CARING FOR ADDICTS WITHOUT A WITHDRAWAL PROGRAM
Another layer of complexity the program must address is that the professional literature from the American College of Obstetricans and Gynecologists ( ACOG ) does not recommend pregnant mothers weaning off opioids during pregnancy . The G . R . A . C . E . solution was to require its participating physicians to obtain special licensure to prescribe Subutex ( buprenorphine ), a medication used to treat opioid addiction , which women can use while pregnant . According to MedPage Today , only about 46,500 , or 5 percent , of U . S . doctors have this waiver ( George , 2018 ).
ASSESSING OUTCOMES KEY TO DRIVING FORWARD PROGRESS
Now that G . R . A . C . E . is up and running , the focus is on continually assessing its offerings so that changes can be made around efficiency and quality . This means everything is always under review , a process that can be complicated due to the relative scarcity of similar programs to use for benchmarking .
“ There is little national , or even local data for comparison ,” Dr . Lichtmacher says . “ Data is key , but when you lump this whole group of patients into one big bucket , you don ’ t get the whole picture . Remember , our program is geared towards general addiction — not just opioids . There are differences in our patient population . To assess those differences , we ultimately developed a method of designating what the addiction is : for instance , patients who are addicted to opioids vs . those who are addicted to methamphetamines or barbiturates and things of that nature .”
Even so , the G . R . A . C . E . team is encouraged by patients who often are eager and willing to make changes in their lives and have a motivation to do so in the form of a newborn child .
“ One thing that ’ s working for us is that within the world of addiction , women who are pregnant have a very high level of motivation ,” Wascher says . “ If you take a woman who is addicted to an opioid like heroin , or using meth on the street , and compare her to a pregnant woman doing the same thing , the pregnant woman has more motivation to make a change in her life . Our hope is that we can come along beside her and make sure that she has the right support and resources . We connect her to behavioral health services and to medicationassisted therapy , and really try giving her every opportunity to succeed .”
The whole goal of our program is to help keep the mother as stable as possible during her pregnancy so that the baby will be stable as well , “ Dr . Lichtmacher adds . “ We ’ re not going to cure them , most likely , but we ’ re going to give them an opportunity . We certainly have had women who have done quite well and been able to stay clean .”
R E F E R E N C E S
George , Judy , “ Why Do So Few Docs Have Buprenorphine Waivers ?”, MedPage Today , February 14 , 2018 , Retrieved at https :// www . medpagetoday . com / psychiatry / addictions / 71169 .
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