Jennifer Fraser, PhD

August 2022

 

When I found out I was pregnant with my first and only child in October 2017, it had been only five months since I started opioid agonist therapy. Before that, I was struggling. I hit my rock bottom at the end of 2016, leaving an academic career I had worked tirelessly on for over a decade. My depression and anxiety were at an all-time high, and so was my drug use. I was becoming an ugly person, inside and out, treating my boyfriend at the time in ways that were emotionally and verbally abusive, taking advantage of the generosity of my family and friends, cancelling classes because of migraines and panic attacks.

 

I was prescribed Tylenol 3 (acetaminophen with codeine) when regular old Tylenol and Advil, and then Tylenol 1 and 2, no longer did anything to combat the tension headaches and migraines I had suffered for as long as I can remember. I was in university, sometime between undergrad and grad school. I didn’t abuse it for the longest time. It helped me when I had a headache; I might even be able to be to productive if I took two at the start of a headache coming on, I could still do work. And that was my singular focus from 2001 to 2016: building my academic career with a Bachelor’s degree in Criminal Justice and Public Policy (2005) from the University of Guelph to a Master’s (2007) and eventually a PhD (2014) in Criminology from the University of Ottawa. My focus was on violence against women, and the research, community activism, and volunteering took a physical and emotional toll. Vicarious trauma kept me closed off from intimate relationships; I lived alone and liked it.

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But once I’d been working for several years, teaching at different universities across the country, hopping from one short-term contract to another (because adjunct teaching on a course-by-course basis or one year limited-term contracts is how many universities are filling their teaching rosters, thusly avoiding hiring tenure-track professors), traveling the world going to conferences and playing as hard as I worked, my lifestyle started becoming unsustainable. Between 2012 and 2016, I moved from Ottawa to Toronto to Geneva, Switzerland to Sherbrooke, Quebec to Surrey, British Columbia and eventually returned to my hometown of Kingston, Ontario. I had no home base, many places I lived I knew no one and spent most of my time outside of teaching alone. And those Tylenol 3s felt good.

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So it began slowly. I’d take my Tylenol 3s proactively, just in case I got a headache. And it would give me this warm feeling that started by spreading down my arms. I can still feel that feeling. And I would feel great, and I could do what I needed to do that day with a skip in my step and I was productive and I was good. I was a great teacher, I won awards. I was a great researcher, securing contracts and writing and publishing articles. But as with any substance, the more you use, the more you need to secure that same feeling, and eventually you are just trying to chase down a memory of a feeling; you know the high will never be as good as it was in the beginning again.

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While I had the occasional Oxy or Percocet if a friend had one to share, occasionally smoked pot, and tried cocaine a few times with that same boyfriend, my drug of choice was always codeine. But I didn’t want to hurt myself, I didn’t want to die, and I knew that taking more of the Tylenol 3s than indicated would be too much acetaminophen and that would damage my liver. So I took to the internet to learn about Cold Water Extraction. At the time, you could buy Tylenol 1s over-the-counter at any pharmacy fairly easily and often with no questions asked. Especially when I lived in a bigger city centre, I could visit a different pharmacy every day of the week if I needed to and never raise any suspicion. Smaller, more rural areas were more difficult; pharmacists would remember you, or want to take down your details to keep track of how often you visited. And by the end, I was visiting a pharmacy nearly every day, spending $20 a bottle for 200 pills of codeine with acetaminophen, ibuprofen, or acetylsalicylic acid (aka aspirin which happened to dissolve the best and was my personal favourite).

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Basically, I just wanted to be able to do my work, deal with my fluctuating depression and anxiety, and control my chronic migraines, but my use of codeine went from facilitating my productivity to exacerbating my ill health. My BC boyfriend gave me an ultimatum the Christmas of 2016: stop my codeine use or we wouldn’t be together in the New Year. He held to it, I couldn’t stop over a holiday season, and I knew I could not spend another semester alone in a province across the country from my family and friends in Ontario. I quit my job, flew back to Ontario to stay at my parents’ house, only days after flying to BC after the holidays.

It took a few more months before I finally got to see a special addictions doctor, Dr. Adam Newman in Kingston, Ontario in May 2017. He helped me change my life around, and by helping me stop my codeine use, I’ve been able to reevaluate my life choices and intentionally curate the life I want to live. Dr. Newman started me on a Suboxone (buprenorphine and naloxone) regimen, which began with visiting the pharmacy every day to obtain my pill that I would take sublingually (under my tongue) in front of a pharmacist every day. Some of the pharmacists were more compassionate than others; I remember waiting for over 45 minutes to get my pill one day because one of the more unfriendly pharmacists saw me, but would not acknowledge my presence while she was serving another customer. It was obvious she was taking her time on purpose, when it would have been very easy to pass me my pill between grabbing paperwork or talking to a colleague. I missed my 12-step yoga class that day because I expected to be in and out of the pharmacy in the usual 15 minutes it took to take an observed pill.

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So when I found out I was pregnant only five months after being in active addiction, I was both ecstatic and terrified. Ecstatic because I was 35, thought I would never have a child of my own, but in recent years had really been feeling the maternal pull. Terrified, because I still felt on shaky ground, and now I was going to have to take care of a baby as well as myself, and had only been seeing my current partner for about three months. By this time, I was also a regular cannabis smoker, having replaced my all-day codeine use with medical marijuana. I decided to stop smoking cannabis for the duration of my pregnancy (and up until my child’s first birthday as I was breastfeeding), as I was already taking the Suboxone for my opioid agonist therapy, as well as fluoxetine for my depression and anxiety, all under Dr. Newman’s supervision. Dr. Newman continued as my addictions doctor but also became my primary healthcare provider for my pregnancy and the doctor who would deliver my baby; having that continuity of support from him has been invaluable to my recovery. I still see him every two months for a check-in.

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My pregnancy was fairly uneventful for being a “geriatric pregnancy” and “high risk” given the prescriptions I was taking. The primary concern was that my baby would be born with Neonatal Abstinence Syndrome (NAS) because of the Suboxone treatment. Babies with NAS can be irritable, of lower birth weight, and have other symptoms associated with withdrawal from a substance – in other words, the baby would be withdrawing from the Suboxone in my system. To combat this, the plan was for me and baby to room-in at the hospital for five days of observation after delivery, so nurses and other support staff could monitor baby’s progress and help us with breastfeeding and maternal bonding.

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Unfortunately, my baby’s delivery ended up being a traumatic birthing experience. I was 41+5 weeks pregnant when I was induced at 9:30 am on a Friday morning. Soon after, contractions began and I opted for an epidural, primarily because other (narcotic) drug options were not available to me because of my Suboxone treatment. I spent the day lying in the hospital bed until I was dilated enough to start pushing around 8pm. After a solid two hours of pushing, baby got stuck in the birth canal and her breathing was compromised. From there, the Neonatal Intensive Care Unit (NICU) was called bedside as Dr. Newman called for the vacuum to facilitate the birth. My daughter was born at 10:22pm, not breathing, flopped grey on my belly. I had no wherewithal to register the severity of her condition as the NICU team whisked her away to put her on a CPAP machine to help her breathe. The adrenaline drop after labour and delivery had me in a serious case of the “shakes” and for what felt like a long time, I was lying alone in the delivery room, freezing cold, my body its own small earthquake, while doctors and my partner were following my baby’s progress on another floor of the hospital.

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The CPAP machine collapsed my daughter’s lung, so she was intubated and put on a ventilation machine. Thankfully, after this intervention her lungs and breathing improved, she was taken off the ventilator and extubated, and was breathing on her own by the end of her second day of life. However, we didn’t get the rooming-in experience that I expected. Instead of five days in a room with a view of the lake to bond and work on our breastfeeding relationship, my baby was in the NICU for five days, while I went from a temporary room on the delivery floor, to another night on the floor for families of patients, eventually to being discharged without my baby. The first night away from the hospital without my baby was thankfully her last night in the NICU; we brought her home the next day.

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My experience with the NICU at Kingston General Hospital was overwhelmingly positive; I received compassionate care from almost all the doctors and nurses and other staff I encountered. Of course, the one negative experience I had with a NICU nurse sticks out in mind. All babies with potential NAS symptoms are monitored for jaundice, or the yellowing of the skin due to high bilirubin levels in the liver. This is typically treated with phototherapy in newborns. While no previous doctors or nurses had indicated any concern about jaundice with my daughter, one nurse loudly noted the NAS status of my baby and told me that she looked jaundice to her and that she would probably need light therapy because of her NAS. This nurse made me feel like a bad mother by judging me for putting my daughter in the compromising position of potentially suffering NAS because of my Suboxone treatment. Yet, this nurse had no idea whether I was using illegal or recreational opioids or if I was in opioid agonist therapy, which was the case. At the time, I felt like I was doing the right thing by getting treatment but I was still being judged, at least by this one nurse, either for needing the therapy in the first place or because she assumed I was using recreational opioids.

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Other than that one instance, my experience with the healthcare and social care system was overall positive during and after my pregnancy. I was enrolled in a Nurse Home Visitation program through my public health unit wherein a public health nurse would visit me during pregnancy to offer support and answer any questions I had, and then after my daughter was born her expertise was integral in solidifying our breastfeeding relationship. My daughter and I have also taken advantage of the amazing programming offered at our local EarlyON centres, a provincially-funded service for all children 0 to 6 years of age, including free baby groups, play groups, and outdoor adventures.

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This year my daughter turned four years old and is a happy, curious, imaginative kid. I have been clean of opioids for five years and counting and continue to use cannabis, fluoxetine, and Suboxone to manage my mental health. I live a quiet life in a rural setting, where my partner and I raise our daughter in a home with a big yard and garden, a dog and cats; lots of chances for explorations and adventures for us all. I continue to deal with chronic migraines, but after working with a Neurologist, I have finally found a medication that is not a narcotic that is effective in stopping my headaches in their tracks (Suvexx, which is naproxen and sumatriptan, for other migraine sufferers) – at least for now. I have also since taught one online university course during the early days of the pandemic, and am now involved in consulting on two research studies based in the Department of Gynecology & Obstetrics at Queen’s University.

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As a writer and teacher, I always knew I would share my story someday. The Impact Research Study has given me the opportunity to use my voice in an effort to normalize conversations around drug use in pregnancy. Whether it’s prescribed or not, a lot of people are using substances to get through the day and deal with a variety of mental health challenges.  I am so lucky I had supportive people surrounding me, especially that BC boyfriend who pushed me to change, my parents for always providing a place to land, and now my daughter who gives me a reason to fight for something better each day. I want to make absolutely clear that I recognize the privilege I have experienced throughout my life that has allowed me to pursue advanced degrees in post-secondary education and not “fall through the cracks” of a society in which so many people find themselves without familial or financial support, having experienced abuse, trauma, and violence firsthand, and who end up coping with these violations and stressors in unhealthy ways. It can be an impossible spiral to break out of if you don’t have those social ties (e.g., family, a job/career, friends, hobbies, etc.) to ground you. While my journey has cost me a few relationships I would have once held dear, most of my closest family and friends have supported me unconditionally, and for that I am eternally grateful.

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My hope for the Impact study is that it will contribute to reducing the social stigma around drug use, moving us away from the view of drug use as a personal failure or even as a criminal justice matter, towards more of a trauma-informed perspective. If the healthcare system can work within a harm reduction framework and approach substance users as individuals in need of healing, perhaps we will see less pregnant drug users skipping their prenatal appointments due to fear of being judged by their doctor, or less babies being separated from their birth parents even when drug use is involved because our health care system recognizes maternal/birth parent bonding as one of the key protective factors against NAS symptoms. The work of the primary investigators and their colleagues around the province is inspiring and has the potential for wide-reaching improvements in the health and wellness of pregnant people and their babies in the future.