Pregnant and addicted to opioids: Moms of the drug crisis

Lucy Brown did not realize she was pregnant until three months before her due date.

The 24-year-old’s life had been in disarray for the last five years, since taking Percocet after having her wisdom teeth removed. Despite her family’s attempts to help her, the drug took hold, she dropped out of college and spent time in jail.

In the spring of 2011 Lucy noticed her clothes didn’t fit, stole a pregnancy test in Wal-Mart and used it before leaving the store. When she went to the Health Department in Moore County, North Carolina, to confirm the test’s positive result and found out she was having a girl – and soon.

But this was not enough to help her kick her addiction to prescription opioids. Instead, it fueled it.

She says she remembers thinking: ‘Now I can’t stop because I have a baby who could die if I stopped using.’ She was convinced that quitting would cause her baby to experience harsh withdrawal symptoms so she continued taking 30, 40 or even 50 pills a day to satisfy her cravings.

Her reaction is not uncommon: America’s current opioid crisis has left many women far too deep in a battle with addiction to consider quitting when they find out they are pregnant. If they do decide to quit, finding doctors who can both provide prenatal care and give them the resources they need to stop using is a challenge in itself.

At eight months pregnant, Lucy found care at a clinic in North Carolina, but she did not go willingly. In between finding out she was pregnant and the beginning of her ninth month, Lucy had gotten arrested, and the only way she could avoid having her baby in prison was admitting herself to the treatment program. In retrospect, she says, the program saved her child’s life, and, in turn, having a child saved her life.

Now 30, with two healthy children – including the one she carried while abusing opioids – Lucy works at that same treatment center as an advocate for women who do not know where to turn for help.

‘A lot of these women don’t have anyone, and we’ve helped lots and lots of people. I’m just glad that I’m one of them,’ she says.

Lucy is one of four women who spoke to DailyMail.com to tell their stories of getting hooked on prescription painkillers, then desperately trying to get clean before parenthood.

Opioids are a class of drugs used to treat severe pain. The highly-addictive medications have been overprescribed in recent decades partially because pharmaceutical companies that manufacture the pills have falsely advertised them.

City and state governments in places where the opioid epidemic has hit hardest are now suing these companies for telling doctors the drugs they were selling were not addictive.

Many people who start out taking prescription opioids to treat pain end up turning to deadly illicit versions of the drugs such as heroin and fentanyl when their doctor stops prescribing painkillers to them or they can no longer afford the expensive, legal medications.

This perfect storm has led to America’s worst drug crisis in modern history, which killed a staggering 64,765 people from February 2016 to February 2017.

Maternal opioid use in the US has increased five-fold since 2000 

The epidemic has escalated rapidly; that figure jumped more than 20 percent from the number of deaths linked to drug overdoses that occurred from February 2015 to February 2016. The CDC has said more than 90 Americans a day die from an overdose involving an opioid.

Epidemiology experts are now desperately urging doctors to think twice before doling out a prescription for opioids, which is all too often what starts the process of a person becoming addicted to illegal drugs.

Common brands of opioids are OxyContin, Vicodin, Roxicodone and Percocet, which is what Lucy was originally prescribed and became hooked on in 2006. The clinic that helped her get and stay clean is one of only a few in the US successfully treating pregnant women with opioid use disorder.

This is despite the CDC saying that women are more likely than men to be prescribed painkillers and are given higher doses of the medications. The agency has also said that women are more likely to use them for longer periods of time.

The number of pregnant women abusing opioids has increased nearly five-fold since 2000 so the epidemic has not spared children.

It has led to an increase in babies born with Neonatal Abstinence Syndrome (NAS), which translates to withdrawal symptoms including tremors and seizures. It takes an average of 16 days and $66,700 to treat a baby born with NAS.

The problem has left healthcare providers with a complex question: how do prenatal care physicians help mothers-to-be – and their babies – diagnose and treat painkiller and heroin addictions?

‘I TOLD THE DOCTOR I WAS USING AND THEY TOLD ME TO PRETEND I HADN’T SAID ANYTHING’: THE CONFUSING BATTLE TO SEEK DRUG TREATMENT DURING AN UNEXPECTED PREGNANCY

Lucy Brown’s addiction began after she was prescribed Percocet when she had her wisdom teeth removed as a 19-year-old sophomore at Western Carolina University, which was a little more than five hours away from her hometown of Pinehurst, North Carolina.

But she did not use the medication to treat the pain she experienced post-surgery.

‘I didn’t use it at all. But maybe about six months later somebody said: “Oh, you know you can sell that medication?” And so I did,’ she said. The person that she sold the last of her pills to invited her to do them with him, and this was how her five-year opioid addiction began.

‘It was just this immediate high, and I felt terminally cool. And I used it, I think, daily from that point on,’ Lucy remembered. She did not know in the beginning that she was addicted.

Lucy started buying any kind of prescription opioids from drug dealers in her area.

Lucy (left) now has another child, Juniper (middle), who is 10 months old. Lucy credits her love for her daughter Luna (right) with helping her stay sober after she first gave birth six years ago

‘For a long time, I thought: “This is just a fun, recreational thing that I do every day.” And then it switched over to: “Okay, yeah, I have a drug problem, but it’s not that bad.”‘

But one morning when she found herself in a McDonald’s at 6am with a friend, another customer’s comment shocked her into seeing how bad the problem was.

‘We’re in line, and this old man said: “Look at those junkies.” And I just died inside. I was like: “Wow, I look the part now,”‘ she said.

The need for more and more of the drugs took over her life. She dropped out of college. She robbed her landlord and got caught. Her parents got her out of jail that time.

Lucy stole from other people to be able to afford her drug habit, rummaging through strangers’ unlocked cars to look for valuables.

‘I worked up a tolerance to where I had to use a lot of medication constantly. There was just no way that I could feasibly work and pay for that,’ she explained.

She was living in a one-room shack that had no water with her boyfriend, who was also using drugs, in 2011 when she noticed she had recently gained weight.

Lucy said: ‘I just remember I couldn’t fit into my clothes anymore, and my partner at the time said: “I wonder if you’re pregnant.” I was. I don’t even know how many months I was at that time.’

The county health department referred her to an obstetrician. ‘I did tell them. I did disclose that I was using, and they asked me not to,’ she recalled.

Neonatologist Dr Anne Johnston, who works with addicted pregnant women at the University of Vermont, explained how this became the standard advice women who struggle with opioid addictions receive upon hearing that they are expecting.

‘Historically, physicians and every other person that knows [about a woman’s addiction] is going to say: “Stop using.” And most of the time you can’t stop,’ she said.

Sometimes, though, obstetrician-gynecologists (OBGYNs) do not ask if a patient they suspect is addicted to opioids is dependent on drugs.

Dr Hendrée Jones, director of Horizons, the clinic for pregnant women with opioid use disorder at the University of North Carolina Chapel Hill where Lucy got sober, said that research shows 50 percent of OBs do not address substance abuse disorder. 

‘I’ve had multiple OBs tell me: “I don’t want to ask because I don’t know what to do with a “Yes” answer,”‘ she said. 

Whether or not they are asked, the response they receive is usually ‘just say no’. However, for most of these women ‘just saying no’ is no longer an option. 

‘If “just say no” actually worked, we wouldn’t have a drug problem,’ Dr Jones explained.

Luna was born on August 27, 2011. She was not born addicted to substances and did not go through withdrawal. She is pictured (left) with Lucy outside the treatment center weeks after she was born and (right) earlier this year

This can be attributed to what an opioid addiction does to a person’s brain, according to Horizons outpatient therapist Selden Holt.

‘It corrupts the part of your brain that makes good decisions. It proves the point of how insidious a disease it is: you think the most strong instinct is that mother protecting a child instinct,’ Holt said. ‘I think a lot of women would like to quit and they know that what they’re doing could possibly be harmful to their children, but it doesn’t feel like a choice.’

Dr Jones said that in this respect, societal views have not caught up with the science proving the disease’s effects. ‘We’re still not there yet. There’s still the underlying bias: it’s still in some way a “choice”,’ she explained.

Holt says many of the patients she works with react the way Lucy did, afraid to quit for fear of the painful withdrawal symptoms and misguided concerns that it could hurt their baby. 

‘Having the baby wait and go through withdrawal after birth sometimes seems less dangerous than quitting cold turkey in the middle of the pregnancy,’ Holt explained.

Lucy found herself turning to this line of thinking when she learned that she was having a baby in a few months. But now, six years sober, it seems foreign to her.

‘It’s really hard for me to think about. The hospital there, they give out the What to Expect When You’re Expecting book to each of their clients. And I left, and I immediately thought, “What a good surface to use pills on.” And I did.’

Lucy continued to use until she got arrested for stealing her mother’s credit card at the beginning of June 2011, at which point she was taken to jail.

The only way Lucy could get out of giving birth while incarcerated was by enrolling in a treatment center, and this is how she ended up at Horizons, which, though normally $14,000 for a stint, was free with Medicaid. 

Lucy moved into the onsite residences at Horizons on August 1 and had Luna, now six, on August 27. At the clinic she went to therapy to learn to deal with her life without drugs. Horizons staff members also helped her with basic parenting tasks, such as putting Luna to bed.

These resources, as well as the love she felt for her daughter, helped her remain sober.

‘[Luna] was every bit of me that I liked, every good part of me. And there was nothing negative about her. And so I wanted to make sure that there was nothing negative about me. I made a full effort to be the best mom I could be, and that included following through with the treatment plan. So I stayed.’

The group therapy room (pictured) at Horizons, the clinic that helped Lucy Brown get off drugs, features a wide circle of chairs and soft lighting

‘I USED TO JUDGE WOMEN – WOMEN THAT WERE PREGNANT USING. UNTIL THAT HAPPENED TO ME’: MOTHER-OF-FOUR MYRA GOT HOOKED ON OPIOIDS WHILE BATTLING BACK PAIN IN HER SECOND PREGNANCY 

Myra, a 32-year-old mother-of-four who got hooked on painkillers for back pain, abused opioids during her second, third and fourth pregnancies.

‘I was mad,’ she said. ‘My thought was: “What’s wrong with me, and why can’t I stop using? Why? I mean I’m pregnant. What’s wrong with me?”‘

Myra, from nearby Rutherford County, North Carolina, has been a patient at Horizons since May 31. Her youngest two children, Kendra Kaye, one, and Kenneth Lee, four, live with her in the facility’s onsite residences, and her oldest two live with their fathers.

The clinic is the only addiction treatment center in the state with a licensed childcare facility offering regular pediatric care and therapy to children as well medication-assisted treatment to babies with NAS.

Dr Jones said it became clear early on that they needed to offer these facilities for women who want to get clean. If they have to leave their children behind to get help, they might choose to forego treatment, she said.

‘When women are forced to make a choice about treatment or their children – what a gut-wrenching choice that is – so we have women and children stay together,’ Dr Jones explained.

Myra (middle), 32, abused opioids during her second, third and fourth pregnancies. Her youngest two children, Kenneth Lee (left), four and Kendra Kaye (right), one, now live with her at a treatment center she started attending in May. None of her children were born addicted to substances

Fortunately, Myra’s children were not born addicted and did not go through withdrawal. ‘Thank goodness. I had something on my side,’ she said, but adds: ‘I still worry that something could be wrong with them.’

Myra first struggled with a cocaine addiction, but she got clean before she had her first child. Her addiction to opioids started while she was pregnant with her second child, when her mother gave her tramadol to treat back pain.

Neither she nor her mother were aware of how easy it was to become dependent on them. ‘Because it “wasn’t that strong” I thought it was okay. She did too, obviously. But I got addicted to them – I got addicted quick,’ Myra said.

‘I went from using one a day to three or four a day while I was pregnant. After I had my child I was taking anywhere from 10, 12, 15 of them a day.’

The addiction quickly escalated and Myra was soon using heroin and meth to get through the day. ‘I started using heroin, and I got to where I couldn’t even get up out of the bed to go use the bathroom without eating three Roxis, 30s and doing half a gram of meth,’ she said. ‘Roxis’ are tablets of Roxicodone, a brand of oxycodone, and ’30s’ also refer to tablets of oxycodone.

This poster hangs in the group therapy room at Horizons. Part of what the women learn there is what particular situations can trigger a relapse

On top of this Myra was trying to parent. ‘I thought I was a momma. I thought I was the “functioning addict”. But there is no functioning,’ she said.

During her third and fourth pregnancies, Myra found herself abusing prescription painkillers and meth, even though she never could have dreamed she would end up using while pregnant.

‘I used to judge women – women that were pregnant using. Until that happened to me,’ she said.

Her youngest two children, who lived with her, were taken from her by the Department of Social Services in October 2016 when they discovered she was using drugs. Kenneth Lee was allowed to go stay with his paternal grandmother, but her daughter Kendra Kaye was sent to a foster home.

‘That’s another thing. I was like, “My kids will never go to foster care,”‘ Myra said. After Kenneth Lee and Kendra Kaye were taken from her, she desperately tried to sober up so she could get them back.

Enrolling in a treatment center would allow Myra to keep her children, so she went to Horizons. She called the facility at 9.30pm one evening in May, desperate to go in straight away.

‘I had already relapsed. But I was starting to – I was thinking about needles. And I was like, “How could I even think about this?” So I called, and I was like, “I need to come to your facility,”‘ she said.

The person on the other end of the phone call tried to keep her talking even though they could not help her that late at night. ‘They’re like, “You can’t come at 9.30,”‘ Myra remembers. ‘But one of the staff members was like, “But don’t let me go. I want to talk to you.” She talked to me for three hours on the phone.

‘I probably would have went and found some heroin and used a needle that night. I don’t know. I just know they were there, like, right on time.’

Myra (center) started taking opioids to treat back pain when she was pregnant with her second child. She said prior to this she was not aware of how addictive the substances are

This artwork is displayed in the cafeteria the women eat lunch in at Horizons, and it represents their treatment goals

‘I HEARD THE DOCTOR SAYING SHE WOULDN’T BOTHER TELLING ME ABOUT TREATMENTS’: ANDREA ABUSED OPIOIDS DURING TWO PREGNANCIES – BUT SHE WAS NEVER TESTED AND MEDICS AVOIDED HER ATTEMPTS TO GET CLEAN

Andrea McSwain (pictured), 31, struggled with addictions to alcohol, opioids, cocaine and over-the-counter medications

Like many women who abuse opioids during pregnancy, Andrea McSwain was never tested, though doctors suspected.

Andrea, now 31, had struggled with addictions for almost 15 years. She started drinking excessively around the age of 12 because she felt like she never fit in anywhere, until her junior year of high school when she found opioids like Percocet and oxycodone.

The birth of her four children – Tai, 14, Kay, 12, Kel, 10, and Cash, three – did not stop her from using, but when her youngest son was taken from her at one week old, something inside her snapped and she knew she needed help.

‘That was my last straw,’ she said. ‘I can’t describe that kind of pain: I don’t know who has my baby. I don’t know who’s taking care of him. I won’t see his first anything if he does something different.’ 

Ironically, it was this fear of losing control, she says, that had kept her using and dodging doctors during her last two pregnancies.

‘As soon as I got up I’d get myself together, and the only way I could get myself together was by using [cocaine],’ she explained. ‘I would avoid going to the doctors if there was something I felt wrong. I was scared. I was absolutely terrified the entire time that something was going to be wrong with my child, and it didn’t change – the fact that I used.’ 

If she feared anything was wrong with her baby, she would ‘go to the emergency room, get checked out real quick,’ then leave as soon as possible.

Doctors that she did see while pregnant did not speak to her about her addiction or offer her helpful resources. ‘They never, never tested me, and it was absolutely mind-blowing that they never, never once tested me.’

Andrea’s story is another example, Dr Jones says, of doctors avoiding the subject of substance abuse when treating pregnant women so that they do not end up with a tricky situation on their hands.

There is no uniform approach to screening pregnant women for opioid use disorder, which can be a delicate topic to approach when a physician is evaluating a pregnant patient that they suspect is using drugs.

Dr Jones said that all OBGYNs at UNC ask pregnant women if they are addicted to substances, whether or not they suspect they have a problem. ‘We ask them about their substance abuse because it’s an important part of their health,’ she said.

They ask for permission to do a urine sample and proceed if the woman agrees. Dr Jones made clear that the sample is used only to help physicians better treat their patients. She said: ‘It’s not used to report them to the police.’ If a test reflects that a patient is using drugs, whether or not she originally disclosed this information, they try to help her come up with a plan.

Dr Jones explained: ‘Then we have a conversation about the urine test coming up positive and what we want to do as the next steps.’

Andrea’s experiences with doctors while she was pregnant and abusing substances were not as smooth.

She once went to the emergency room while pregnant because she was passing a clear fluid and she was worried she was going into labor. She disclosed that she was a drug addict.

‘I got honest with one of the doctors. I still remember this guy,’ she said. ‘I was honest with him because I was scared. I was like: “Am I going into labor? What’s going on?” So I got to the hospital, and I told them that I had been using.

‘He was like: “You’re fine – just – you’re about to go into labor soon, but you might want to stop using before you do.”‘

She recalled another instance in which a physician flat-out refused to tell her about help that she could get for her addiction.

Andrea said: ‘I had a doctor, whenever I was pregnant with my third child, even though I was using, she chose to not test me. She didn’t know that I overheard her. But she chose not to test me and then told the intern outside: “I know she’s getting high on these drugs.” And then she named some of them. She said: “But what I’m not going to do is I’m not going to waste my time telling her about treatment.”‘

The incident stuck with Andrea. She said: ‘I’ll never forget that. I’ll never forget that lady. And she was talking to an intern.’ 

Dr Johnston said the major challenge for healthcare providers in tackling America’s opioid epidemic is getting addicts to see help as a good thing, not a trap that will separate them from their babies.

‘There’s a huge lack of trust for many women who come forward. They just don’t know what’s going to happen, and they’re full of fear,’ Dr Johnston explained.

‘They also are totally ashamed of it. So if we can work at decreasing shame, which is one of the things we try to do, and be really honest and sincere with what is going to happen’ it will help, she added.

Neither of the children Andrea carried while abusing drugs were born addicted to substances, and she has been clean for three years now.

Andrea said: ‘When I got here and got a better understanding of substances – that they’re all mind and mood altering – it became less of a struggle to want to stay clean.’ 

‘I DIDN’T KNOW I WAS ADDICTED’: KIMBERLY, 31, TOOK PAINKILLERS FOR YEARS AFTER FRACTURING HER BACK IN A CAR ACCIDENT – BUT WHEN SHE GOT PREGNANT SHE REALIZED SHE COULDN’T STOP

Kimberly Holt, 31, started taking painkillers after a car accident which fractured her back when she was 14, and a heavy duty surgery.  

The surgery wasn’t fully effective, and she needed four more, each time being prescribed Percocet, muscle relaxers, anti-inflammatories and steroids to manage her pain. 

About eight years ago, she decided to stop taking the medications her doctor prescribed her because they were making her sick.

She did not know that she was already addicted when she decided to quit, and that desperate fight against the highly-addictive drugs became even more devastating when she got pregnant.

‘I never abused them, and I wasn’t educated. You don’t know it happens by the time it happens. You’re addicted before you know you’re addicted,’ Kimberly explained.

Now, the mother-of-two from Chatham County, North Carolina, is currently delaying another crucial operation she needs, as she is petrified of the inevitable prescriptions she will receive. 

Kimberly Holt, 31, holds up a picture (left)of her two children, Nathan, five, and Natalie, two. Kimberly abused illicit Suboxone while pregnant with Natalie, but her daughter (also pictured right) was born healthy

Instead of taking Percocet, which was making her ill, she turned to illicit Suboxone, a narcotic that, when prescribed legally, helps people addicted to opioids stop abusing them.

‘I didn’t feel high; I felt normal. I wasn’t sick. I wasn’t throwing up. I did research, and I stayed on them for several years without going to the doctor. Then I found out I was pregnant.’

Kimberly, then 28, called the obstetrics department at UNC to ask for medical advice when she was three months pregnant and first learned she was expecting.

She remembers clearly the conversation. She said: ‘I found out I was pregnant, and I called the OBs. And when they asked, I told them, “I’m taking Suboxone off the street. I do not want my daughter to be hurt. What do I do?”‘ She added: ‘My priority, my first concern, is my daughter.’

That phone call was how Kimberly, who already had a son who was three at the time, ended up getting treated at Horizons. There, Kimberly was prescribed medication-assisted treatment, and she was able to take Suboxone legally for the rest of her pregnancy.

Treating pregnant women with Suboxone or similar drugs to keep them from doing illicit opioids is controversial because their children might still be born addicted to a substance.

However, both Dr Jones and Dr Johnston stressed how vital the treatment is for pregnant women.

Dr Johnston said: ‘Medication-assisted treatment for opioid dependent pregnant women is the standard of care. There’s no doubt that they do better on medication-assisted treatment. In fact, it’s much healthier for your pregnancy for you to be able to be on medication-assisted treatment [than to be abusing opioids].’

Lucy, who now works to promote the clinic that she turned to during her opioid addiction six years ago, explained the stereotype that comes with receiving medication-assisted treatment, instead of just going cold turkey.

She said: ‘Outside of treatment, in the recovery communities, it’s not always looked highly upon to be on medication-assisted treatment. That’s hard because I have this insight that they don’t always have, like where I see it works.

‘There are so many benefits of it for the moms, for the babies, just to get stable enough to continue or to really even get a grip on what’s going on in their life. It’s huge.’

Lucy said that, while she personally never tried medication-assisted treatment, she has seen both data and real-life examples to show how it does help combat drug addiction in mothers and babies.

‘I’m glad that I know so when I do go out into the recovery community and see peers and they’re like, “Why do you give women medication?” I can say: “Dude, I know it works. I’ve seen the statistics. I’ve seen these women succeed. I’ve seen these babies come home from the hospital and not ever have to go to the NICU,”‘ Lucy said.

When Kimberly’s daughter Natalie was born, she did not show symptoms of Neonatal Abstinence Syndrome despite that fact that her mother took Suboxone while pregnant. ‘She did not go through withdrawal. I was really blessed. She’s healthy, perfect,’ Kimberly said, beaming. 

Kimberly is still taking legal Suboxone. ‘It just makes it to where I can live normal,’ she said.

CAN THE EPIDEMIC BE STOPPED IN MOTHERS? DOCTORS WARN AMERICA NEEDS TO TACKLE DOMESTIC ABUSE FIRST – SINCE 90% OF PREGNANT WOMEN IN FACILITIES SUFFER TRAUMA

Kimberly has relapsed a couple of times, turning to Xanax to confront traumatic events she has lived through. But she continues to receive addiction treatment at Horizons. She said her relapses were a result of anxiety, depression and stress.

‘I had some really bad things happen when I was a kid. And it’s not necessarily going back to relive it, but it’s how do you get past it? And how do you move forward in a positive way?’ Kimberly said.

‘Relapse can be part of the recovery process,’ Dr Jones said. She said when patients relapse her staff members work to figure out what people, places or scenarios caused the relapses rather than judging the patients.

This chart shows how the number of babies affected by the opioid crisis in the US has shot up since 2000

Kimberly is not the only one at Horizons affected by trauma: Dr Kim Andringa, director of research at the clinic, said that a recent survey suggested that 85 to 90 percent of the women the facility treats have experienced childhood sexual or physical abuse or domestic abuse.

Dr Andringa said this number is probably higher because it is based on what patients say when they first come to Horizons.

They might not be comfortable sharing deeply personal experiences before building relationships with staff members there. Therefore, ‘we basically make the assumption that it’s everybody,’ Dr Andringa said.

In addition to this, Dr Andringa said data reflect that about 15 percent of the patients were trafficked at one point or another. Dr Jones explained that, for this reason, her clinic is ‘trauma-informed’.

‘They are women that are incredible survivors. I mean they’ve gone through more things than I think I personally could ever have gone through and be as well put together as they are, in terms of sexual, physical and emotional abuse from early childhood all the way through adulthood,’ Dr Jones said.

She explained that this needs to be taken into consideration when society is debating whether or not pregnant women utilizing mediation-assisted treatment is ethical.

‘It’s not to condone illicit drug use or to somehow say, “Yay, that’s good,” but it’s to understand what they’ve been through, which gives us a much better idea of how we need to be approaching people that have had those types of experiences,’ Dr Jones explained.

This is the lobby at Horizons, which has both outpatient and inpatient programs. It is the only treatment center with a licensed childcare facility in the state of North Carolina

She went on to say that societal judgments drive many people to drugs. 

‘If we really treated trauma as a public health epidemic and made an effort toward preventing it before it ever started, I think we could actually move the needle on the proportion of the population that becomes addicted to drugs,’ she said.

The societal judgments Dr Jones talked about have not left Kimberly unscathed.

However, Kimberly said the community of patients she has gotten to know at Horizons has helped her stay sober.

‘Most women in here have been through traumatic experiences like me, and we’re all fighting together. And this idea of addiction: it’s not willpower. It’s a disease, and it’s hard. It’s just like cancer. They both kill people every day,’ Kimberly said.

Dr Jones echoed this saying Medicaid needs to provide care for addiction patients ‘just like we do for cancer patients. There’s followup and after care for cancer patients. Where’s that for people who have opioid use disorder?’

‘People are looking for cures, and we don’t have cures for this medical illness. We have treatment. The path isn’t always straight; people don’t always come into treatment and do well forever,’ Dr Jones added.

Kimberly talked about the pressure of the judgments passed on her, saying: ‘When you think opiates, you think heroin. You think “bad”, “prostitution”, “They’re doing it because they want to or because they’re foolish”. That’s not the case. I had back surgery,’ she said.

Her hope is for people outside of her community to realize the damage they are doing by stigmatizing women like herself. ‘If society could just give us a chance – because we’re all good people. We just got dealt some really shitty cards,’ she said. 

Selden Holt, the outpatient therapist, said that this message of hope Kimberly now promotes is one that never ceases to amaze her.

She said: ‘The thing that doesn’t get talked about is – there are a lot of setbacks and challenges, but every day I feel like I see miraculous things happening here.’

Kimberly has another back surgery looming in the distance. The thought of it is daunting because of the medications she will have to take to function after the operation.

‘It’s going to be put off because I’m not ready. Within a year, I’ll have one.’ She explained that she knows a prescription for painkillers is inevitable. ‘Percocet, I’m sure. Maybe OxyContin, I don’t know. I mean it’s major surgery.’

Kimberly is trying to delay the operation until she is sure she can handle it. She said: ‘My scar tissue is closing the nerve canal, which is causing my right leg to go numb. They’d have to go in, and they’d have to clean it. It’s just a matter of waiting as long as possible and trying to figure out what’s the best course in treatment to go down as far as minimal pain meds.

‘So just to find out how fast I can just get it over with when I have to do it and get back to being, living my normal life.’