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Delivering Mothers—and Their Babies—From Addiction

The Opioid Epidemic

The United States is in the middle of an opioid epidemic. More than 90 Americans die each day from an opioid overdose, according to the Centers for Disease Control and Prevention. Aetna is working to reverse the trend with integrated pharmacy, behavioral health and medical programs. Here are some of the steps we’ve taken in the past year:

  • The Aetna Foundation announced that it would provide $6 million in grants to state and local projects that address the opioid problem. The first grant, for $1 million, went to North Carolina to help fund its “Rural Opioid Overdose Prevention Project.” The second $1 million grant went to the Pennsylvania Department of Health to turbo-charge the state’s innovative opioid dashboard, a collaborative project between the Pennsylvania Department of Health and the University of Pittsburgh.
  • Aetna limited initial opioid prescriptions for acute pain to a seven-day supply in its commercial business. This stricter limit follows federal guidelines, and will help reduce the potential for abuse and addiction.
  • Aetna was the first national payer to waive copays for Narcan— a lifesaving, highly effective opioid overdose reversal agent—for fully insured commercial members once their deductible is met.
  • In 2017, Aetna continued the initiative it began a year earlier to reduce the number of opioid prescriptions, sending letters to more than 1,000 dentists and oral surgeons who were identified as being opioid super-prescribers.

When Jessica Crawford found out she was pregnant, she knew she needed to get off the drugs that she had been using for nearly two decades, including heroin.

She just didn’t know how.

“I was a mess,” she said. “I wanted to stop, but I didn’t know how to stop. I failed so many times, so many times.”

Her desire to get clean, even for her baby, wasn’t enough. She needed help—but she didn’t welcome help. Ashli Samples, an Aetna case manager working with doctors on high-risk pregnancies in West Virginia, contacted Crawford after a drug screen during her checkup tested positive for a myriad of drugs—including heroin, as well as tranquilizers and antidepressants.

Crawford pushed her away.

“Let me alone,” she’d say. “I’m sick.”

Samples is part of an Aetna program to identify pregnant women who use opiates and steer them into treatment. The program aims to mitigate the damage that drugs can inflict on newborns, which can include addiction and lengthy stays in neonatal intensive care.

Since the program began in March 2014, it has enrolled 1,176 mothers and babies. Samples was not optimistic that Crawford would become one of its success stories.

“I thought this is not going to work out for her,” Samples says. “She had tried and failed and tried and failed.”

90+

More than 90 Americans die each day from an opioid overdose.

Lynne Kain
Lynne Kain, a nurse and Aetna case manager, works helping women overcome opioid addiction during their pregnancies and stay sober after delivery.


What motivated you to make the transition from traditional nursing?

When I was a NICU nurse at University of Kentucky’s Children’s Hospital, I always wondered what happened to the families when we discharged them. After they left the hospital many new moms would call to talk to the nurses who took care of them, because they’d formed a trusting relationship.

What’s the biggest challenge your patients face?

Environment is a big challenge. When a mother admits she’s using again, it’s often because she’s going back to the same living situation that supported her previous drug use. Often there is no other place to go. Addiction can also interfere with your body’s ability to feel intense joy—like a mother’s euphoria that helps her bond with her baby.

What would you like to tell readers about the people affected by opioid addiction?

I remind folks that no little girl said, “I want to be an addict when I grow up.” The first time someone takes a drug, it usually is a choice. But once addiction has started, the choice is gone.

Crawford started using drugs in her late teens, with pain pills a boyfriend took from his grandfather. Over time, she used anything she could get her hands on. “You name it,” she says. “I was taking it.”

Her continued use of drugs meant she was turned away from a program providing Subutex®, a drug to treat opiate addiction by reducing or eliminating craving. So she purchased Subutex on the street. On her own, she eventually weaned off most of the drugs. But not the heroin.

Samples never gave up. “She stayed on my case,” Crawford said. “She was so good.”

They were racing against time: The longer an expectant mother takes drugs while pregnant, the greater the risk to the newborn. There were many stumbles along the way. Samples was able to get Crawford admitted to an outpatient treatment program to wean her off the drugs—but Crawford relapsed. Samples managed to enroll Crawford in Turning Point®, an inpatient treatment center in Beckley. Crawford lasted only 60 of the scheduled 90 days before being kicked out for smoking cigarettes.

Samples persisted.

At Crawford’s request, Samples helped get her back into a program with her obstetrician, Dr. Ammar Shammaa in South Charleston, West Virginia, one she’d been kicked out of earlier.

But now there were only 30 days until she was due, and there was no guarantee her baby would be born free of addiction.

The Cesarean delivery went smoothly. Still, it would be five days before doctors could declare her baby drug-free. Crawford visited her daughter hour after hour in the neonatal intensive care unit.

“She was perfect. I couldn’t believe it,” Crawford said. “I begged God, pleaded, don’t make her sick. I promise to be the best mom ever.”

Her pleas were answered; her daughter suffered no withdrawal symptoms.


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Since the birth nearly three years ago, Crawford has remained clean, the longest she’s gone without using in two decades.

“I wasted a lot of years,” she said. “I am so thankful for Ashli. I think the sun rises and shines out of her. She really stuck with me. That’s what I needed. I usually can’t mention her name without crying. I am a totally different person.”

Crawford remains on Suboxone®, the version of the opioid treatment drug for women who are not pregnant. She’s working as a medical assistant and plans to get her nursing degree after her daughter starts school. Though she is no longer in the program—case managers follow mothers for a year after giving birth—she keeps in touch with Samples.

And she keeps in touch with Dr. Shammaa, whose parents are patients at the cardiology office where she works.

“He tells me, ‘You were so far gone,’” she said. “‘Look at you now.’”

News and information about Aetna’s fight against opioids:
https://news.aetna.com/opioids/
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