Community impact of a primary-care clinic-based Medically Assisted Treatment program for pregnant, opioid dependent women

Between 2001 and 2010, the New Mexico drug overdose death rate jumped 60%. Since then, our state has consistently led the nation for overdose deaths and narcotic use. The epidemic centers on young adults, including women of child bearing age. In Santa Fe, up to 20 women per year were giving birth to drug-dependent infants. There is effective and safe addiction treatment available during pregnancy, but until recently, women could access these services in only one program in the state, at the University of New Mexico in Albuquerque.

Faced with this huge public health the problem and knowing the difficulty drug-using pregnant women had accessing care, La Familia Medical Center launched one of the first community-clinic-based comprehensive pregnancy care and opioid treatment programs in the country. Starting in late 2013, we began offering drug dependent women comprehensive care of their pregnancy, including delivery, and family centered care for their children and partners as well. To date we have treated over 70 women and partners and delivered 25 babies with no significant effects of narcotic dependence. Santa Fe County has one referral hospital, giving us an opportunity to analyze the impact of the program on the entire community via Christus St. Vincent's Hospital data.  

We will present program statistics from the first full year of the program to the year before program implementation.  Data include the number of Neonatal Abstinence Syndrome (NAS) diagnoses, average length of stay for all infants diagnosed with NAS in both years and for all infants delivered to buprenorphine patients in 2014.  We will also present data on the characteristics of women and infants in the treatment program compared to those in 2013 diagnosed with NAS including timing and frequency of prenatal care, birthweight, and birth outcomes.  Preliminary data analysis shows that average length of stay and NAS diagnoses have dropped dramatically from 2013 to 2014 in our community.   

Several states have passed laws criminalizing drug use in pregnancy and discouraging women from seeking the prenatal care and treatment they so desperately want and need. We will also discuss the costs and publc health effects of both approaches. 

We conclude that comprehensive primary care including buprenorphine treatment, substance abuse counseling, pregnancy care and family centered care for opioid using women and their children and partners is effective, has significant public health benefits, and can be feasibly implemented by community clinics.