Overdose Epidemic

Stepping up to help pregnant patients with substance-use disorders

Andis Robeznieks , Senior News Writer

“Treatment works. Judgment does not.”

That was how Ruchi M. Fitzgerald, MD, concluded an essay marking International Overdose Awareness Day on the website for Rush University Medical Center, where she is an assistant professor of family medicine and psychiatry and behavioral sciences.

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Ruchi M. Fitzgerald, MD
Ruchi M. Fitzgerald, MD

In her work as a family physician and addiction medicine specialist, AMA member Dr. Fitzgerald has worked to educate the public that substance-use disorders (SUDs) are chronic illnesses and not moral failings. She has also endeavored to provide care to two groups that often feel the most stigma while seeking treatment: pregnant mothers and physicians.

During her addiction-medicine fellowship at Rush University in Chicago, Dr. Fitzgerald worked with other committed faculty to start an SUD curriculum. Part of the curriculum includes education and awareness on topics such as stigma, overdose prevention, SUD in pregnancy, and physicians and SUD.

To help shatter these stigmas, Dr. Fitzgerald openly shares her story as a physician in long-term recovery and shares how she sought help through a physician health program.

“I am also a physician in long-term recovery and have found joy in caring for patients who have been deeply stigmatized over and over by the health care system, society and even their family for having a disease that is a chronic medical illness,” Dr. Fitzgerald wrote in her essay.

“Through education, advocacy for our patients, and modeling nonstigmatizing language and compassion, I have hope that our patients will come to feel more comfortable accessing the health care system and the care they deserve,” she added.

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Dr. Fitzgerald sees the need for increased access to evidence-based SUD care on a daily basis in the community addiction-medicine fellowship program she developed. She also sees it at the PCC Community Wellness Center addiction-medicine consult program at West Suburban Medical Center, a safety-net hospital in a Chicago suburb that borders the Austin neighborhood on the city’s West Side.

Dr. Fitzgerald is also the service chief of inpatient addiction medicine at PCC Community Wellness Center, which is a federally qualified health center that operates 14 locations serving Chicago’s West Side communities and Near West suburbs.

It's a “unique setup,” Dr. Fitzgerald said, explaining that the program is the recipient of a grant designed to encourage addiction-medicine fellowship programs to expand and put fellows in the community.

“We are serving a ZIP code that has the some of the highest rates of opioid-overdose fatalities in the state during the COVID pandemic,” said Dr. Fitzgerald, who took part in a panel discussion on the drug-overdose epidemic at the 2023 AMA State Advocacy Summit.

In addition to caring for older adults affected by SUD in Chicago’s Austin neighborhood, pregnant people have been a focus of her work, and she noted that these patients face numerous policy and institutional barriers, but stigma remains their main obstacle to care.

Most cannot get SUD treatment at the same place they receive ob-gyn care, and places that offer SUD treatment often don’t provide care for pregnant patients.

“It's a lot of navigation and they may have issues with transportation, receiving their medications, and then also—if they have involvement with either the criminal justice or child welfare systems, which have conflicting priorities related to those systems—they just have tremendous fear of incarceration or child removal,” Dr. Fitzgerald said.

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Though the PCC Community Wellness Center has historically provided SUD treatment and ob-gyn care in one location, the program has grown since Dr. Fitzgerald expanded the scope of services in late 2020.

“We really expanded in terms of what kind of services we can offer pregnant individuals,” she said. “Our model is compassionate care and looking at the whole family.

“We have shared our model with other health systems,” Dr. Fitzgerald added. “However, we are the one program in the area that really has what we call a ‘one-stop shop,’ where patients can get prenatal care, receive case management—including a doula—and then addiction treatment all in one visit.”

The AMA believes that science, evidence and compassion must continue to guide patient care and policy change as the nation’s opioid epidemic evolves into a more dangerous and complicated illicit drug overdose epidemic. Learn more at the AMA’s End the Epidemic website.

Visit AMA Advocacy in Action to find out what’s at stake in ending the overdose epidemic and other advocacy priorities the AMA is working on.