-old G2P0010 woman with a history of severe opioid use disorder (OUD) learned she was 13 weeks pregnant after a polysubstance overdose while on methadone treatment. She did not engage in prenatal care, despite many encounters with the healthcare system. Her pregnancy course was marked by polysubstance use, hospitalizations, and incarcerations. While incarcerated, she delivered a healthy baby at 37 weeks, and her parental custody rights were suspended.

The obstetrics team successfully advocated with the jail for continuing methadone postpartum due to the increased risk of relapse and overdose on release. After release, she continued methadone treatment with no further illicit opioid use, began to engage in counseling, 12-step meetings, and worked towards custody of her son.

Conclusions: The postpartum and post-incarceration periods are 2 high-risk periods for women with OUD. OAT in and out of incarceration provided some stability and benefit, in the midst of a prenatal course that was fragmented by polysubstance use, hospitalization, and incarceration. Maintaining and prioritizing access to OAT for patients who are incarcerated is necessary, though not sufficient, to address the high risk of overdose. Empowering healthcare providers to advocate for incarcerated patients with OUD on an individual level is 1 key strategy to optimize addiction treatment for incarcerated people.

Dr. Raymond Oenbrink
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