START

Pregnant patients who have a history of substance use disorder often face challenges finding appropriate care that combines their obstetric and chemical dependency needs. Many obstetricians hesitate to treat them because of the risks to the fetus. Medication managers, who create treatment plans and monitor patients’ prescription drugs to help treat substance use disorder, may also choose to discontinue treating a patient once the patient becomes pregnant.

“I’ve had a patient come into our clinic with her chart in her hand,” said Abi Plawman, MD, the Addiction Medicine Fellowship Director at East Pierce Family Medicine. “Her medication manager had essentially written in her chart that he wouldn’t be responsible for a baby born with defects due to substance use — even though she had been sober for four years.”

East Pierce Family Medicine’s Substance Treatment and Recovery Training (START) outpatient program offers walk-in services where pregnant patients who are currently or have previously struggled with substance use disorder are able to access OB care, medications to treat substance use disorder, as well as referrals to other services such as housing assistance or Women Infants, Children (WIC).

“We are often their last resort,” said Dr. Plawman. “Patients come here because we’re a safe place.”

The clinic is staffed by physicians, nurses, social workers and medical residents and fellows. Together, the team works to provide treatment based on what each patient needs. It varies from patient to patient, but it could include ensuring each patient has medication stabilized to effectively treat substance use disorder, providing prenatal care, connecting patients to essential resources, or preparing parents for Child Protective Services intervention.

“We really focus on helping each person for their best long-term success,” said Dr. Plawman.

East Pierce Family Medicine’s program not only helps patients during pregnancy but continues to provide care through six weeks postpartum, at which time patients can choose to transition into a different treatment program.

“We are lucky in Washington state that we can have a program like this,” said Dr. Plawman. “Pregnant patients facing substance use disorder are vulnerable. Without treatment and care programs that address both the realities of pregnancy and addiction, pregnant patients risk falling through the cracks of the health care system. We can’t let that happen.”