by Danièle Todorov

The complexity and pervasiveness of the opioid epidemic has forced government agencies to be innovative with their resources. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in a prime position to care for pregnant women affected by the epidemic and has stepped up to the plate.

In January of 2016, then Secretary of Agriculture Tom Vilsack was appointed by President Obama to lead an interagency taskforce to address the opioid epidemic in rural America. Secretary Vilsack, who’s been outspoken about his own mother’s struggle with prescription drug addiction, knew that compassion and collaboration would be vital. His agency, the USDA, has unique resources and relationships in rural areas, putting it in a prime position to address the epidemic.

Addressing the epidemic is no simple task. According to the CDC, 91 Americans died daily from opioid overdose in 2015. Nearly half of these deaths involved a prescription opioid, used in the treatment of pain. In a town hall meeting in Missouri last July, Secretary Vilsack stated that due to “the devastating toll that opioid misuse has taken on our communities, and particularly rural areas, I have tasked USDA with creatively using all of the resources at our disposal to stem the tide of this epidemic” [1]. Interestingly, Secretary Vilsack highlighted WIC as a resource that could be creatively used. “For many women”, he stated, “WIC is their first point of entry into the healthcare system, and we have an opportunity to intercept and potentially prevent dangerous health outcomes for both the mother and the child” [1].

Pain management is an important part of pregnancy care. The prescription of opioids for pain in pregnancy is increasingly common; 1 in 5 Medicaid-enrolled women were prescribed an opioid at some point during their pregnancy in 2014 [2]. However, the effect of opioids on birth outcomes is understudied. In utero opioid exposure may be associated with preterm delivery and low birth weight [3]. Exposed neonates may develop withdrawal symptoms, a condition known as neonatal abstinence syndrome, which is associated with increased risk of seizures and breathing difficulties [3]. Similarly understudied are the rates of opioid abuse during pregnancy. We do know that pregnant women with substance abuse problems are particularly vulnerable to food and job insecurities and unstable housing, which exacerbate potential health complications [4].

The healthcare system often stigmatizes and underserves pregnant women with substance abuse problems. However, WIC is increasing its ability to engage them in care. WIC’s mission is to promote the health of low-income women and their children by providing nutritious food, health education, and referrals. Starting in 2014, WIC agencies have increased staff training surrounding substance abuse [1]. Staff are better equipped to notice potential substance abuse, to educate WIC participants about the dangers of substance abuse during pregnancy and breastfeeding, and to connect them with local resources. These expanded roles align with WIC’s mission, not only because they aim to protect the health of the women they serve, but because WIC “acknowledges that substance use is incompatible with good nutrition” [5].

WIC is forming relationships with women at a promising point in time in their lives. In their staff training guide, WIC cites a study showing that women are “more motivated to improve their lifestyle and health habits during periods when they make the transition from one life situation or role to another… WIC participants are a natural target audience for substance use information because they are, by definition, in the life transition stage of pregnancy and new motherhood” [5].

WIC is playing an important part in the collaborative response to the epidemic. As the director of the USDA, Secretary Vilsack understood that a holistic response was the only effective solution and embraced President Obama’s mandate. “This disease isn’t a personal choice,” says Secretary Vilsack, “and it can’t be cured by willpower alone. It requires responses from whole communities, access to medical treatment, and an incredible amount of support. To me, our mandate is clear: don’t judge, just help” [6]. Secretary Vilsack’s endorsement of his replacement as Secretary of Agriculture, nominee Sonny Perdue, gives hope that the USDA will continue this vital endeavor.

Sources

1. Agriculture Secretary Vilsack Announces Substance Misuse Prevention Resources for Low Income Pregnant Women and Mothers In Order to Battle the Opioid Epidemic, U. Office of Communications, Editor. 2016.
2. Desai, R.J., et al., Increase in prescription opioid use during pregnancy among Medicaid-enrolled women. Obstetrics and gynecology, 2014. 123(5): p. 997.
3. Patrick, S.W., et al., Prescription opioid epidemic and infant outcomes. Pediatrics, 2015. 135(5): p. 842-850.
4. Sutter, M.B., S. Gopman, and L. Leeman, Patient-centered Care to Address Barriers for Pregnant Women with Opioid Dependence. Obstetrics and Gynecology Clinics of North America, 2017. 44(1): p. 95-107.
5. Substance Use Prevention: Screening, Education, and Referral Resource Guide for Local WIC Agencies, F.a.N.S. U.S. Department of Agriculture, Editor. 2013.
6. USDA. Addressing the Heroin and Prescription Opioid Epidemic. 2016 02/17/17].

Danièle Todorov is a first-year nutritional epidemiology student with a focus on pregnancy nutrition and birth outcomes.