Allison didn't believe asking for an over-the-counter pain reliever and an ice pack was out of line. She just gave birth. She was in pain.
But one nurse gave her a hard time about the request, she said, and others snubbed her or behaved rudely.
The 29-year-old Bristol Township woman said the nursing staff started treating her differently after learning she had taken prescription opioids she bought off the street — instead of the heroin she was addicted to — during her pregnancy, thinking it would be safer, though it exposed her baby to the drug.
“I could feel them judging me. They were treating me like I was drug seeking. You’d think I was asking for a Percocet. It was really making me feel like crap,” said Allison, who asked that her last name not be used. “It’s very easy to be judgmental when you haven’t walked in someone’s shoes.”
Allison's experience with the health care community when she delivered her son in 2015 is still commonplace, according to drug treatment providers and mothers in drug recovery. Multiple studies have found health care providers often view drug dependence in pregnancy more harshly than other behaviors, an attitude that can put the health and well-being of women and children at risk.
The recent surge in pregnant and postpartum women with drug dependence has created a new call for advancing addiction education and substance abuse knowledge in primary and specialty care among health care providers in the Philadelphia region and beyond.
Pam Blackburn often hears complaints from pregnant and postpartum women about negative experiences with medical workers. She's a counselor with Mobile Engagement Services, a program at the Penn Foundation in West Rockhill that works directly to support new moms in recovery from drug dependence.
“Just the attitude and sideways comments made to them,” Blackburn said. “A lot of them are made to feel like bad people when they’re in the hospital.”
Complaints about negative comments to patients in drug treatment who are prescribed drugs to replace heroin during pregnancy led Melinda Goodwin to develop a presentation on addiction and pregnancy for hospitals. Goodwin is coordinator of the pharmacotherapy program at Aldie Counseling Center in Doylestown Township.
What Goodwin found when speaking to staff is they lacked knowledge, especially in the use of opiate replacement drugs. Since she started the presentations two years ago, Goodwin said clients have noticed improved staff attitudes at the hospitals she has worked with.
“These are not terrible parents or terrible people,” she added. “They are sick in ways most of society will never understand.”
- FACING PREJUDICE
- Dr. Barbara Schindler speaks about training doctors to manage bias when treating new mothers who are dealing with... fb.me/1qAd1vXRG
- Negative treatment of drug abusers is not a new phenomenon in the medical community.
During the cocaine epidemic of the 1980s and 1990s, Dr. Barbara Schindler of the Drexel University College of Medicine started surveying the attitudes of health professionals toward women with substance abuse disorders. What Schindler, a professor of psychiatry and pediatrics, found was that the emergency room doctors who were surveyed had the worst attitudes, followed by OB-GYNs.
That situation hasn’t improved, either. A 2015 East Carolina University study found health care providers frequently are biased against pregnant substance abusers and that bias affects the medical care the women receive. The researchers blamed, in part, negative attitudes on a lack of knowledge, training and experience in dealing with addiction and because addiction is often viewed as a controllable behavior, rather than a chronic medical condition.
Most practicing primary care doctors and specialists like OB-GYNs and pediatricians in practice — then and now — received their degrees when there was virtually no addiction medicine in the curriculum. As a result, she found, those doctors don’t know how to evaluate and advise pregnant and parenting patients with suspected or known drug dependence.
They also can pass down their bias to the next generation. Often, medical residents develop negative attitudes about people with substance abuse disorders from supervising doctors who oversee them during specialty clinical rotations, said Schindler, the founder of Drexel’s Caring Together program targeting drug dependent mothers and their children.
“It’s almost a Stockholm syndrome,” she said. “When they get on their clinical rotations, they pick up their attitudes because these are the folks evaluating you. A student isn’t going to say (an evaluating doctor) is being unfair.”
As more Philadelphia hospitals closed maternity units over the last 15 years, more pregnant patients, including ones with drug dependence, have traveled to suburban hospitals to deliver, said Marie Korb, a veteran maternity unit nurse and instructor for the licensed practical nursing program at Bucks County Community College.
The burden has only increased as the opiate and opioid epidemic spread into the surrounding suburbs, a combination that resulted in dramatic increases in maternity patients with drug dependence issues. These patients were a new experience for nursing staff, which could explain some of the frustration and poor attitudes among nurses, Korb said.
Veteran emergency room nurse Diane Yoakam agreed the medical staff often treats patients with a drug history with more skepticism. “Their pain is not evaluated objectively,” she said.
Yoakam believes the negative attitudes some medical workers display toward patients is a defense mechanism; most nurses derive job satisfaction from seeing patient health improve, but with substance abusers, improvement is often slow and odds of relapse are high. At hospitals, nurses and doctors often only see drug abusers for a short time and when they're at their worst, which increases their frustrations, she said.
“Sometimes, the attitudes of health care professionals is because we are shielding ourselves. A lot of the marginalization we see among addicts stems from the fact we feel helpless," Yoakam said. "If you are judging someone before you even encounter them, people with addiction see that readily, and they won’t tell you what is going on.” - “I could feel them judging me. They were treating me like I was drug seeking.” bit.ly/2zHbHm6 #BornIntoAddiction #heroin
- CHANGING VIEWS
Medical research has found health care provider interactions with pregnant drug users has a direct impact on how closely they follow prenatal care advice. Positive interactions result in better outcomes for mother and child. Poor experiences lead to more patient anxiety, less compliance and follow-up care, and higher risk of relapse, the studies suggest.
As a result of that research, the medical community is recognizing the need to address the drug crisis with future doctors, officials said.
First year medical students at Drexel University now get lecture topics including opiate addiction and women with substance abuse disorders, Schindler said. Students and medical residents in her clinical rotations also meet with women in recovery to better understand their needs and point of view.
Drexel's College of Medicine and the University of Pennsylvania School of Medicine jointly operate one of four National Institute on Drug Abuse Centers of Excellence in Physician Information. The centers are national models in advancing addiction education in primary care specialties and identifying gaps in substance abuse knowledge. The goal is to develop curriculum for doctors-in-training to help identify, assess and refer patients with suspected substance abuse disorders.
Two years ago, the American Board of Medical Specialties officially recognized addiction medicine as a certified sub-specialty, which could generate more academic fellowships, said Dr. Tricia Wright, a member of the opioid and addiction treatment advisory committee of the American College of Obstetricians and Gynecologists.
“Hopefully, that will increase the workforce because it’s a big issue,” Wright added. “The number of physicians who are capable of taking care of people with addictions — right now — that is part of the problem.”
Locally, nursing schools also are incorporating more addiction medicine education and experiences into the curriculum.
Substance abuse is covered as a general topic in a 49-hour mental health course that is part of the practical nursing curriculum program at Bucks County Community College. The program’s director, Michelle Rue, developed the course, which addresses misconceptions about substance abuse.
“The whole dispelling of that stigma is a major part of the course for being a good nurse. You have to get away from those biases. You can’t transfer it to the patient," Rue said. "If you go in with bias, you’re not doing your job as a nurse.”
Neonatal abstinence syndrome and opioid dependency are topics in the standard curriculum for the bachelors of science nursing program at Holy Family University School of Nursing and Allied Health in Philadelphia, said Denise McFadden, a professor specializing in women’s health and child bearing. But they aren’t covered in depth since neonatology is a specialty field, she added.
For the last decade, some Holy Family senior nursing students have worked directly with pregnant and parenting women recovering from substance abuse at Libertae in Bensalem. The residential center is one of the six locations where nursing students can be assigned for a 12-week community health clinical rotations each semester.
The students meet weekly with residents leading lessons in parenting and childhood health education and performing basic health assessments on women and children who also live at the center.
“It gives the students the opportunity to meet the women one-on-one,” said Yoakum, who oversees the Libertae rotation. “To get to know them more as a person, not a disease.”
For students the experience is attitude-changing, said Dara Lovett, director of social services and student nursing program coordinator at Libertae.
“They always talk about how their thinking changed. They didn’t know the women are just like them,” Lovett said. “They kind of see themselves and that is something they didn’t walk in the door with. It really does change their perspective.”
Holy Family senior Arianna Berardi said she was a little nervous, at first, about working with the women since addiction is a topic only brushed at in the curriculum.
"It's one thing to read it in a book; it's another to see it," Berardi said.
Fellow senior Kacie Booth also admitted she was apprehensive about the assignment because she didn’t know what to expect. But she believes the experience will better prepare her for the profession.
"We're going to be encountering this as nurses,” Booth said. “It's very valuable to be exposed to this now." - Better training for health care providers may reduce stigma, improve outcomes, for drug-dep.. #HealthCare #bhivedld.bz/gpdfY
- Better training for health care providers may reduce stigma, improve outcomes, for drug-dependent ... bit.ly/2yKmjmv#healthcare …
- Better training for health care providers may reduce stigma, improve outcomes, for drug-dependent ... ift.tt/2gYc5VB
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