A dozen years ago, Dr. Geogy Thomas wasn’t prepared to see pregnant women addicted to pain medication in his little rural primary-care clinic. When they trickled in, he’d refer them to a high-risk obstetrics practice at the University of Tennessee Medical Center in Knoxville, an hour away.

Then he started seeing more and more of them – later and later in pregnancy. He realized many weren’t going to UT Medical Center. Many weren’t getting prenatal care at all.

“We didn’t feel comfortable taking care of the patients here, but they weren’t getting the care anyway,” Thomas said. “And that’s when we had to do a little soul-searching of our own, to say, ‘How do we take care of our own community?’”

Thomas is chief medical officer for Dayspring’s Indian Mountain family health center in Jellico, as well as for Dayspring’s other two clinics in nearby Clairfield, Tenn., and Williamsburg, Ky. The federally qualified health clinics provide primary and obstetrics care to underserved people in the towns along the Tennessee-Kentucky line.

Thomas came to Jellico in 2000 from California, where he’d seen a lot of heroin, cocaine and other street drugs. But the culture of addiction to prescription painkillers and “nerve pills” was new to him, patients coming in with drugs prescribed by “specialists” in the pill mills that dotted the area, Thomas said.

“I came into this community very ill-prepared for the amount of medications that were being prescribed,” Thomas said. “All these things I’d never seen used to treat pain were being utilized for what we would have prescribed ibuprofen and Tylenol for.”

And he’d see pregnant women taking high amounts of the opioid replacement drug buprenorphine, used in Suboxone and Subutex. They got them from freestanding clinics and didn’t know their babies could still go through withdrawal from these drugs after birth. The majority of mothers in Tennessee and Kentucky whose babies are born drug-dependent are on addiction replacement medications.

In the past two years, Tennessee has shut down nearly half of its 300 pain clinics and imposed regulations that prevent the same clinic from prescribing both pain medications and addiction treatment. Still, Thomas said, pill mills are still prevalent in his area. He’s now seeing a lot of people addicted to the non-opioid gabapentin, or Neurontin, used to treat nerve pain and seizures, which can cause severe withdrawals in newborns.

One-quarter of his pregnant patients now come in addicted to something.

But the weeks ran out, and their babies were born addicted. In 2016, the East region of Tennessee, which includes Campbell and the 14 other counties surrounding Knox, reported 206 resident babies born with “neonatal abstinence syndrome” – more than any other region in the state. More than 26 of every 1,000 pregnant women in the East region last year had NAS babies. By the end of February this year, 118 NAS babies had been born in Tennessee, 24 of them from the East region – second only to the Northeast region around the Tri-Cities, which had 42 NAS babies.

“Every child born with NAS is costing the state $62,000 a year,” Thomas said – and that’s only for infant medical care. “Not the aftercare (and later problems), not the devastation of the family, not court and foster care and social workers” a family with ongoing addiction issues likely will need.

Thomas began telehealth sessions that allowed patients in his clinic to be remotely seen by practitioners at Knoxville’s High Risk Obstetrical Consultants. But he soon realized the women’s partners and even parents were also addicted.

“There’s nothing worse than taking an OB patient, cleaning her up and then sending her back home to her boyfriend, or her mother, who’s still abusing the drugs,” Thomas said. “What would it look like if we took that whole family? Husband, mother, grandmother – we’re talking about whole families that have another chance at life.”

Read more in the Knoxville News Sentinel.

Kristi L. Nelson is a general assignment news reporter who covers health, social services and other issues.  As a health reporter, she earned a Kaiser Family Foundation Fellowship for reporting on AIDS/HIV in Tennessee, and a National Health Journalism Fellowship from the University of Southern California at Annenberg for a series on the role of foreign-born primary-care physicians in rural East Tennessee. She is a member of East Tennessee Society of Professional Journalists and the Association of Healthcare Journalists.