It had been six months of constant breastfeeding when postpartum depression consumed Shanna Lintz. She stayed clean throughout her pregnancy and while breastfeeding, but she desperately needed an escape. She laid her 6-month-old baby down in her crib and snuck off to the bathroom to stick a needle in her arm, tears rolling down her face. This was the first time Lintz relapsed in three years.
“I didn’t even know how it had gotten to that point,” the 31-year-old Hicksville resident said. “I felt like, ‘I shouldn’t be feeling like this. What’s the matter with me?’ I’d cry constantly. I just didn’t know why I felt the way I did.”
The relapse only lasted a week before Lintz knew she had to ask her parents for help. She found treatment at a methadone clinic and has stayed clean for the past five years. She stressed that she is lucky compared to most mothers who deal with opioid addiction.
The United States opioid crisis has gravely impacted pregnant and postpartum women, according to a Stony Brook University study published in the American Journal of Obstetrics and Gynecology (AJOG) in September.
The study, which is based on data from 22 states and the District of Columbia, indicates that deaths involving opioids either during pregnancy or up to one year postpartum more than doubled in the United States from 2007 to 2016. The increase is most evident in white women, though black women have a higher risk of pregnancy-associated mortality due to any cause. The data suggests that the rise was mostly driven by heroin and synthetic opioids like fentanyl, which surpassed heroin as the deadliest drug on Long Island in 2016.
This year, the Nassau County Police Department reported a 30 percent decrease in drug overdose deaths after a local opioid crackdown, marking the first decline in five years. But Long Island addiction experts still express concern for pregnant women and mothers struggling with addiction.
“We need to pay particular attention to this extremely vulnerable population who are struggling to find recovery and dealing with the additional burden of internalized shame,” Richard Buckman, president of the Long Island Recovery Association, said. “These are our people too. We must do all we can to make treatment accessible and to provide additional recovery resources for this often overlooked population in great need.”
Pregnant women and mothers who are addicted to opioids often face the fear of having their children taken away from them, which is one of the biggest reasons that they may not seek help, according to Patricia Hincken, director of Addiction Recovery Services at Zucker Hillside Hospital.
“Drug addiction is no different than any other medical condition, except it’s highly stigmatized,” Hincken said. “It’s accepted that other risk factors of pregnancy — like gestational diabetes or high blood pressure — would be treated. We try to teach people to stop seeing [drug addiction] as a shame-based, self-inflicted issue. It’s just a medical condition, like every other medical condition that you just treat with medication.”
According to an AJOG special report, substance abuse — including smoking and use of alcohol or illicit substances — is as common or more common than many conditions routinely screened for and assessed during prenatal care, such as gestational diabetes and postpartum depression.
A healthcare professional may call the Administration for Children’s Services if they believe the mother is unable to provide for her child’s concrete needs — including safety, constant supervision and psychological well-being — or if the child is exposed to inappropriate behaviors. A social worker will then look for signs of neglect and abuse. If the mother is deemed unfit, the child will be admitted to foster care.
“That’s the extreme, of course,” Antigone Joannou, a licensed clinical social worker who specializes in addiction, said. “It all depends on where [the mother] gets her care and what socio-economic background she comes from. It starts with the primary care doctor and gynecologist. Do they know? Are they making the appropriate recommendations? Is the woman motivated to do something about her addiction, not necessarily for herself, but to protect her child?” If the answer to each question is “yes,” then the mother may be able to keep custody of her child.
But punishing those who struggle with addiction is not a solution, Lintz said.
“Women are scared after they have a baby that if they relapse and they tell someone, the baby is going to get taken from them. And that’s what can happen, that’s real,” Lintz said. “But there has to be a safe haven for women to be able to get help and not be penalized for it. They’re not terrible women, they’re just in a bad spot.”
According to the study, 20 to 40 percent of pregnancy-associated deaths involving opioids occur after six weeks postpartum. And since the data reflects the broader opioid epidemic, lead author Alison Gemmill suggests that a range of interventions are urgently needed. This includes evidence-based interventions that prevent and treat addiction and abuse, interventions that help and support pregnant women who use opioids, and specialized strategies that address the needs women face after giving birth — especially for those with opioid use disorder.
“This is a difficult task, given that many women do not even attend their recommended postpartum checkup,” Gemmill wrote in an email. “These [interventions] hopefully would include governmental support, since the opioid epidemic is one of the largest health crises of our times.”
Neither Nassau or Suffolk counties offer any programs specifically for treating pregnant women and mothers who struggle with opioid addiction, “but it would be nice to have those programs and we’d certainly be open to implementing them,” DuWayne Gregory, Presiding Officer of the Suffolk County Legislature, said.
“We are working on tackling it more as a disease. We can’t just lock people up,” Gregory said. “It’s a battle that they’re going to face for the rest of their lives. If we don’t give them the tools to handle that, they’re just going to keep repeating the cycle until they get locked up for a long time or until they die. And we don’t want either of those things.”
Gregory has worked with Suffolk County law enforcement to combat the opioid epidemic with what he calls “a three-prong approach.” Law enforcement works to arrest high-level drug dealers on the streets, while the legislature invests money in prevention to steer as many people away from opioids as possible, and medical professionals ensure that enough treatment options are available.
“Medical treatment without criminal sanctions have been shown to be the most effective option for women, their children and families,” Dr. Elizabeth Shmidt, Medical Director of Planned Parenthood Nassau County, said. “For pregnant and postpartum women who are substance users, we know that a medical, multidisciplinary team approach is best. We refer these patients to special programs that can tailor treatment to optimize maternal and infant outcomes.”
Some Long Island hospitals and doctor offices are starting to implement a program known as SBIRT (screening, brief intervention and referral to treatment), a public health approach to educate patients about how alcohol or drug use may impact their overall well-being. The program also connects patients with substance abuse problems to appropriate community resources. Stony Brook University Hospital went live with the program in February 2016.
“It’s just a normal part of of medical care,” Hincken said about medical intervention programs. “With [SBIRT], every woman would be screened, every woman would be educated, every pregnant woman would be given her options in a very non-judgmental way.”
External judgment and internal shame are the hardest obstacles to overcome when dealing with addiction, Lintz admitted. However, she said, women should know that they can ask for help without fear.
“Don’t be ashamed, other women have been through the same thing,” Lintz advised. “It’s okay, you’re not a horrible person. People just need to get more help.”