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Caring for Maternal Addicts Without Using a Withdrawal Program

Breaking free from opioid addiction is a difficult and multifaceted challenge. For many women who are addicted, the process is made even more complex by pregnancy. Often these women are unable to tap into any kind of healthcare, whether for substance abuse treatment or prenatal treatment. The result is that they pursue neither, endangering two lives. That’s where the Giving Respect and Compassion to Expecting Moms, or G.R.A.C.E., program steps in. Created by the team at Lovelace Women’s Hospital in Albuquerque, NM, G.R.A.C.E. has been ground-breaking for a highly under-served population, says Dr. Abraham Lichtmacher, Chief of Women’s Services, who developed the program’s clinical protocols and support systems.

Caring for Addicts Without a Withdrawal Program

A 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,” Waschler 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 medication-assisted 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.”

This blog post is an excerpt from the HealthStream article, SAVING G.R.A.C.E. - Program engages with at-risk mothers through prenatal care, delivery, and beyond. The article also includes:

  • A Multifaceted Program with One Overarching Goal
  • Building a Training Program from the Ground Up

Clinical development training, like that necessary for treating those affected by opioid addiction, is just one of the healthcare workforce development solutions offered by HealthStream for providers and employees. Explore HealthStream Clinical Development Solutions.


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