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Published on March 21, 2016

Hope for the smallest opiate victims

(This story was updated on March 25, 2016 to reflect corrected information about SoberMommies founder Julie Maida. The original story misreported that Maida had relapsed after each of her three children were born, when, in fact, she has been sober since May 2, 2000.)

Deborah Heavilin, a trained obstetrician, recovering opiate addict, and mother of three, sits at Starbucks as charged as a racehorse. She is, indeed, ready for a sprint against time to try and save as many women and babies as she can from the scourge of the Cape’s opiate and heroin epidemic.

Heavilin has been to hell and back herself, having lost her medical license twice because of addiction. But, now nearly 15 years sober, she has been named director of a new three-year Cape program – Moms Do Care – to get pregnant women with substance use disorders into medication-assisted treatment and prenatal and postpartum care.

“These moms love their babies as much as anyone else,” she said. “Of course, if they are in the grip of active addiction, they can’t access that.”

The Cape program will be funded with part of a $3 million grant awarded to the state by the federal Substance Abuse and Mental Health Services. The money is being administered by the Massachusetts Department of Public Health to a collaborative that includes Cape Cod Healthcare and UMass Memorial Medical Center in Worcester. CCHC will receive $600,000 over three years to establish and run the recovery and support program.

The extent of the problem is no secret. Barnstable County had 43 fatal opiate overdoses in 2013 and 35 last year [pdf], according to the state Department of Public Health. At least 3.1 percent of the county’s 220,000 residents [pdf] are addicted to or dependent upon heroin or prescription opioids, according to the Barnstable County Department of Human Services. And perhaps the most frightening statistic of all is this epidemic’s effect on the most innocent of county residents: newborns. Nationally, the rate of maternal opiate use was 5.63 per 1,000 hospital births in 2009, according to federal data.

Five percent of babies born at Falmouth Hospital and Cape Cod Hospital are exposed to substances in utero, according to a report done recently by Cape Cod Healthcare. This includes the three percent of newborns diagnosed with Neonatal Abstinence Syndrome (NAS). NAS refers to infant withdrawal from substances, which may start within hours or in days to weeks of birth, depending on the type and frequency of prenatal substance exposure.

Even within the convoluted world of addiction, the plight of mothers and babies is complicated. Withdrawing from opiates while pregnant puts a mother at high risk for relapse, and the fluctuating level of drugs endangers the unborn baby, Heavilin said.

Through medication-assisted treatment, women with substance use disorders are put on a substitute medication, such as buprenorphine, administered under medical supervision that prevents highs, lows, and cravings. Babies do better being weaned from substitute drugs after birth and mothers are less likely to relapse if they try to get sober after the baby is born, Heavilin said.

The Cape was chosen as a pilot ‘rural’ project site for the Moms Do Care project because the health system, like many in rural areas across the state and country, is somewhat decentralized for pregnant women – especially for those who choose medication assisted treatment during pregnancy.

The Moms Do Care grant pays for staff to support the women with care coordination and peer recovery support throughout pregnancy and for up to six months postpartum. The staff funded by the grant includes Heavilin and one full-time and one part-time Recovery Coach Moms.

“The Peer Recovery Coaches hired through this grant are mothers with experience of addiction during pregnancy who have found recovery and play a critical role in modeling that recovery is possible and motherhood is an important part of that recovery” said Lisa Guyon, Community Benefits Director at Cape Cod Healthcare.

“The stigma for these moms is really intense. Even among other people with substance use disorders there’s a tremendous shaming,” Heavilin said. “A lot of these moms were showing up in labor and the family or spouse didn’t know.”

In addition to the coordination of medication-assisted treatment for mothers and prenatal and postpartum health services, the grant will also support the expansion of parenting and recovery support groups and provide child care so moms can attend.

Once women are enrolled in the Moms Do Care program, they are encouraged to attend these and other support groups, and use the resources of PIER (Positive Individuals Engaged in Recovery) Recovery Center of Cape Cod at 209 Main Street in Hyannis, run by a Springfield organization, the Gandara Center, according to Guyon.

Even if a new mother decides to get sober, the normal postpartum issues of isolation, fluctuating hormones, and mood swings make it difficult, Heavilin said. Also, traditional 12-step programs do not consider participants on medication-assisted treatment “sober,” and few offer childcare, she added.

Mothers are supposed to put their children’s needs ahead of their own, but in order to stay sober, there are times women might have to make themselves a priority, said Julie Maida, a Boston-area mother who started an online recovery community called SoberMommies.

“Being a mom is hard and being a woman in recovery is hard,” said Maida. She has three children, ages 20, six and three, and has been sober for 16 years.

“How do you balance all that stuff?” she said. “And if you’re alone in life and you don’t have a tribe or support around you? You don’t have someone to tell you that being overwhelmed (as a new mother) is normal?”

Heavilin says she first got addicted to pills near the end of her medical residency and at one point was admitted as a heroin addict at the hospital where she was practicing medicine. She now is working to get her medical license reactivated, this time in the field of addiction. In the meantime, she has done odd jobs, worked in clinical research, done admissions for Gosnold Treatment Center, and taught at Emerson House, a residential treatment facility run by Gosnold in Falmouth.

In January 2014, she and Falmouth pediatrician  Jean Talbert, MD founded a support group for recovering mothers in Falmouth that has grown into the nonprofit Mothers and Infants Recovery Network Inc.  They now sponsor another recovery group for women in Hyannis and have been asked to expand to Orleans and the Barnstable County Correctional Facility, Heavilin said.

For Heavilin, the race to save two generations ­– mothers and their babies – is personal on many levels. She understands the effort, energy, and focus it requires to stay sober and be a good mom. She knows women who are struggling and she sees the toll overdoses take on the Cape community.

“When you’re using, you’re not thinking of the consequences, you’re thinking of the next fix,” she said. This year, “we lost five moms, leaving six kids.”