One of the major issues across our nation is the increasing abuse of opiates. In fact, the White House commission examining the nation's opioid crisis recently recommended that the opioid epidemic be declared a national public health emergency.

While this is not a new problem, it is affecting a broader range of people (lower, middle, and high socio-economic class). Multiple factors contributed to this epidemic including the pharmaceutical industry's encouragement to healthcare providers to eliminate pain, and organizations such as the Joint Commission on Accreditation of Healthcare Organizations including pain as a vital sign to be treated. When treating patients, unfortunately, providers didn't understand the addictive nature of opiates.

While opiates treat pain, they also have an effect on mood, causing a state of euphoria. The major problem is it changes our brain function and the reward pathway in our brain so when individuals use opiates for a certain amount of time, issues of dependence can become a problem.

If people are prescribed opiates for an appropriate pain situation, for a limited amount of time, and given a limited amount of medication, issues of dependence can be limited or monitored. Unfortunately, in recent decades, that did not occur so many individuals in the public had access to more prescription opiates than they needed.

It is true that many people take opiates appropriately for a limited amount of time, and dependence does not become an issue for them. However, most do not dispose of the medication, and it remains in their house for individuals who are seeking opiate medications to access. Frequently those medications are stolen by friends or family members who visit.

The Lloyd C. Elam Mental Health Center at Meharry Medical College has several programs to treat substance use disorders. One program that stands out as unique is the Rainbow Program. This program is designed to treat pregnant and postpartum women with substance use disorders. These women have been included in the increasing number of people who use opiates. Opiate overdoes can result in death ... and for a pregnant woman, death can occur to her and her unborn child.

As part of the Rainbow Program, women with opiate addictions can receive medication-assisted treatment in the form of Buprenorphine. This medication is an opiate, but it is different than heroin, fentanyl or other opiate pain medications. When individuals are prescribed Buprenorphine, it prevents several problems from occurring. First, the individual doesn't get the emotional high from this medication. Next, it blocks other mediations from attaching to the receptor in the brain. Third, it prevents individuals from going into withdrawal. People with opiate addictions greatly use excess opiate medications either to prevent themselves from going into withdrawal or to experience the euphoric or pleasant feeling.

When individuals are treated with Buprenorphine, they receive a prescription for the medication that helps them take a consistent amount and avoid excess use and contact with dirty needles. It also helps them learn to think clearly.

The women in our Rainbow program are also required to receive counseling while they receive this medication. Many are able to taper off Buprenorphine after they have received adequate treatment and counseling. For those who do not taper off Buprenorphine, it allows them to maintain functional lives without increasing inappropriate use of the opiate medications.

Individuals with addictions often need treatment for several months while their brains recover from exposure to substance abuse. The Rainbow program allows women to be in treatment at the facility for 90 days, providing significant support toward their recovery. Mothers in this program are allowed to have their toddler children with them at the facility up to age three. Childcare is provided during the weekdays, which allows the mothers to participate fully in the recovery process. Their program not only includes classes about addiction but also includes parenting classes. The Rainbow program provides a longer length of stay for treatment, as well as the Buprenorphine which many other programs do not do.

The Department of Psychiatry at Meharry Medical College obtained grants from the Tennessee Department of Mental Health and Substance Abuse Services to fund the Rainbow Program and to provide Buprenorphine treatment. These funds allow us to serve all individuals, including those without insurance coverage. We believe these programs save lives and help pregnant women with addiction receive comprehensive addiction treatment.

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Meharry Medical College
Rainbow & Other Substance Abuse Programming