Pregnant women on montana reservations find few options for drug treatment antiemetic definition

This time, quitting was even harder. During the first five months of her pregnancy, she relapsed several times, eventually relying on Suboxone, a prescription medication used to treat addicts that helps relieve opiate withdrawals and cravings. Aripa bought the pills from a friend and broke them into small pieces, which kept her from using for the last four months of her pregnancy.

Montana’s reservations are geographically isolated, and the Indian Health Service, which provides health care on most reservations, has been underfunded for decades. Native Americans often must travel farther than other Montanans to access treatment centers and quality medical care. And many say they are hesitant to go to hospitals because of discrimination, previous bad experiences, or tribal laws that ban drug users.

In 2016, nearly half of infants born in Lake County, which includes the Flathead Indian Reservation, were at risk for neonatal abstinence syndrome, the medical term for a dangerous set of withdrawal symptoms in drug-dependent infants including tremors, convulsions and high-pitched crying.

But for many Native women, who often lack even prenatal care, it takes hours to drive to the closest inpatient centers that admit pregnant women. Aripa lives 90 minutes from the nearest inpatient center in Missoula. Proven outpatient services, like those that provide counseling and a prescription for Suboxone to aid with recovery, are often full or far away. Nicole Callahan, a mother on the Flathead reservation, had to drive three hours one way for Suboxone treatment in Helena.

Addiction treatment experts say pregnancy is a perfect “window of opportunity.” Pregnant women are more likely to want to quit, knowing drug use can affect their children. While women rarely develop addictions during pregnancy, it is often the first time they’re diagnosed.

Only two inpatient treatment centers, in Billings and Missoula, regularly admit pregnant women. A treatment center run by the Blackfeet Tribe in Browning has two beds for pregnant women, but it is primarily equipped for alcohol addiction. Mothers using opiates are sent two hours away to Great Falls to detox, a system that director Louella Heavy Runner said often results in the mothers dropping out of treatment.

Among reservations, only Flathead has an outpatient program that combines behavioral therapy with a prescription for buprenorphine, which the American Congress of Obstetricians and Gynecologists suggests as the safest and most effective way to treat pregnant mothers with addictions. The Blackfeet Tribe is currently studying how best to offer those services.

The Flathead outpatient program often has a six-month waiting list, and pregnant women are not given priority, despite the urgency of their situation. The long wait is due in part to a severe shortage of doctors in the state who prescribe buprenorphine: Only one doctor in the 120 miles between Kalispell and Missoula is certified.

Women are referred to Kalispell or Missoula when the Flathead program is full, but even there, they may not find treatment. Some programs do not accept patients who live far away over fears they won’t show up for daily or weekly appointments.

Doctors found evidence of opioid use in her umbilical cord, which retains information from an entire pregnancy, but does not show how long ago a woman stopped using. Even though she passed a drug test after giving birth, Aripa said doctors wrote a note on her son’s incubator saying nurses should not allow her to breast-feed.

Professional medical associations encourage women with substance use disorders who have stopped using — often even those prescribed anti-opiates like methadone or buprenorphine — to breastfeed their children, as it supports recovery and bonding. Studies also show that skin-to-skin contact reduces the severity and length of an infant’s drug withdrawal.

Child and Family Services was called to the Kalispell hospital. Aripa said that a social worker told her she should have sought help earlier in her pregnancy. Aripa replied that she was afraid of losing her baby, afraid of being judged, afraid of all that she was now facing.

Carma Corcoran, the Indian law program coordinator at Lewis and Clark College in Portland, Oregon, and a Chippewa Cree tribal member, said historical trauma and discrimination makes it especially difficult for Native pregnant women to seek help at hospitals.

Fifteen percent of Native Americans have avoided going to a doctor out of concern they would be discriminated against or treated poorly, according to a national study by Harvard University and the nonprofit Robert Wood Johnson Foundation. Some studies of maternal care have shown that people from minority groups may be screened for drugs more often than white parents at some hospitals.

“It’s important that people realize that many Native people are born into trauma. So it’s not something that is of their own making,” Corcoran said. “So when you’re at that place that you can ask for help, and you’re treated badly because of the color of your skin and that you’re Indian, it is painful. Who is going to go back to that place?”