[Music] so I used to believe that drug addicts
so I used to believe that drug addicts
so I used to believe that drug addicts were lesser people lesser people and
were lesser people lesser people and
were lesser people lesser people and that they could get over their problem
that they could get over their problem
that they could get over their problem if they were just a little bit motivated
if they were just a little bit motivated
if they were just a little bit motivated I felt that way because that’s what my
I felt that way because that’s what my
I felt that way because that’s what my parents and teachers taught me as a kid
parents and teachers taught me as a kid
parents and teachers taught me as a kid and society has since then reinforced
and society has since then reinforced
and society has since then reinforced that view this mindset has led to
that view this mindset has led to
that view this mindset has led to individuals with addiction being the
individuals with addiction being the
individuals with addiction being the most stigmatized group in our culture I
most stigmatized group in our culture I
most stigmatized group in our culture I would say the equivalent of modern-day
would say the equivalent of modern-day
would say the equivalent of modern-day lepers some people will say just write
lepers some people will say just write
lepers some people will say just write them off this is a tragedy but it’s one
them off this is a tragedy but it’s one
them off this is a tragedy but it’s one with a possible happier ending as a
with a possible happier ending as a
with a possible happier ending as a practicing neonatologists here in
practicing neonatologists here in
practicing neonatologists here in Columbus my goal has been to have
Columbus my goal has been to have
Columbus my goal has been to have healthy newborns as concerned citizens I
healthy newborns as concerned citizens I
healthy newborns as concerned citizens I think we all share the goal that these
think we all share the goal that these
think we all share the goal that these back all moms and babies should have the
back all moms and babies should have the
back all moms and babies should have the best possible future today I want to
best possible future today I want to
best possible future today I want to talk to you about a program that
talk to you about a program that
talk to you about a program that reinforces the maternal newborn bond it
reinforces the maternal newborn bond it
reinforces the maternal newborn bond it promotes healthy families and it helps
promotes healthy families and it helps
promotes healthy families and it helps women deal with their addiction issues
the illicit opiate problem it continues
the illicit opiate problem it continues to grow and with it more and more babies
to grow and with it more and more babies
to grow and with it more and more babies are exposed in utero to maternal opiate
are exposed in utero to maternal opiate
are exposed in utero to maternal opiate use when I first came to Columbus a
use when I first came to Columbus a
use when I first came to Columbus a dozen years ago I would see maybe just
dozen years ago I would see maybe just
dozen years ago I would see maybe just three or four babies a year who had been
three or four babies a year who had been
three or four babies a year who had been exposed to maternal opiates and now I
exposed to maternal opiates and now I
exposed to maternal opiates and now I see about 200 per year the Ohio
see about 200 per year the Ohio
see about 200 per year the Ohio Department of Health has reported that
Department of Health has reported that
Department of Health has reported that on average there are 84 newborns
on average there are 84 newborns
on average there are 84 newborns withdrawing from maternal opiates in an
withdrawing from maternal opiates in an
withdrawing from maternal opiates in an Ohio Hospital each day
let’s openly admit why it can be
let’s openly admit why it can be difficult to be non-judgmental when we
difficult to be non-judgmental when we
difficult to be non-judgmental when we think about a mom who abuses drugs
it can be heartbreaking to see a baby
it can be heartbreaking to see a baby with dry infamous mothers opiates the
with dry infamous mothers opiates the
with dry infamous mothers opiates the baby can cry inconsolably for hours and
baby can cry inconsolably for hours and
baby can cry inconsolably for hours and have trouble getting any sleep
have trouble getting any sleep
have trouble getting any sleep in this scenario we tend to view the mom
in this scenario we tend to view the mom
in this scenario we tend to view the mom as a villain as if she decided that her
as a villain as if she decided that her
as a villain as if she decided that her drug abuse was more important than the
drug abuse was more important than the
drug abuse was more important than the needs of her baby but now we know that
needs of her baby but now we know that
needs of her baby but now we know that mom herself is the victim of a chronic
mom herself is the victim of a chronic
mom herself is the victim of a chronic neurological disease and by adjusting
neurological disease and by adjusting
neurological disease and by adjusting our attitudes towards addiction we can
our attitudes towards addiction we can
our attitudes towards addiction we can have improved outcomes for both moms and
have improved outcomes for both moms and
have improved outcomes for both moms and their babies when I was in medical
their babies when I was in medical
their babies when I was in medical training I was taught that drug addicts
training I was taught that drug addicts
training I was taught that drug addicts were highly manipulative drug seekers
were highly manipulative drug seekers
were highly manipulative drug seekers and only a rigid rules approach to give
and only a rigid rules approach to give
and only a rigid rules approach to give them the guidance they needed to improve
them the guidance they needed to improve
them the guidance they needed to improve we were told that we would look foolish
we were told that we would look foolish
we were told that we would look foolish to everyone if we tried to work
to everyone if we tried to work
to everyone if we tried to work cooperatively with them
cooperatively with them
cooperatively with them but now we know that addiction is
but now we know that addiction is
but now we know that addiction is actually the expression of a disease
actually the expression of a disease
actually the expression of a disease process and there are specific genes
process and there are specific genes
process and there are specific genes that have been identified in certain
that have been identified in certain
that have been identified in certain susceptible individuals that we know
susceptible individuals that we know
susceptible individuals that we know places them at higher risk of addiction
so let’s be clear for a moment how most
so let’s be clear for a moment how most addicts get started
addicts get started
addicts get started typically it begins with a physician’s
typically it begins with a physician’s
typically it begins with a physician’s prescription for painkillers following a
prescription for painkillers following a
prescription for painkillers following a surgery or a traumatic event and when
surgery or a traumatic event and when
surgery or a traumatic event and when that susceptible individual runs out of
that susceptible individual runs out of
that susceptible individual runs out of pills they discover that they’re
pills they discover that they’re
pills they discover that they’re starting to go through withdrawal and in
starting to go through withdrawal and in
starting to go through withdrawal and in order to continue to be able to function
order to continue to be able to function
order to continue to be able to function as a parent the spouse or an employee
as a parent the spouse or an employee
as a parent the spouse or an employee they need to find alternative sources of
they need to find alternative sources of
they need to find alternative sources of opiates and that typically inevitably
opiates and that typically inevitably
opiates and that typically inevitably leads to illicit drug seeking behavior
leads to illicit drug seeking behavior
leads to illicit drug seeking behavior the other group at particularly high
the other group at particularly high
the other group at particularly high risk are those who have under treated
risk are those who have under treated
risk are those who have under treated mental health issues especially when
mental health issues especially when
mental health issues especially when accompanied by highly stressful social
accompanied by highly stressful social
accompanied by highly stressful social situations blaming these individuals for
situations blaming these individuals for
situations blaming these individuals for their drug addiction is like blaming the
their drug addiction is like blaming the
their drug addiction is like blaming the person who has epilepsy or dwarfism and
person who has epilepsy or dwarfism and
person who has epilepsy or dwarfism and compounding the problem the stigma
compounding the problem the stigma
compounding the problem the stigma associated with addiction makes it very
associated with addiction makes it very
associated with addiction makes it very difficult for these people to seek out
difficult for these people to seek out
difficult for these people to seek out the treatment they need typically when a
the treatment they need typically when a
the treatment they need typically when a woman becomes pregnant she might decide
woman becomes pregnant she might decide
woman becomes pregnant she might decide to lead a healthier lifestyle and I
to lead a healthier lifestyle and I
to lead a healthier lifestyle and I think we’ve all known people who have
think we’ve all known people who have
think we’ve all known people who have given up caffeine or cigarettes and so
given up caffeine or cigarettes and so
given up caffeine or cigarettes and so my mom’s may try to give up illicit
my mom’s may try to give up illicit
my mom’s may try to give up illicit drugs unfortunately we must discourage
drugs unfortunately we must discourage
drugs unfortunately we must discourage complete opiate abstinence in opiate
complete opiate abstinence in opiate
complete opiate abstinence in opiate addicts during pregnancy because it can
addicts during pregnancy because it can
addicts during pregnancy because it can be dangerous for the baby to withdrawal
be dangerous for the baby to withdrawal
be dangerous for the baby to withdrawal inside of mom so the preferred method is
inside of mom so the preferred method is
inside of mom so the preferred method is to replace moms illicit opiates like
to replace moms illicit opiates like
to replace moms illicit opiates like heroin with prescribed methadone or
heroin with prescribed methadone or
heroin with prescribed methadone or suboxone which is an opiate replacement
suboxone which is an opiate replacement
suboxone which is an opiate replacement therapy that can remove much of the drug
therapy that can remove much of the drug
therapy that can remove much of the drug seeking craving in the mom allow her to
seeking craving in the mom allow her to
seeking craving in the mom allow her to have improved nutrition and better
have improved nutrition and better
have improved nutrition and better prenatal care
prenatal care
prenatal care this medication however does not prevent
this medication however does not prevent
this medication however does not prevent the risk of withdrawal in the baby after
the risk of withdrawal in the baby after
the risk of withdrawal in the baby after birth so when a woman delivers the
birth so when a woman delivers the
birth so when a woman delivers the hospital is going to be using a scoring
hospital is going to be using a scoring
hospital is going to be using a scoring system to look for the presence and to
system to look for the presence and to
system to look for the presence and to assess the severity of the babies
assess the severity of the babies
assess the severity of the babies withdrawal and this scoring system looks
withdrawal and this scoring system looks
withdrawal and this scoring system looks at things like excessive crying or
at things like excessive crying or
at things like excessive crying or excessive sucking spitting up after
excessive sucking spitting up after
excessive sucking spitting up after feeds or watery stools but of course
feeds or watery stools but of course
feeds or watery stools but of course these are symptoms that all babies can
these are symptoms that all babies can
these are symptoms that all babies can display to one degree or another and so
display to one degree or another and so
display to one degree or another and so what we found is that the scoring system
what we found is that the scoring system
what we found is that the scoring system tends to create an adversarial
tends to create an adversarial
tends to create an adversarial relationship between the new mom and the
relationship between the new mom and the
relationship between the new mom and the healthcare team which really prevents us
healthcare team which really prevents us
healthcare team which really prevents us from establishing good rapport and
from establishing good rapport and
from establishing good rapport and getting good parental teaching of safe
getting good parental teaching of safe
getting good parental teaching of safe newborn care if the baby scores too high
newborn care if the baby scores too high
newborn care if the baby scores too high then he’s transferred to the Nina
then he’s transferred to the Nina
then he’s transferred to the Nina intensive care unit where he can be more
intensive care unit where he can be more
intensive care unit where he can be more closely monitored and received
closely monitored and received
closely monitored and received medication to control his symptoms the
medication to control his symptoms the
medication to control his symptoms the unfortunate consequence of NICU
unfortunate consequence of NICU
unfortunate consequence of NICU admission is that mom and baby are now
admission is that mom and baby are now
admission is that mom and baby are now physically separated and we’ve
physically separated and we’ve
physically separated and we’ve interrupted that golden opportunity to
interrupted that golden opportunity to
interrupted that golden opportunity to establish a strong maternal infant bond
typical NICU stay for this disorder is
typical NICU stay for this disorder is going to be about two weeks and imagine
going to be about two weeks and imagine
going to be about two weeks and imagine how – how long that two weeks must seem
how – how long that two weeks must seem
how – how long that two weeks must seem to the woman who has other children at
to the woman who has other children at
to the woman who has other children at home or who maybe has transportation
home or who maybe has transportation
home or who maybe has transportation challenges and finds it difficult to
challenges and finds it difficult to
challenges and finds it difficult to visit her baby while in the NICU and
visit her baby while in the NICU and
visit her baby while in the NICU and imagine how frustrating it must be for
imagine how frustrating it must be for
imagine how frustrating it must be for her when this is the outcome after she
her when this is the outcome after she
her when this is the outcome after she did all the difficult difficult things
did all the difficult difficult things
did all the difficult difficult things we asked her to do during the pregnancy
we asked her to do during the pregnancy
we asked her to do during the pregnancy like giving up her addictive substance
like giving up her addictive substance
like giving up her addictive substance attending to more frequent doctor visits
attending to more frequent doctor visits
attending to more frequent doctor visits remembering to take a daily medication
remembering to take a daily medication
remembering to take a daily medication and answering a lot of probing questions
and answering a lot of probing questions
and answering a lot of probing questions from judging professionals upon and I
from judging professionals upon and I
from judging professionals upon and I see you discharged about 80% of these
see you discharged about 80% of these
see you discharged about 80% of these babies will go home with their mom but
babies will go home with their mom but
babies will go home with their mom but we’ve interrupted the maternal newborn
we’ve interrupted the maternal newborn
we’ve interrupted the maternal newborn bond often times and for some we’ve
bond often times and for some we’ve
bond often times and for some we’ve really ruined mom’s confidence in her
really ruined mom’s confidence in her
really ruined mom’s confidence in her ability to take care of her baby
ability to take care of her baby
ability to take care of her baby comfortably and unfortunately with
comfortably and unfortunately with
comfortably and unfortunately with current traditional care about half of
current traditional care about half of
current traditional care about half of the babies whose moms are in drug
the babies whose moms are in drug
the babies whose moms are in drug treatment need to go this and ICU relp
treatment need to go this and ICU relp
treatment need to go this and ICU relp so in 2012 I was lucky enough to hear
so in 2012 I was lucky enough to hear
so in 2012 I was lucky enough to hear dr. Ron Abraham speak about an amazing
dr. Ron Abraham speak about an amazing
dr. Ron Abraham speak about an amazing program he had at the first Center in
program he had at the first Center in
program he had at the first Center in Vancouver Canada for addicted moms and
Vancouver Canada for addicted moms and
Vancouver Canada for addicted moms and their babies
their babies
their babies he used the care model called harm
he used the care model called harm
he used the care model called harm reduction which recognized that if
reduction which recognized that if
reduction which recognized that if addiction is truly a chronic medical
addiction is truly a chronic medical
addiction is truly a chronic medical condition then it’s unrealistic to
condition then it’s unrealistic to
condition then it’s unrealistic to expect an immediate here one would not
expect an immediate here one would not
expect an immediate here one would not expect an immediate curve for diabetes
expect an immediate curve for diabetes
expect an immediate curve for diabetes or for hypertension and so it’s not fair
or for hypertension and so it’s not fair
or for hypertension and so it’s not fair in addiction either but he discovered
in addiction either but he discovered
in addiction either but he discovered that if he could have gradual
that if he could have gradual
that if he could have gradual improvement in these moms on a
improvement in these moms on a
improvement in these moms on a continuous basis and in the beginning
continuous basis and in the beginning
continuous basis and in the beginning eliminate the most risky behaviors then
eliminate the most risky behaviors then
eliminate the most risky behaviors then he could really make a huge impact and
he could really make a huge impact and
he could really make a huge impact and have improved outcomes being part of the
have improved outcomes being part of the
have improved outcomes being part of the Canadian province system
Canadian province system
Canadian province system he had his funding through the province
he had his funding through the province
he had his funding through the province and he was able to keep many of his moms
and he was able to keep many of his moms
and he was able to keep many of his moms in the hospital for as much as two weeks
in the hospital for as much as two weeks
in the hospital for as much as two weeks before in two weeks after delivery and
before in two weeks after delivery and
before in two weeks after delivery and he had many more good outcomes than we
he had many more good outcomes than we
he had many more good outcomes than we were used to seeing here so it seemed
were used to seeing here so it seemed
were used to seeing here so it seemed like we had the opportunity to improve
like we had the opportunity to improve
like we had the opportunity to improve what we did and this inspired a group of
what we did and this inspired a group of
what we did and this inspired a group of us to get together to see whether we
us to get together to see whether we
us to get together to see whether we could create a program that provide
could create a program that provide
could create a program that provide comprehensive prenatal care and a
comprehensive prenatal care and a
comprehensive prenatal care and a family-centered approach after delivery
family-centered approach after delivery
family-centered approach after delivery he right here in Columbus we were
he right here in Columbus we were
he right here in Columbus we were fortunate to be given a moms grant from
fortunate to be given a moms grant from
fortunate to be given a moms grant from the state of the hub from the state of
the state of the hub from the state of
the state of the hub from the state of Ohio and that allowed for the creation
Ohio and that allowed for the creation
Ohio and that allowed for the creation of the mother infant recovery clinic so
of the mother infant recovery clinic so
of the mother infant recovery clinic so this clinic was open 1/2 day per week
this clinic was open 1/2 day per week
this clinic was open 1/2 day per week it provided prenatal care medication
it provided prenatal care medication
it provided prenatal care medication assisted therapy and group counseling
assisted therapy and group counseling
assisted therapy and group counseling all in one setting and there were also
all in one setting and there were also
all in one setting and there were also community peer mentors that were
community peer mentors that were
community peer mentors that were available to these moms for the rest of
available to these moms for the rest of
available to these moms for the rest of the week we held a local all-day
the week we held a local all-day
the week we held a local all-day conference for nurses where we
conference for nurses where we
conference for nurses where we introduced the concept of addiction as a
introduced the concept of addiction as a
introduced the concept of addiction as a chronic medical disease and we gave them
chronic medical disease and we gave them
chronic medical disease and we gave them instruction on how they can be
instruction on how they can be
instruction on how they can be supportive to mom and being able to
supportive to mom and being able to
supportive to mom and being able to soothe her own baby
soothe her own baby
soothe her own baby utilizing techniques like skin the skin
utilizing techniques like skin the skin
utilizing techniques like skin the skin care and breastfeeding as much as
care and breastfeeding as much as
care and breastfeeding as much as possible we tried to have all the babies
possible we tried to have all the babies
possible we tried to have all the babies care brought to Mom’s room avoiding the
care brought to Mom’s room avoiding the
care brought to Mom’s room avoiding the loud and brightly lit well baby nursery
loud and brightly lit well baby nursery
loud and brightly lit well baby nursery and we tried to provide the babies care
and we tried to provide the babies care
and we tried to provide the babies care on the baby schedule rather than the
on the baby schedule rather than the
on the baby schedule rather than the hospital schedule the results of this
hospital schedule the results of this
hospital schedule the results of this pilot project were really startling we
pilot project were really startling we
pilot project were really startling we found that 90% of these of these 38 moms
found that 90% of these of these 38 moms
found that 90% of these of these 38 moms and babies in this pilot project 90%
and babies in this pilot project 90%
and babies in this pilot project 90% were
were
were able to go home directly from the
able to go home directly from the
able to go home directly from the postpartum floor after just three to
postpartum floor after just three to
postpartum floor after just three to five days of observation and whereas
five days of observation and whereas
five days of observation and whereas typically we were sending half of these
typically we were sending half of these
typically we were sending half of these babies to the NICU we only sent four of
babies to the NICU we only sent four of
babies to the NICU we only sent four of them to the NICU and in most of those
them to the NICU and in most of those
them to the NICU and in most of those cases those were moms who were
cases those were moms who were
cases those were moms who were physically too ill after delivery to be
physically too ill after delivery to be
physically too ill after delivery to be able to take care of their babies when
able to take care of their babies when
able to take care of their babies when we followed these infants after
we followed these infants after
we followed these infants after discharge
discharge
discharge none of them required inpatient or
none of them required inpatient or
none of them required inpatient or outpatient management for withdrawal
outpatient management for withdrawal
outpatient management for withdrawal symptoms so I think there’s some real
symptoms so I think there’s some real
symptoms so I think there’s some real significant advantages to what we found
significant advantages to what we found
significant advantages to what we found in this program first the moms were
in this program first the moms were
in this program first the moms were confident in their ability to care for
confident in their ability to care for
confident in their ability to care for their babies and they had learned
their babies and they had learned
their babies and they had learned soothing techniques that they they can
soothing techniques that they they can
soothing techniques that they they can then use at home when the baby became
then use at home when the baby became
then use at home when the baby became irritable we didn’t interrupt that
irritable we didn’t interrupt that
irritable we didn’t interrupt that period of maternal newborn bonding which
period of maternal newborn bonding which
period of maternal newborn bonding which should lessen our risk about the
should lessen our risk about the
should lessen our risk about the potential for child abuse and neglect my
potential for child abuse and neglect my
potential for child abuse and neglect my avoiding prolonged and costly
avoiding prolonged and costly
avoiding prolonged and costly and ICU care there were huge financial
and ICU care there were huge financial
and ICU care there were huge financial savings and lastly women who were able
savings and lastly women who were able
savings and lastly women who were able to successfully transition the
to successfully transition the
to successfully transition the motherhood now had the additional
motherhood now had the additional
motherhood now had the additional self-confidence that they could go on
self-confidence that they could go on
self-confidence that they could go on and continue to address their own
and continue to address their own
and continue to address their own addiction disease so we know that the
addiction disease so we know that the
addiction disease so we know that the greatest predictor of long-term
greatest predictor of long-term
greatest predictor of long-term successful child development is being
successful child development is being
successful child development is being present in a stable and loving family
present in a stable and loving family
present in a stable and loving family while we continue to argue about the
while we continue to argue about the
while we continue to argue about the best way to address the opiate crisis
best way to address the opiate crisis
best way to address the opiate crisis there’s tens of thousands of women and
there’s tens of thousands of women and
there’s tens of thousands of women and their children caught in the crossfire
their children caught in the crossfire
their children caught in the crossfire this project with coordinated prenatal
this project with coordinated prenatal
this project with coordinated prenatal care and a family-centered approach
care and a family-centered approach
care and a family-centered approach after delivery required no expensive
after delivery required no expensive
after delivery required no expensive equipment and it should be easily
equipment and it should be easily
equipment and it should be easily scalable to other delivery facilities
scalable to other delivery facilities
scalable to other delivery facilities but proper prioritization of funding is
but proper prioritization of funding is
but proper prioritization of funding is now needed to allow for that growth to
now needed to allow for that growth to
now needed to allow for that growth to occur
I think it’s time for us to advance our
I think it’s time for us to advance our attitudes about addiction to agree with
attitudes about addiction to agree with
attitudes about addiction to agree with the science and allow these women and
the science and allow these women and
the science and allow these women and children to have the brightest future
children to have the brightest future
children to have the brightest future possible thank you
possible thank you
possible thank you [Applause]
”
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