Pregnant and on Opioids? In St. Louis, There's a Medical Center for That 

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Dr. Jaye Shyken never planned for a career dealing with drug-dependent mothers, but it found her. - NICK SCHNELLE
  • Dr. Jaye Shyken never planned for a career dealing with drug-dependent mothers, but it found her.

Shyken did not begin her career thinking she would be working with pregnant women addicted to opioids.

After graduating from Ladue Horton Watkins High School in 1972, she majored in music at Indiana University. She then attended the University of Missouri for medical school and Washington University in St. Louis for a fellowship in high-risk obstetrics. Today she's an associate professor at the Saint Louis University School of Medicine, department of obstetrics, gynecology and women's health.

A lover of vigorous exercise, Shyken, now 63, is a dedicated cyclist and yoga practitioner and instructor. This month, she's launching a yoga class for recovering addicts modeled on 12-step recovery groups.

Shyken began working with chemically dependent women in the late 1980s, a time when the crack-cocaine epidemic was in full swing. The current opiate epidemic is something different. It has hit harder, across all aspects of society.

"It's not just middle-class kids with helicopter parents," Shyken says. "It's all of us. It's reached all aspects of our society. Nobody is safe. This is an equal-opportunity disease."

Shyken blames its reach in part on her fellow physicians.

Two decades ago, Purdue Pharma, the company responsible for OxyContin, deluged both physicians and consumers with marketing appeals that falsely described OxyContin as safe and non-addictive if prescribed properly. It was neither.

At the same time, many American physicians bought into the idea — which was heavily promoted by Purdue Pharma and other drugmakers — that pain was being under-treated. So doctors too often over-prescribed opiate painkillers to too many patients for long periods of time, inadvertently getting them hooked.

As a result, while America represents five percent of the world's population, it consumes 95 percent of the world's opiates.

"There are just a lot of opioids out there, through the over-prescribing of opiates," Shyken says. "I think that we operated under a misimpression that opioids, when used legitimately, did not result in a high risk of addiction. And we were wrong. Dead wrong."

About a decade ago, as states like Colorado and Washington began legalizing medical and recreational cannabis, Mexican drug cartels switched their resources from weed to heroin and fentanyl. The result: a glut of very powerful street drugs at historically low prices.

Throughout St. Louis, for instance, a "button" of heroin costs as little as $10, while the average waiting period to get treatment for a substance-abuse addiction can stretch several months or more. For opiate abusers and their families, a grim truth inevitably emerges: It is much easier to get high than to get help.

"You know some people come to their addiction because of peer pressure, particularly kids," Shyken says. "Some people come to an addiction because the first time they try an opioid it makes their problems go away. They feel awesome. And they probably have a genetic predisposition. That's another piece of the issue: It's hard to measure prevention. And it's hard to know what in terms of prevention really works."

Something else has happened to turn opioid use into a crisis. And that's a shift in the way American society deals with problems, Shyken theorizes.

"I think we've become a society that tolerates very little and expects instant relief in the way of a pill," she says. "So we've marketed ourselves into this situation. Whatever the situation is."

Married to a primary-care physician, Shyken is herself the mother of three grown children. Like any other mother, she worries that her offspring might get into drugs. She lectures them all the time, she says.

"And the message is, 'Not even once,'" she says. "You think I'm not curious? And knowing who I was when I was a teenager? By the grace of God."

Despite all the painful stories she's heard and seen up close, Shyken says she feels optimistic about her patients' ability to move forward with their lives.

"This is unbelievably rewarding work," she says. "Somebody comes in as an addict and they're pretty desperate and they've done some pretty awful things to support their habit, and then you put them on MAT [medication-assisted treatment] and then the real person comes through. And they're so grateful."

Interstate 55 snakes southward from St. Louis parallel to the Mississippi River. The highway rolls through the hills of Jefferson County, through towns named Imperial and Herculaneum, before bringing the traveler to Festus, with a population of slightly more than 11,000.

On a recent evening, the town is quiet, a postcard of small-town America. But Tim Lewis, the town's police chief, sees a different side — the human toll of the opioid crisis that hit his town going on six years ago.

"I've been a policeman for a long time, but I've never seen the heroin as big or as long-lasting as it's been the last few years," Lewis says. "It just took off. Overdoses of opiates. Prescription drugs. Fentanyl. They're all part of the problem."

The purity of the product has gone up while the price has gone down in Jefferson County, he says. "I've been a policeman a long time. When I first started, a button of heroin would cost you $20 or $30. And it might be ten or fifteen percent pure heroin. Now a button costs you $5, and it's 90 percent pure heroin. So the market's flooded."

This is the world Clemens returned to after her release from prison in September 2016. She'd done ten months for drug possession, but quickly started taking Percocet after her release — a mistake she blames on the decision to hang out "with the wrong people," she says.

About six weeks after she began using drugs again, she found out she was pregnant.

"And I caught myself. Because I refuse to let other people influence me anymore," Clemens says. "Because I used to be so, 'I want you to like me, I want you to hang out with me,' type of person. I don't care anymore. I don't care if I don't have one friend. Because at the end of the day I have my kids and I have my family."

She's been using drugs for a long time. Linda Clemens thought of her daughter as a star member of the high school softball team and remembers being horrified to find Rio passed out in her bedroom at nineteen, a syringe nearby on the floor.

"I was shocked because I never dreamt she'd do anything like that," Linda says.

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