As the death toll from COVID-19 nears 100,000 people in the U.S., America’s focus has been on confronting this tragedy with social distancing, economic support, and the rapid development and deployment of solutions from the healthcare community.
While the emphasis must remain on COVID-19, other health emergencies—which had been on the forefront of Americans’ attention in 2019—have largely been forgotten, despite the unfortunate reality that they are being exacerbated by the new crisis.
There were roughly 67,000 drug overdose deaths in the United States in 2018 and more than 50,000 women suffered pregnancy complications, with nearly 700 dying due to these complications.
A recent report by the Well Being Trust suggests our country will lose tens of thousands more annually due to an increase in the number of “deaths of despair”—which includes overdose and suicide, among others—triggered by COVID-19.
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Unlike fatalities caused by COVID-19, which primarily affect older adults and those with underlying health conditions, these crises attack with equal abandon, killing young people, many of which are in their 20s and 30s. Before COVID-19, these calamities were already colliding.
Neonatal abstinence syndrome (NAS) affected 32,000 newborns in the U.S. in 2014, well before the recent apex of the opioid epidemic.
These will be made worse because of COVID-19. Social isolation, a common reason for people with a substance use disorder to avoid treatment, is increasing, as those who normally seek in-person solace at recovery meetings must find alternative ways to connect.
Additionally, known triggers for substance use like anxiety, financial worries, and job loss are all skyrocketing. Today, pregnant and childbearing people face greater challenges in accessing prenatal, childbirth, and postpartum care, including behavioral health care as hospitals restrict labor support companions and visitors. Labor and delivery units are being closed to make room for patients with COVID-19. It is likely more women will be using substances during pregnancy and that delivering quality care for them and their babies will be even more difficult.
Despite the overwhelming difficulty of addressing three convergent crises, some programs have shown promise. UNC-Chapel Hills’ Horizons Program is a substance use disorder treatment program for pregnant and parenting women.
They integrated improvements to their tele-treatment program, provided increased training to their staff, and they have reduced the frequency of urine drug testing as one mechanism to improve social distancing. Other models like Massachusetts’ Moms Do Care program have promoted best practices for moms with opioid use disorder and babies with NAS in the hospital such as breastfeeding, rooming-in, and anti-stigma training for staff—the program has demonstrated results in reductions to the length of stay for babies, improved patient experience and reduced costs of care.
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These promising programs exemplify the sensitivity and creativity needed to improve the delivery of care for those facing COVID-19, substance use, maternal health complications, or NAS, especially when these co-occur and affect the same populations.
Focusing on COVID-19 alone without addressing risk factors like substance use or the racial and economic inequities of our health system will result in worse and more unequal outcomes. By working together across disciplines and sectors, we can scale and sustain solutions to holistically care for growing families facing substance use.
These include ensuring moms can stay on Medicaid coverage through one-year postpartum, have access to remote and telehealthcare and have safe choices for childbirth including midwives, community-based doulas and birth centers.
Katie Shea Barrett is the executive director of March for Moms, a national movement to improve maternal health. Matthew Stefanko is a director in the National Stigma Initiative at Shatterproof, a national nonprofit dedicated to reversing the addiction crisis.