Dartmouth-Hitchcock Medical Center has been awarded a federal grant of $2.7 million to provide support for screening and treating pregnant women with histories of opioid abuse, it announced on Feb. 21. The grant allows for the development of seven Medication Assisted Treatment programs across New Hampshire in Bedford, Berlin, Dover, Keene, Nashua, Laconia and Littleton. The new MAT programs will follow the practices already in use at Dartmouth-Hitchcock’s Moms in Recovery program, a treatment program for pregnant women with histories of opioid abuse.
A DHMC press release noted that in 2015, 7.8 percent of newborns to New Hampshire residents at DHMC were diagnosed with Neonatal Abstinence Syndrome or withdrawal after in utero exposure to substances. The syndrome is associated with mortality and morbidity for women and their infants which can include premature birth, poor fetal growth and neonatal withdrawal and prolonged hospitalization, according to the press release. Additionally, the Centers for Disease Control and Prevention reported that in 2016, New Hampshire’s drug overdose death rate was 39 deaths per 100,000 people.
Julia Frew Med ’05, a psychiatrist and professor of psychiatry and medical education at the Geisel School of Medicine, serves as the medical director of Moms in Recovery and the director of the hospital’s Center for Addiction Recovery in Pregnancy and Parenting.
“New Hampshire is one of the states that has been hardest hit by the epidemic,” Frew said. “[Pregnancy] is seen as a really ideal time to intervene, to try to change the course of potentially two generations’ lives.”
Director of women’s health services for Moms in Recovery Daisy Goodman Med’14 began her work at a clinical practice in rural Maine almost 16 years ago, where she said that the lack of access to treatment for women with opioid use disorders was unsettling.
“I became aware that I was taking care of women who had opioid use disorder and was really struck by the lack of access to treatment women had,” Goodman said. “It was really, really hard for women to find somebody who could care for their addiction.”
Frew added that the approach of Moms in Recovery, which these statewide programs will be modeled off of, brings the traditional elements of treatment under a single roof.
“As opposed to a more traditional situation where women might get their addiction care at an addiction treatment program and their prenatal care at their [obstetrics] clinic, this program brings everything together in one place,” she said.
According to Frew, Moms in Recovery’s success is aided by the program’s ability to provide services that are generally overlooked or impossible to cover by other treatment programs. The program has a case manager who helps women connect with community resources around housing, transportation and employment insurance, she said.
Goodman said that women are much more likely to seek out treatment when they become pregnant.
“Women who have not been able to enter treatment in the past for a variety of reasons are inspired to do so once they become pregnant out of concern for the health of the baby,” she said.
William Torrey ’80, psychiatry professor and vice chair for clinical services of Geisel’s psychiatry department, said every addiction case must be handled individually for the best chance of success, which often includes a mix of medication and addiction therapy.
“Many people have opioid use disorders, but also suffer from stress disorders or post-traumatic stress disorder … and you want to make sure that the person is getting good treatment for that as well,” he said.
Goodman said that DHMC’s approach to treating women with opioid use disorders has been successful in many ways.
“We have a comparatively very high retention rate [of] 64 percent … We have good outcomes in terms of our average deliveries in our program [and] average birth weights are in the normal range,” she added. “We have a low rate of child removal from the home.”
Goodman said that the next hurdle is applying this model to other care sites in New Hampshire.
“We feel like our program has been tested and [has] shown its merit and the question now, or the challenge to us, is can we now expand that approach to these other sites and that’s what this grant is doing,” she said.
