How a Tennessee OB-GYN Turned into An Addiction Specialist for Pregnant Women
SEVIERVILLE, Tenn. – Dr. Jennifer Maddron was drawn to obstetrics in her third year of medical school after she witnessed her first delivery. Guided by her Christian faith, it became a calling, she said.
But a few years after setting up her practice, just a few miles from the Smoky Mountains and Dollywood, the 40-year-old physician started seeing pregnant women her faith and training did not prepare her to help.
Dr. Maddron knew how to treat women during pregnancy. But she didn’t know how to respond to their opioid addiction.
“I would give out my cellphone number and they would call me in the middle of the night, and I’d say ‘you can do this. It’s not going to kill you,’” she said. “Then I realized it’s not that easy.”
Tennessee has one of the highest rates in the nation of babies born to addicted mothers. Most of those babies are born in eastern Tennessee, where Maddron’s LifeSpring Women’s Healthcare practice is located in a small strip mall of medical offices a few miles off the main road to Pigeon Forge.
Of the 194 babies born to addicted mothers in the state in the first four months of this year, 122 were born in this east Tennessee region.
Babies born to addicted mothers stay in hospitals longer and suffer distressing withdrawal syndromes that cause their bodies to jerk and shudder. They cry uncontrollably. They suffer birth defects and development problems at higher rates than other babies.
Those infants’ struggles often come with a financial cost to taxpayers. TennCare data shows the state spends $48,854 per NAS (neonatal abstinence syndrome) baby versus $4,951 for non-low birth weight babies in 2014. A baby born with NAS spent an average of 24 days in the hospital, compared with two days for a healthy baby.
Their births often signal an end to families rather than a beginning. Child welfare officials are called in. In fact, Tennessee saw a 50 percent surge in parental rights terminations between 2010 and 2014, in large part because of maternal drug use, experts say.
As a solo provider with a small-town practice, Maddron has fumbled through the opioid crisis without a map.
Her patients told her they wanted to stop using, but kept returning to homes where husbands, siblings or parents were abusing opioids. At Narcotics Anonymous meetings, they’d feel judged as pregnant women, she said. Some of her patients landed in jail during their pregnancies. There were no other doctors Maddron could refer them to. Primary care physicians are reluctant to treat pregnant women already under the care of an OB-GYN.
“My patients are a package deal,” she said. And there are still scarce resources that address the whole package when it comes to opioid addiction.
Maddron sought out training she didn’t get in medical school. She is now one of a handful of obstetricians in east Tennessee who is certified to administer “medication assisted therapy” — a class of substitute opioid drugs that work in the same way methadone does for heroin addicts by providing a relief to opioid cravings without the highs associated with it.
Less than 1 percent of all obstetrician-gynecologists in the United States have gotten that certification, according to the American Society of Addiction Medicine.
Under the Drug Addiction Treatment Act of 2000, qualified doctors can obtain special waivers allowing them to dispense buprenorphine drugs that provide an alternative to opioids.
Large, urban OB-GYN practices increasingly have designated staff members who have received those waivers, though its uncommon for all OB-GYNs in a big practice to get the required training, said Dr. Mishka Terplan, a professor of obstetrics, gynecology and psychiatry at Virginia Commonwealth University who is certified in both obstetrics and addiction medicine. He is also a member of the American College of Obstetricians and Gynecology's work group on opioid addiction.
"The big picture is that we can only move forward if addiction assessment and treatment is integrated into the rest of healthcare," including obstetrics and gynecology, Terplan said.
Since receiving that waiver in 2014, about 20 percent of Maddron’s practice now consists of treating opioid-addicted mothers.
The goal is to wean them off the medication assisted therapy before they deliver. But there are rules. Her patients must attend recovery meetings and show a log of their meetings when they come for check-ups. They must submit to random drug tests and pill counts. They have to get a counselor. It’s a protocol that Maddron pieced together through experience.
“For a long time I struggled with knowing there was a problem here and hoping someone would bring a model,” she said. “Then I thought, ‘OK,’ I’m just going to jump in. There are so many people who know more than me that I’m a little tickled that someone thinks I’m an expert. I’m not. I’ve just tried to let my patients teach me and try new things as we go along.”
Maddron’s receptionist, Nikki Osborne, lost custody of both her children in 2007, after years of her own opioid addiction that began shortly after the birth of her oldest son 17 years ago. She was in and out of jail on bad check, drug and theft charges. She was lucky. Her family helped her get into an 18-month recovery program.
Osborne landed a job at the local Leconte Medical Center in Sevierville where she met Maddron.
“I realized she had an interest in ladies with addiction,” Osborne said. And when Maddron offered her a job two years ago, she immediately took it.
Maddron encouraged her to talk to fathers who accompanied expectant mothers on visits. Then Osborne stepped in to lead a support group for Maddron’s patients that meets at the local library every Monday. For the first six months, no one came. Today between seven and 16 women attend.
Maddron also serves on the board of directors for a drug court serving Sevier County.
"She's really been able to get ahead of the curve, even though there wasn't any sort of insurance payment or funding," said Duane Slone, one of the drug court's two judges.