Monday, December 13, 2010

Another Great Mom


It's been a while since we had a World's Best Mom post. Here is another nominee:

A 21-year-old female came in for heroine intoxication. She was 6 months pregnant. She had been abusing heroine most of her pregnancy. She had been in 3 different detox programs, but left them all AMA to go use and abuse again.

The only reason she came in this time was because her grandmother caught her shooting up and called EMS.

I heard her on the phone with her dad...."Are you going to bring me cigarettes up here or not?"

I called our psych team, and they could do nothing for her due to her leaving AMA all the time. Same went for our social worker. All I could do was notify CPS. They already had a case against her.

Personally, I think since she is harming a child she should be legally locked into a room AGAINST HER WILL until she detox's. It won't kill her.....too bad that can't happen.


- ER Doc

21 comments:

cara said...

Shockingly, pregnancy is not a cure for heroin addiction. That said, abortion is an effective cure for pregnancy . . . I wonder if this woman fully understood her options.

Anonymous said...

We actually just had a similar issue come up in our ED section meeting. The lawyers for our health system said that if we know a pregnant mother is abusing drugs (prescription or illegal) and we can prove it (in this case with a drug screen) we can put the mother on a 72 hour involuntary hold for the protection of the unborn baby. I'm not sure what happens after the hold is up, but I'm guessing our Chem Dep people would pursue commitment.

Anonymous said...

Cara, you are clueless. I can't even formulate a response to your comment because it is so freaking ridiculous.th

cara said...

Anonymous10:14, maybe you'll feel a little less tongue-tied in a moment so you can participate in an exchange of ideas. It's true I don't know much about this situation - I wonder what you have to contribute.

Calabresella said...

Yes, Cara, pregnancy is not a cure for heroin addiction. People who have addictions care about no one, not even themselves - just how to get their next fix to cure the withdrawal that they would soon be facing otherwise.

To nip it before it can even start, I'm not spouting regurgitated crap - my father was a drug addict who got clean after years of drug abuse. Drug addicts get clean when the time is right for them. They have to want to, no situation or force can make them get clean. Many times drug abuse is the manifestation of something deeper going on in their lives that they haven't dealt with in constructive ways. It's not often that a person spirals out of control for no reason.

*sigh* but we do have to ask - what kind of life will that poor baby grow up into? What kind of disabilities and possible foster home will he/she be forced into because of the decisions of the mother?

There's never an easy answer to this one.

cara said...

Thanks for sharing your personal experience, Calabresella. I agree that there are no easy answers here. It seems that the baby of this young woman is going to need LOTS of extra resources and support no matter what happens at this point. It's always sad when a kid is born into such a messed up situation.

Anonymous said...

Team Cara.
And I'm an ex-addict, but at least I only screwed my own life up.

Anonymous said...

Cara is right in my opinion. If ur gonna be a shitty person and abuse drugs then get prego, have the decency to have an abortion early on.

The patient did not look 6 months pregnant at all. The baby wil be tiny and I'm sure be born into heroine withdrawal. Not fair for the kid. Doesn't have a chance at life.

ER doc

Crazed Nitwit said...

People like this are the reason I believe a license should be required before any pregnancy should occur.

Holly said...

I don't know that I'd say "doesn't have a chance", depending on if she is allowed to even keep the child. If Child Services or social services gets involved....she could leave the hospital without the baby.

I have a good friend who has the daughter of her niece and T is above average in many areas. She was taken from her mother at 2 and given to my friend. T will be 8 in March.

This would *never* have happened had she been left with her mother.

arzt4empfaenger said...

Sadly, I basically agree with you.
On the other hand you never know, maybe - one day - having had this child will do something for her, and will help her to get her shit together. Not that the chances are high, but for some people, changes like this work out.
I have - during a bedside teaching - interviewed a young to-be mom who was in for early contractions (32nd week or so). She'd been prostituting herself without protection and had been abusing alcohol and drugs, but stopped after three months into her pregnancy. It seemed to have done something for her, and albeit late, she sort of started coming to her senses. For the child I can only hope that it wasn't too late (hey, but better late than never), and that she didn't relapse.

The fact that people willingly and knowingly harm their babies, be it unborn or born, makes me impossibly angry. They don't even have to be what you call low social status. More than enough "educated" couples keep smoking despite pregnancy and birth, and for me as a non-smoker and parent, this is aready violence to the child. Damn fuckers.

Eileen said...

Any of you - have you EVER seen a baby born to a addict mother in the first weeks after birth? Seen it twitching in the incubator? Because the child is born a drug addict, and has to go through rehab.

arzt4empfaenger said...

Eileen - that is why I agreed with the idea of forcing her to detox. Unfortunately I believe there isn't any way to actually achieve that, and even if one could forcefully detox her, she might do something else to harm the child or end the pregnancy *just because*.

I haven't seen an addicted baby yet, but I've heard the stories. It must be horrible, and anyone who provokes that is inhumane. Maybe showing women like this videos of addicted babies would actually get through... but I doubt it. Those poor, poor babies.

Anonymous said...

I can go you one better. When I was in nursing school, we had a patient who got pregnant so she could shoot up in the enlarged, visible veins in her belly. Wow.

Eileen said...

artzt4empf...it IS horrible. They are all twitchy and are apparently inconsolable - we can't know what or how they feel, but anyone working in the SCBU just feels so inadequate. You're supposed to be able to cuddle a tiny baby and comfort it.

Anonymous said...

As a nurse who works at a detox/treatment center, it's a really bad idea for a pregnant woman to just stop heroin/narcotic pain medication, the withdrawals can cause misarriage and early labor. We usually send the pregnant moms to a Suboxone doctor for treatment we have on staff(ususally with Subutex while pregnant), and have seen VERY wonderful results with this. I've seen mothers turn their lives around and atually make their living situation better for them and the baby. And babies born while the mother is on Suboxone/Subutex don't have any withdrawals symptoms at birth or hardly any at all like you would see with them still on the drugs of choice or Methadone treatment.

I really wish and hope one day that ERs and other clinics would keep a list of Suboxone certified doctors on hand (espially ones that take medicaid) and help get these people into treatment right away if they want it. Most addicts like this treatment better cause it usually requires only seeing a doctor once amonth and they can fill it at the local pharmacy, so their's no forcing them into being locked up and away from home. I know it isnt a perfect medication(only takes care of the physical symptoms and not the mental), but very soon it's gonna come in a form where they put a rod under the skin in the arm ( called Probuphine)and it releases the medication for 6 months, so that takes away any diversion...

Anonymous said...

Most of the time, opioid withdrawal is a non-emergency, no matter how shitty it makes you feel; here's some clonidine. In pregnant pts and in some CV situations, it's a different situation.

Pregnancy that is being carried to term is not the time to detox a pt. There is a withdrawal risk for SAB due to uterine contractions; there's also increased risk of abruption, fetal demise, etc. The opioids aren't ideal but actually, in managed doses, aren't that harmful when they are in a safe supply and stable dose. Increasing doses are needed in later pregnancy - users are often trying to reduce their own doses, then end up in wd and going into preterm labor, etc. Alternately, they just keep trying to get to the right dose and overshoot (so to speak) and then overdose themselves and/or the fetus. 10 minutes of explaining this to the pregnant addict does a lot of good and I can usually get them to connect to treatment at that point, with no need to use 'scare' tactics - just a clear explanation of the physiology.

Whether or not anyone thinks she should be parenting or raising a child, and I'm not seeing her as Mom Of The Year either, withdrawal itself is still a significant risk at 6 months' gestation.
http://www.ncbi.nlm.nih.gov/books/NBK26113/

Any patient can receive methadone as an INPATIENT (NOT as an outpatient) for addiction pending acceptance into a methadone tx center - no X-license required for inpatients. Pregnancy and severely CV unstable pts will qualify for medical necessity. I fairly often admit pregnant pts to the perinatal unit while getting them into the methadone outpt center. Pregnancy is the highest acuity ranking for outpt opioid maintenance, followed by active IDU in HIV/HCV. We're really underserved - I live in the sticks - and I can still get them in within a couple of weeks at the worst.

Anne said...

Come to Wisconsin.....you could have put her in jail :)

Hal Apeno said...

If she was really a heroine, she wouldn't be addicted.

Mona said...

This makes me utterly ill. I am currently a MICU RN who sees the end stage of life due to the adult decision of ETOH/ drug abuse. I'm truly saddened by this article. I wish there was more I could do!

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