Overdose deaths rose among pregnant people, postpartum parents

Overdose deaths during pregnancy and in the months after childbirth rose between 2018 and 2021 as the number of Americans who died while using drugs reached record highs, according to a new study.

Some of the most dramatic increases were among Native American and Alaskan Natives and women aged 35 to 44. Deaths within two to 12 months after giving birth nearly doubled for drug users.

The findings, from the National Institute on Drug Abuse (NIDA), were published in JAMA Psychiatry. Researchers said the results reveal important trends that affect maternal mortality rates and the drug overdose crisis.

“This has profound implications for the way we discourage, directly or indirectly, women from seeking care during pregnancy,” said Dr. Wilson Compton, an addiction psychiatrist and NIDA’s deputy director.

The reasons pregnant people with an addiction don’t seek care are well-documented. Many fear an OB-GYN or nurse will call child protective services. Women have been forced to give up babies at birth. Others may be required to stop treatment medications to keep their child. Treatment programs may consider pregnant women a liability or not allow infants.

Dr. Stephen Loyd, who treats pregnant patients addicted to opioids in Nashville, said these fears compromise care. Loyd described a new patient he met last week. The young woman was 29 or 30 weeks pregnant and attempting to treat herself by buying buprenorphine on the streets. The medication is commonly prescribed to ease cravings for deadly opioids. She was scared to make an appointment with an addiction specialist or an OB-GYN.

“Therein lies the danger,” said Loyd. “She had no prenatal care.”

Loyd said he’s seen attitudes change when doctors and nurses learn about the trauma that feeds addiction and the challenges a pregnancy compounds. Loyd and other physicians said addiction prejudice harms patients.

“We need to understand discrimination as a patient safety issue,” Dr. Mishka Terplan, a member of the Addiction Medicine Expert Work Group at the American College of Obstetricians and Gynecologists, said in an email. “People are dying because they are devalued.”

“We need to understand discrimination as a patient safety issue. People are dying because they are devalued.”

Dr. Mishka Terplan

In this study, as in others, most of the people who died were found alone. Dr. Davida Schiff, director of perinatal and family-based substance use disorder care at Massachusetts General Hospital, said people need safe spaces where they can use drugs and be revived if they overdose. There are only two supervised consumption sites or overdose prevention clinics operating in the U.S., both in New York City. A top federal agent has said he may move to close them.

In families, Schiff added, it may be wise to train everyone, including older children, to keep Narcan handy and know how to use it.

“We need to think creatively about how we empower families,” said Schiff, “to administer a life-saving medication.”

For parents starting treatment, Schiff said some basic support like infant care can help with the sleep deprivation and other early childhood stresses. The investments, she said, pay off.

“Pregnancy really is a motivating time for people to get into treatment,” Schiff said. “We need to enhance and expand that care in the postpartum period.”

Schiff and some child welfare advocates in Massachusetts are lobbying to change a law they say discourages treatment. It mandates reporting of babies born with traces of addiction treatment medications.

The opioid epidemic has upended the lives of millions of children and their relatives. It has also strained foster care systems across the nation. Compton, at NIDA, said success rates for pregnant women in treatment with buprenorphine and methadone are good. So helping mothers begin and sustain recovery, he said, could improve the health and well-being of many.

“By encouraging medications for opioid use disorder for pregnant women,” Compton said, “we may be able to help in all three areas: saving their lives, improving their offspring’s outcome and improving their outcomes in the long run too.”