1. Perinatal Substance Abuse: Methadone Maintenance Treatment Presented by: Toni Royer, MHS, NCGC, CAC-AD Executive Director, ARS Pantops Clinic

2. About ARS Pantops Clinic Addiction Recovery Systems is a company dedicated to the belief that addiction should be treated like any other medical condition that affects every aspect of a patient's life. We believe addiction cuts across all levels of our society and affects people of all types.

3. We believe that addiction is similar to other medical conditions like diabetes, hypertension, or health problems that may have been triggered by genetic predisposition and brought to reality by behavioral choices and general health practices. Unfortunately in our society we consider some medical problems to be "acceptable" and others are stigmatized and those suffering from these diseases are "shunned". We believe this is both short-sighted and tragic.

4. Addiction Recovery Systems has a core value of dignity and respect. We believe that persons with addictive diseases should be treated with the same consideration that persons receive in any professional environment. That is why we have invested time and attention to detail in creating our facility environment. Finally, we believe that treatment for addiction should always be based on what is best for the patient and based solely on their individual needs. No one medication or treatment program is right for everyone. That's why our programs may be "medication-free" or include medications like methadone, Suboxone, or other medications proven effective in aiding recovery.

5. MMT & Pregnancy Withdrawal for pregnant women is especially dangerous because it causes the uterus to contract and may bring on miscarriage or premature birth. MMT can reduce or eliminate cravings for opiods, prevent the onset of withdrawal, block the effects of other opiods, and promote increased physical and emotional health. Pregnant women in MMT show greater improvement in prenatal care than opiate dependent women not in MMT. Women are also offered intensive case management, pregnancy and parenting groups, clinical support, and referrals to community services that they might otherwise not be aware of, including prenatal care referrals, mental health referrals, and continuity of care with the department of social services.

6. Referrals Referrals are not required to enter the MMT program at ARS Pantops clinic. Patients can self-refer by calling us directly. Referrals are accepted by primary care physicians, pain management centers, departments of social services, dentists, CSBs, OB/GYN, family members, other treatment programs, and anyone else who knows someone needing help with an opiate addiction or dependence.

7. Referrals Referrals are made by contacting the clinic at (434) 220- 0080 during business hours (5:30am to 2:00pm) or after hours cell phone (434) 906-9292. Please have available the patients name, phone number, presenting problem(s), and date of birth. A counselor will then contact the potential patient directly to obtain additional information about their mental health history, substance abuse and treatment history, area of residence, and employment status. This information is obtained in order for our clinic to determine if our program is suitable for the patient or if they should seek a higher level of care.

8. Criteria for Admission (all patients) At least 18 years of age Evidence of an opiate dependence/addiction for at least one year Released (within 6 months) from institution but met criteria prior to entering institution Is pregnant and addicted or dependent on opiates Was previously on maintenance within 2 years of discontinuing prior maintenance treatment Experienced two unsuccessful attempts to detox within past 12 months

9. Fee Requirements Admission Fee: $188.00 for Methadone – covers the first week of treatment. Weekly fee of $88.00 or a daily fee of $13.00 after the first week. All fees are due at the time of service. Additional fees may be required if the treatment team determines it necessary. These fees include items such as additional urine screens or a peak and trough.

10. What Happens after a Pregnant Patient is Admitted for MMT? They will be assigned to the designated pregnancy counselor, Lindsay Feggans. They are required to sign releases allowing ARS to coordinate their care with their OB/GYN and PCP. If they do not have an OB/GYN, ARS will refer them to OB/GYN Associates and Dr. Helmbrecht. Each time they visit their OB/GYN, ARS asks the doctor to complete a form and return it to our clinic indicating any complications, concerns, and dates of ultrasounds. ARS will work closely with these physicians to ensure the patient is receiving the necessary prenatal care. ARS will also refer the patient to Martha Jefferson Hospital, Anne Cary House. Patients will attend the clinic orientation within 7 days of admission and 4 required education groups (HIV, Stages of Change, Methadone, and Relapse Prevention) within 30 days of admission. Patients are required to attend a minimum of 4 hours of counseling monthly including the pregnancy group, parenting group, individual sessions, and other groups as determined to assist them in meeting their treatment goals. Patients are educated on numerous prenatal topics including the risks associated with methadone while pregnant, infant withdrawal symptoms, prenatal care, breastfeeding, nutrition, housing/living situation, infant care (immunizations, the importance of pediatric care), family planning, birth control, etc. ARS will work with the patient on finding community resources available to meet their needs. We have referred numerous patients to Project Link, MACAA, and Social Services.

11. If you learn nothing else today, remember this: The disease drives the behavior; the behavior does NOT drive the disease.

12. One of our patients has volunteered to share her experience with perinatal and postnatal methadone treatment at our clinic. Please welcome her.

13. Questions????