Knox Doctor Successfully Detoxes Hundreds of Pregnant Women Off Opiates
Alisia Torres sat in Dr. Craig Towers' High Risk Obstetrical Consultants office in October 2017 as substance abuse coordinator Emily Katz asked if she had a history of drug addiction.
"Yes, I do," Torres replied.
Torres started using opiates at 17. Six years later, she was pregnant and given the choice to go through a detoxification process with Towers at UT Medical Center.
Nine months later, her daughter Lamya was born without Neonatal Abstinence Syndrome (NAS). Now Torres participates in the Helen Ross McNabb Center's Great Starts substance abuse treatment program and shares her success story with others there.
"I'm very thankful," she said. "There are a lot of girls I was telling about (program), and they're seeing (Dr. Towers) too. He's helping a lot of pregnant women."
Detoxing while pregnant is not common practice
When Towers, a maternal-fetal medicine specialist, came to UT Medical Center in 2010, there was a large number of pregnant women addicted to opiates.
"We were inundated," he said.
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In most cases, the first thing he heard was "I didn't plan to get pregnant." The second? "I don't want to be on these drugs and have my baby suffer."
For the more than 35 years Towers worked as an OB-GYN and high-risk pregnancy specialist, he told women it was harmful to the baby to detox while pregnant. That was the industry standard.
"You get tired of hearing yourself say the same thing over and over to the number of patients that we had, so I went to the literature to get the research that had been done theoretically to produce this recommendation (not to detox)," Towers said.
He found that the research consisted of just two cases from the 1970s.
Dr. Craig Towers, 2018 Health Care Heroes recipient, Friday, August 17, 2018. (Photo: Michael Patrick/News Sentinel)
"Medicine 40-50 years ago was run by giants more so than research," Towers said. "If giants in the field made a comment, that's really how things were done. So with these two cases, it got propagated that it's harmful to do this during pregnancy, so we don't do it."
Towers decided to explore the possibility of helping pregnant women detox.
Towers finds detoxing isn't a harm to the baby
Two years ago, Towers completed a five-year study that detoxed more than 300 patients with no fetal losses or harm.
Since the study began, more than 600 women have undergone the detoxification process. Towers said at least three-fourths of those babies would have been born with NAS otherwise.
A baby born with NAS stays approximately five more days in the hospital than a baby without NAS, Towers said. The cost of care for an NAS baby is approximately $65,000 more than a baby without NAS, so hospital spending has decreased with Towers' program.
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Since presenting his study nationally, a ripple effect has taken place, and various studies have been conducted that back up Towers' research.
In January of 2017, Towers developed a dedicated opiate use disorder clinic for mothers with opiate addiction.
Towers' program is much like other programs that put pregnant women into medication assisted treatment (MAT) therapy. The women get off elicit drugs then go into a MAT program. Once they're stable in MAT, Towers gives them the option to detox through tapering, in which he takes the dose they're on and stair steps the dose down until they're off the drug. Patients then use Naltrexone to prevent cravings and keep them clean.
He explains the risks of detoxing or not detoxing to each mother. Staying on opiates throughout the pregnancy is a risk to the baby, he said. Research shows that babies born with NAS have smaller head sizes and behavioral health problems into early childhood and even teenage years.
Choosing to taper off drugs presents a risk to the mother. If she relapses, she could overdose.
"They, most of the time, choose their baby," he said. "They say they won't relapse. And they can't know that for sure, but we haven't had a single loss."
Staffer Amanda Beck checks with Dr. Craig Towers, 2018 Health Care Heroes recipient, between patients Friday, August 17, 2018. (Photo: Michael Patrick/News Sentinel)
Industry pushes back
Towers has experienced push back to his process, especially from the American Society of Addiction Medicine.
Push back could come from the belief that the risk of a mother relapsing is too great or the belief that NAS isn't harmful to the baby, Towers said.
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But Towers believes once the mother is stable in a MAT program and has been informed of the risks to detoxing, she should have the option.
"Give her the choice of what she wants to do," he said. "It's her pregnancy. ... I really do believe in my heart when our studies are out and a couple other locations' (studies) are out that ultimately, the standard of care in the country will switch to where the woman is given the choice. And that’s all I’m pushing for."
Katz joined Towers in 2013 and took a special interest in these mothers after her own daughter went through addiction. She shares her story with the patients and provides support any way she can.
She calls it "heartbreaking" that Towers gets backlash.
"People are constantly saying the reason he should taper is 'What if a girl relapses?' And that's true," Katz said. "That can happen. But I take myself back to watching my daughter. Yes, she could relapse, but what if they don't? ... Because if they're successful, the domino effect that can happen in that woman's life, in that child's life and generations to come is incredible."
Towers found that 70-80 percent have been "horribly abused" in their past, many before they were 13.
Many used marijuana at first and drifted into opioids.
"They're using opiates to treat mental anguish," he said. "They just need someone to trust them and believe in them, and that's what we do here. A lot of these women feel like they deserved what happened to them, and I’m trying to tell them, no you didn’t deserve what happened to you. You're the victim here.
"We’re now trying to put the pieces back together."