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The University of Kentucky has received almost $5 million to expand and improve a program to help pregnant women with opioid dependence problems before, during and after delivery.
The Perinatal Assistance and Treatment Home (PATHways) program is currently based in Lexington, helping pregnant women with medication, peer support and health services to reduce the number of babies born with an opioid addiction. The program continues after birth with peer counseling and health services.
Between 2014 and spring 2017, more than 150 women received treatment through PATHways. Of those, 77 percent were admitted to labor and delivery without any illicit drugs in their systems.
For every time a mother attended a group session in the program, she was almost 15 percent more likely to have a negative drug test and 50 percent less likely to relapse once the baby was born. Often, babies born to moms on medication-assisted therapy show some withdrawal symptoms. Nationally, the average is between 40 percent and 58 percent of babies, but in PATHways the average is only about 30 percent.
With the grant from the federal Patient-Center Outcomes Research Institute, UK researchers will compare two elements of the PATHways program in rural areas. In one, women will attend pregnancy/parenting support and education groups led by a trained nurse and a peer support specialist every other week.
In the other, women will have meetings via telemedicine with specialists in high-risk pregnancy, addiction care, pediatrics or substance counseling.
Dr. Agatha Critchfield, assistant professor of obstetrics and gynecology and medical director of PATHways, helped start the program because she watched mothers give birth without any medical or emotional support for their disorders. Both moms and babies left the hospital still addicted, and many were separated by child protective services. She worked with colleagues in psychiatry, medicine and nursing to launch the program three years ago.
"The PATHways program has seen great successes during the first three years that we have been in operation including reduced neonatal withdrawal, less maternal relapse and more infants going home with their mothers," Critchfield said. "However, at this time, PATHways is only available at our main health care campus in Lexington and many patients with opioid use disorder reside great distances from our clinical home and have transportation difficulties that make it impossible for them to access this level of comprehensive care."
Kentucky has one of the highest rates in the nation of babies born with neonatal abstinence syndrome (NAS), a rate that has climbed from 46 babies in 2001 to 1,115 in 2016, according to hospital discharge data collected annually by the Kentucky Cabinet for Health and Family Services.
This past legislative session, the General Assembly put more pressure on prospective mothers with an opioid use disorder; a section of House Bill 1 expands the definition of child abuse and neglect to include a baby born with NAS. The state could begin the process of terminating parental rights unless the mother enrolls in a drug addiction treatment program within 90 days of birth.
The $4.9 million award has been approved pending completion of a business and programmatic review.
"We hope our findings will serve as a model for other areas in the U.S. that struggle with delivery of substance abuse services in rural settings." Critchfield said.