We recently announced a new initiative to address drug use in pregnancy. Over the last three years, my staff and I have talked with hundreds of people around the state to understand the major health challenges facing Montana communities. I was surprised at how often the hospitals, health care providers, and community members we spoke with brought up perinatal (during and after pregnancy) drug and alcohol use as a major concern and a problem that seemed to be on the rise. As a foundation, we began looking into this issue more seriously. What we found was deeply troubling to me as a family physician who has helped hundreds of families through pregnancy.
We learned that throughout Montana, pregnant women and young families face a profound lack of access to treatment for addiction. In our 2017 report on substance use disorders, we found that at the time, only 6% of Montana’s state-approved substance use disorder treatment facilities had programs for pregnant and postpartum women. We also found that Montana had among the nation’s lowest rates of buprenorphine treatment capacity for people with opioid use disorders.
The data we found shows that this lack of care is contributing to a serious and growing public health crisis. The number of Montana children in foster care has more than doubled since 2011, and out of the more than 3,200 children in foster care in 2016, 64% were removed from the home for reasons related to parental substance use. Among Medicaid patients (the only insurance coverage for which this data is available), the percentage of infants with perinatal drug exposure increased from 3.7% in 2010 to 12.3% in 2016.
In the face of such a serious problem, is there any good news? Yes, we believe that there is. In a recently released report, we found many examples of programs that are facing similar challenges and achieving amazing results. It turns out that a simple, low-cost set of interventions can make a huge difference by lowering the rate of drug-exposed newborns, saving health and social service costs, and keeping more families together. The Kaiser Health System, for example, reduced complications among newborns and yielded a net savings of $6 million. In Vermont, a similar statewide system cut by two-thirds the number of newborns transported for intensive treatment for drug withdrawal. Studies in other systems in the U.S. and Canada showed similar results.
What does it take to achieve such impressive outcomes? The same, simple set of measures lies behind many of the programs we reviewed:
- Team-based care that pairs prenatal care with substance use disorder treatment: Prenatal care providers check for drug and alcohol use as a routine part of prenatal care. Hiring an addiction treatment provider to work in the prenatal setting (such as a licensed addictions counselor or licensed clinical social worker) can benefit patients by providing immediate, supportive care as soon as a problem is identified. This low-cost approach can help pregnant women start outpatient-based treatment promptly while helping reduce wait times for the few residential or inpatient treatment programs that serve pregnant women.
- Addressing unmet social needs: The challenge of perinatal substance use disorders is often compounded by homelessness, domestic violence, lack of transportation, and other social needs. Care coordination provided in a team-based prenatal care setting can address many of these issues. Some programs go further, pairing affordable housing with social services. For example, the Exodus Program in Los Angeles reported that over its first six years of operation, less than 5% of the 264 infants born into the program had positive toxicology screens.
- Collaboration among health care providers, child welfare, social services, and criminal justice: Periodic multi-disciplinary care conferences and collaborative management of high-risk patients contribute to marked reductions in the complications of perinatal substance use disorders and the burden on the justice and foster systems.
Montana’s perinatal drug use problem is both serious and solvable. When such simple solutions exist, the time for action is now. Consequently, we have decided to partner with the Montana Department of Public Health and Human Services to bring these critically needed interventions to communities around the state:
- We are offering grants and technical support to hospitals and perinatal practices that agree to implement team-based prenatal care that will serve their communities and regions.
- MT DPHHS will support this initiative by providing leadership, facilitating the participation of caseworkers and other staff in multidisciplinary care conferences and management of high-risk patients, and evaluating reimbursement for team-based prenatal care.