TWO PATIENTS IN ONE
GROWING AN INTEGRATED TREATMENT PROGRAM FOR OPIOID USE DISORDER : ONE CHALLENGE AT A TIME
Jonathan Weeks , MD
INTRODUCTION :
The substance use disorder scourge is an ever-increasing challenge nationally and in the Commonwealth of Kentucky . The most recent National Survey on Drug Use and Health reported that 21.4 % of people aged 12 or older ( 59.3 million people ) used illicit drugs within the past year . Among the 9.5 million who misused opioids in the past year , 9.3 million misused prescription pain relievers and 902,000 used heroin . In 2019 , 70,630 drug overdose deaths occurred in the U . S . Opioids accounted for 71 % of overdose deaths and over 70 % of opioid deaths were synthetic opioids , primarily fentanyl derivatives . Drug overdose deaths involving psychostimulants such as methamphetamine are also increasing . 1
The number of pregnant women with an opioid use disorder ( OUD ) more than quadrupled between 1999 and 2014 . Rates in Kentucky are 25-40 % higher than the national average and by 2010 , most labor and delivery units were seeing an alarming number of pregnant women in acute withdrawal . My OUD work began in 2011 when I was serving as an OB-GYN faculty member . A bright senior resident presented a patient who was 28 weeks gestation without prenatal care , in severe withdrawal and unable to cooperate during the history and physical . The patient was seen under similar circumstances in her previous pregnancy , stabilized and referred to a methadone treatment program . However , she dropped out of care approximately two months after delivery .
I was profoundly affected by the resident ’ s obvious frustration and by the patient ’ s seeming lack of regard for the well-being of her children . I was far less knowledgeable about the neurobiology of addiction at the time , but my immediate thoughts were 1 .) Regardless of the actions of the mother , the baby was an innocent victim in need of care , 2 .) The opioid epidemic was unremitting and would be a continuing challenge for all clinicians , including obstetricians ; 3 .) To best serve the young physicians I was charged to train and mentor , I needed to pursue additional substance use disorder knowledge and clinical acumen .
( continued on page 14 ) MARCH 2022 13