Six years ago, Krista Turner and Dr. William Johnstone were both in very different places.
Krista was a heroin and crack addict who had checked off nearly every box on the list of terrible things that drug addicts do. She had done everything but end up dead, and she had been close to that a couple of times.
Dr. Johnstone, an obstetrician who practices at New Hanover Regional Medical Center, felt little empathy for drug addicts, especially young women who would afflict their unborn babies with the dangers of addiction and the misery of withdrawal.
As the opioid epidemic seized the Cape Fear region, Dr. Johnstone saw more young pregnant women trying to deal with addiction.
“As an OB/GYN, I didn’t know much about addiction, so the result was kind of a haphazard treatment approach,” Dr. Johnstone said. “I recognized the need to educate myself about addiction, and it became apparent that I was going about it the wrong way.”
By studying medical research, he came to realize that addicts don’t choose to become addicted to opioids. Addiction can start with a careless decision by an uninformed teenager. It can be rooted in a dark childhood where irresponsible adults provide no protection, or worse, facilitate the wrongdoing.
“Opioid addiction changes your neurophysiology and pathophysiology,” Dr. Johnstone said. “It’s a disease, and you can’t just stop it. Once you are addicted to opioids, your brain is rewired and you can’t go back.”
Sometimes, the beginning of opioid addiction starts during medical care, when a doctor, trying to satisfy a patient’s need for pain relief, would prescribe an opioid.
As Dr. Johnstone became more educated on addiction, he started working on measures to solve the problem of Opioid Use Disorder in pregnancy. The University of North Carolina Horizons Program was helping pregnant mothers end their addictions, so Dr. Johnstone and a group of advisors worked to emulate that program in Southeastern North Carolina.
A short stay
Krista was in the throes of addiction, having never recovered from a painful, abusive childhood that led her to drugs before she was old enough to apply for a driver’s permit. In her late teens, she gave birth to a son, but her pattern of drug abuse and associated crime caused her to lose custody of her son. She had alienated everyone in her family by lying and stealing and was living on the streets when she wasn’t in jail. During one of her trips to the Emergency Department, she was admitted to NHRMC with endocarditis, a bacterial infection in the heart that, Krista says, was most likely caused by using dirty needles.
As he had before, NHRMC Substance Abuse Counselor Jeremy Mullis offered to enroll Krista in a treatment program. As she had before, Krista turned him away. As soon as she was no longer at risk of immediate death, Krista routinely tried to sneak out of the hospital, more desperate for a fix than to complete her medical recovery. Once, when she had been brought to the hospital from the jail, she locked herself in a bathroom and tried to escape through the ceiling. She soon found out that the walls extend above the ceiling tiles, and she had nowhere to go. She was recaptured, and her efforts only earned her additional criminal charges for absconding.
In 2016, Dr. Johnstone was treating a young pregnant mother. Dr. Johnstone’s obstetrical team delivered the baby and despite all efforts to save her, the young mother died shortly after giving birth.
“She lost her life to dirty needles and heroin,” Dr. Johnstone said. “Her death severely impacted my psyche. I was more determined than ever to help these women. If I could get the organization running, maybe I could save just one person.”
Dr. Johnstone built a Board of Directors from local recovery experts and advisors, and in October 2017, he established The Tides, a non-profit residential treatment program for women with Opioid Use Disorder who are pregnant, anticipating pregnancy, or recently gave birth. The program weaves together community programs to establish an intensive, residential treatment program. The program’s goal is to help the mother get and stay sober and maintain the bond between mother and baby.
It includes medically assisted treatment, substance use treatment, group care, psychiatric care, spiritual care, and many other tools to help these women stay off of drugs. Most importantly, perhaps, Tides employs a team of professionals who believe the women can recover and take care of their babies.
In 2018, Krista Turner returned to NHRMC with another bout of endocarditis. At age 29, she was pregnant and in poor health. After 15 years of addiction, she was nearly as tired as she was sick.
The NHRMC medical team nursed her back to stability again. For the 11th time, a substance abuse counselor visited Krista to see if she would enroll in treatment. This time, she let him in.
Krista listened to the options available to her and realized that the lifeline being presented to her might truly be her last chance at surviving addiction. Plus, she had a baby to consider.
“There was a big change in her disposition,” said Mullis, the substance abuse counselor. “Normally she just blew me off, but this time she sat up and said she wanted to get better.”
Knowing her history of attempted elopement, Krista asked to be labeled as an involuntary commitment. That meant that a sitter would stay in her room at all times to ensure that she didn’t attempt to run away from her room and her needed medical care.
Mullis’ work is part of Code Outreach Safety Team, an NHRMC program designed to treat patients with Substance Use Disorder. The program includes substance abuse counseling through weekly meetings, regular appointments with social workers, pain management, and alternative therapies such as yoga and music therapy. A significant part of the program is connecting the patients to resources outside the hospital where they can continue to receive help after discharge. If patients can be connected to an external doctor, they stand a better chance of staying sober.
Krista enrolled in the Tides program, where she met Dr. Johnstone. Despite Krista’s fragile state and regrettable past, Dr. Johnstone gave her a sense of hope and the reassurance that he truly believed she could recover from addiction and be present in her baby’s life.
“Our purpose is to keep the mother-baby unit intact,” Dr. Johnstone said. “Our communities' foster family programs are overburdened, so we want to keep the baby with mom, or in a supervised kinship, where mom has supervised visits. We want the baby to breastfeed, feel mom’s skin and hear mom’s voice.”
Krista had faced the challenges of sobriety before, usually from inside a jail cell. So, she knew the anguish she would have to endure. But with a new outlook borne of dedication to her baby and desperation in her own life, Krista was determined to turn her life around.
The postpartum stage is particularly tough for recovering moms, Dr. Johnstone said, because postpartum depression can trigger and intensify cravings.
“That’s why we can’t stop treating these women a few weeks after they deliver their babies,” Dr. Johnstone said.
The Tides Program refers patients to NHRMC - Coastal Family Medicine to enable program participants to continue care for mothers and babies.
As part of her treatment in the Tides program, Krista was prescribed buprenorphine, which stimulates opioid receptors in the brain without providing a “high.” Subutex (the brand name of buprenorphine) poses its own challenges, so Krista will have to continue Subutex indefinitely, slowly taper her use, or face withdrawal.
Since giving birth to Raelyn, Krista has avoided drugs, an accomplishment she never envisioned when she was an addict lying, stealing and prostituting to get her next fix. She is now closing in on one year of recovery.
In addition to being a proud mom, she has adopted a dog, reclaimed her driver’s license and started painting as a hobby – all because of her sobriety.
As she works through recovery, she has spoken openly about her past – detailing the darkness of her childhood and subsequent addiction in a January Facebook Live interview with motivational speaker Earle Van that reached more than 6,000 views and received more than 900 comments. In February, public radio station WHQR interviewed her for a piece about addiction and recovery.
“I want to help take away the stigma of recovery,” Krista said. “I want to help others who are struggling with some of the same things I went through.”
This openness signals a shift from shame and denial to ownership of addiction. As addicts openly form recovery support groups, they are trying to change public perception.
Dr. Johnstone is among those who have had a change of heart.
“Three years ago, I was on board with putting these women in jail,” he said. “My colleagues say, ‘Boy, you’ve changed.’ And I have. I’ve educated myself about addiction and I feel more empathy and compassion for these women.”
Krista understands that others won’t easily forgive the lying, stealing and other acts of desperation that severely damaged relationships. But she sees the changes in herself and believes that others can take the same steps to repair relationships and overcome their past.
She’s in training to become a peer counselor for those with Substance Use Disorder.
“If I see someone in recovery who needs help, I will do whatever I can for them,” she said. “Somebody has to believe in them for them to be successful.”
For her, it was Dr. Johnstone.
“He saved my life,” she said, and it’s not hyperbole.
Krista was certainly on a dangerous path, and her health was deteriorating rapidly. Still, Dr. Johnstone won’t take all the credit.
“She saved her own life,” he said. “She chose to begin recovery. We are here to make sure she has the resources to be successful. Watching people like Krista reach milestones gives me hope and faith.”
Dr. William Johnstone expressed his thanks to the volunteers and advisors of Tides, for working to help these mothers overcome their addictions.
- Elizabeth Harris (Board member/officer)
- Martin Greene
- Mary Heintz
- Frankie Roberts (Board Chairman)
- Kenny House (Board)
- John Thorpe (Board)
- Hendree Jones
- Scott Whisnant (Board)