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toward more happy beginnings: managing opioid addiction and pregnancy

Katie Yanez, 28, delivered two healthy boys before she became addicted to Percocet® prescribed to treat severe migraines. Unhappy in her marriage, Katie started using heroin. The next few years became a downward spiral. Her marriage ended, methadone treatment proved ineffective, and Katie ended up in jail.

While she was incarcerated, Katie’s second husband found Valley Pain Relief & Wellness Center (Valley Wellness), a new member of Fairview’s provider network, Fairview Health Network. 

Katie is among the 11,131 people statewide who entered treatment either for prescription opioids or heroin addiction in 2017, according to preliminary data from the Minnesota Department of Human Services. Research shows that only 10 to 17 percent of people who need treatment, get it. 

Last year, 376 women who sought treatment for opioid addiction in Minnesota were pregnant. While in treatment for her addiction, Katie became pregnant with her third child.

A doable challenge

The three providers at Valley Wellness know first-hand that treating pregnant women with opioid addiction presents unique challenges. But the story can have a happy ending—and a happy beginning. 

With locations in Burnsville and Minneapolis, Valley Wellness is one of the few clinics in Minnesota to offer Suboxone® treatment. Suboxone contains buprenorphine combined with naloxone. Suboxone can control opioid effects and cravings, while allowing the patient to taper off the medication without symptoms of withdrawal. 

In addition to Valley Wellness, network prenatal addiction care services include a new partnership between St. Joseph’s hospital and University of Minnesota Physicians. The program launched in January. 

When Katie became pregnant, she had been a patient at Valley Wellness since June 2016. At that time she transitioned from Suboxone to buprenorphine because there is limited data on the safety of naloxone when used during pregnancy.

“Nearly 50 percent of our patients come to us for addiction medicine,” says Ashwin George, MD, Addiction Medical Director at Valley Wellness and a Diplomat of the American Board of Addiction Medicine. 

On July 24, 2017 Katie delivered Noah via C-section. Valley Wellness’ Svetlana Zaydman, DO, board certified both in physical medicine/rehabilitation and pain medicine, coordinated Katie’s care with her obstetrician. 

Successful treatment requires careful monitoring

“Communication with the ObGyn in each trimester ensures we’re all on the same page,” says Zaydman. “In Katie’s situation, we allowed Dilaudid® during labor if needed, and I approved low dose oxycodone for a few days following surgery.” 

Most babies like Noah are born dependent on buprenorphine and must stay in the hospital for a few days after the mother goes home. Thanks to Katie’s managed treatment, however, Noah did not suffer from withdrawal and Katie was able to breastfeed him. 

“The amount of buprenorhine in breast milk is insignificant,” says Lindsay Bergstreser, PA-C, one of Katie’s Valley Wellness providers. 

“The drug is not absorbed from the stomach effectively, so any little amount that makes it into Noah’s stomach won’t absorb well into his system,” she says. 

Thriving

Katie is among a growing number of women who have successfully delivered or who currently are pregnant and in treatment at the clinic. George attributes success to close communication with the ObGyn provider and very careful monitoring. 

“We see our pregnant patients weekly during their first trimester, then once every two weeks thereafter," he says.

As he approaches his first birthday, Noah and his family are thriving. Katie and her husband recently bought a home, and Katie is tapering down on buprenorphine.

“Noah now weighs 20 pounds and I am more than just happy, I’m proud,” says Katie.