The moment Ashley learned she was pregnant in the fall of 2015 was also, she felt certain, the moment she would stop using drugs.
Ashley, who grew up in a happy, financially stable home and was a jock, had begun drinking heavily in college, then experimented with what she calls party drugs — marijuana, cocaine and ecstasy. Eventually, she became addicted to heroin and other opiates.
“In my mind it was like, ‘There’s no way I’m going to continue to get high when I’m pregnant. You have to be a really, really bad person to do that,” Ashley, who is now 31 and lives in West Virginia, told HuffPost. “In my mind, it was kind of like I was guaranteed nine months of sobriety.”
She checked into — and completed — a rehab program, then moved in with her boyfriend. But almost immediately, she got high again.
“I thought, ‘I’m just going to do it one time, and that’s it, because I’m pregnant and nobody gets high when they’re pregnant,’” Ashley recalled. “But I could not stop at all. I got high every single day until I gave birth to her.”
“The rate of opioid use among expectant women ... more than quadrupled from 2004 to 2015.”
Findings published this week in the American Journal of Public Health suggest that her experience is indicative of a growing public health crisis in this country as the use of opioids and amphetamines — especially meth — during pregnancy skyrocketed in the last decade, particularly in rural areas of the country.
Researchers examined hospital data from some 47 million deliveries around the country from 2004 to 2015 and found the rate of opioid use among expectant women — as captured through the codes listed on their records — more than quadrupled from 2004 to 2015, from 1.5 per 1,000 delivery hospitalizations in 2004 to 2005 to 6.5 per 1,000 delivery hospitalizations in 2014 to 2015.
Meth use also jumped during roughly the same time. Detection of amphetamines doubled, from 1.2 per 1,000 delivery hospitalizations in 2008 to 2009 to 2.4 per 1,000 in 2014 to 2015. Hospital coding doesn’t distinguish between illicit amphetamines and prescription drugs, but the researchers said most people treated for amphetamine use took meth.
Use of both types of drugs rose disproportionately in rural counties, and by 2014 to 2015, amphetamine use complicated about 1 percent of deliveries in rural parts of the West.
Study researcher Lindsay Admon, an OB-GYN at the University of Michigan Von Voigtlander Women’s Hospital, told HuffPost that she and her team were particularly surprised by the rates of meth use they found.
“Very little has actually been published on amphetamine use in pregnancy in the last 10 years,” she said, arguing that relatively little attention has been paid to meth in public health spheres and the media since its heyday in the early and mid-2000s.
“Even among some of my mentors and colleagues, when I’ve tried to tell them about this finding, it’s almost like people didn’t want to hear it. They wanted me to be doing work on opioid use disorder only, because that’s obviously such a big problem and that’s where so many resources have been focused,” Admon continued. “But I think maybe we’ve been focusing so much on that at the expense of monitoring what is going on with other conditions.”
And yet her team’s findings suggest that amphetamines may be particularly detrimental to the health of moms and their babies. The risk of serious maternal complications and death during childbirth was higher among women who had used amphetamines than those who had used opioids, as was the incidence of premature birth.
The American College of Obstetricians and Gynecologists has spelled out a clear gold standard of care for women who use opioids during pregnancy, recommending — among other things — universal screening and medication-assisted treatment with opioid replacement drugs, like methadone or buprenorphine. But for meth use during pregnancy, there isn’t a clear recommended treatment plan.
Research shows that women who use drugs or drink during pregnancy may be reluctant to seek prenatal care because of social stigma, as well as a fear of being punished or having their babies taken away. Punitive drug enforcement policies are common. Nearly half the states in this country consider substance use during pregnancy to be child abuse — and in Minnesota, South Dakota and Wisconsin, it is grounds for civil commitment.
“By 2014 to 2015, amphetamine use complicated about 1 percent of deliveries in rural parts of the West.”
Ashley went to prenatal appointments but concealed her drug use from her OB-GYN. When she went into a hospital to deliver, the only people who knew were her boyfriend, who had kicked her out of his place, and her parents, who had taken her in. She described the day her daughter was born as the best of her life and also the worst.
“I just told them everything I had done,” she said. “I remember it, the pain. It’s really hard to describe, but at that point I was almost beyond feeling ashamed. I felt like a terrible person. I felt like I really didn’t have a reason to live.”
Ashley’s daughter was diagnosed with neonatal abstinence syndrome and stayed in the hospital for a week before she was transferred to a center specializing in the treatment of drug-addicted babies. She received methadone and stayed in a quiet, dimly lit environment. Anything too bright or too loud made her agitated and caused her withdrawal symptoms to increase. Ashley signed guardianship over to her mom, checked into an in-patient treatment center in Kentucky and stayed for a year. She has been sober since and works as a recovery coach for pregnant women.
Her daughter is now 2 1/2 and stays with Ashley several days a week. The girl loves to sing and dance and these days is very into unicorns. There are some suggestions her speech might be somewhat delayed, but she seems otherwise healthy.
Ashley, meanwhile, shares her story in the hopes of spreading the message that substance abuse is a chronic disease, not a moral failing.
“Words cannot describe how painful and miserable it feels to be so dependent on such a horrible thing when you’re pregnant,” she said. “Every day, I’d think, ‘I’m not going to do it again,’ and then the next day would come. It had such a grip on me that I don’t even know how to explain it.”