For women who are pregnant and addicted, MAT offers stability and better outcomes because the treatment is medically controlled, avoids the up-and-down cycle of using street drugs and eliminates other risks associated with illicit drug use. While methadone was the standard replacement drug for pregnant women, studies have shown buprenorphine is safer and more effective for pregnant women.

Women who get into an MAT program, then wean off the replacement drug, or find a dosage that will work long-term, are able to provide a more stable environment for their children, which can translate to better long term health, said Dr. Don Teater, a substance abuse specialist in North Carolina who works with the Centers for Disease Control and Prevention.

“I’ve seen MAT help someone from the worst point in their life, losing their families, homes, and jobs, to getting all of that back and being extremely successful,” Teater said. “So, I really see this medication as being part of the answer to this epidemic.”

MAT hasn’t been accepted as the only treatment approach, Teater said, and abstinence programs are still frequently used.

“Detox and abstinence-based treatment are primary in a lot of communities,” he said, “and a lot of people in the addiction field think that MAT is trading one addiction for another, but studies show that MAT is by far the most effective.”

MAT is effective because the replacement drugs, methadone and buprenorphine, are “pharmacologically long-acting.” That means a patient can take one pill in the morning and then feel normal for the rest of the day, Teater said, eliminating the need to seek out the drugs they were using before.

While Gila County’s need for addiction treatment outpaces what’s available, Prescott, the main population center in Yavapai County, northeast of the Phoenix metro area has become a national destination for addiction recovery. The city of 40,000 people has more than 200 group homes, but not many options for receiving MAT treatment.

For people in other parts of the county, which is about the size of Massachusetts, access to rehabilitation care is scarce.

Yavapai County has only one methadone center: Prescott Valley Opioid Replacement Services, operated by Southwest Behavioral and Health Services (SWBH).

SWBH also operates the only methadone treatment center in Coconino County and the only treatment center in Mohave County.

“Some of our clients live an hour away from our site, some live an hour-and-a-half away,” Woodward, the program director for Yavapai County SWBH, said.

For clients who can get to the clinic, Woodward said the stigma is a major impediment, leaving some expecting mothers resistant to using MAT, or causing them not to return for ongoing treatment.

“There’s very much the 12 step kind of attitude, of you’re not really sober or in recovery if you’re on medication to be sober,” Woodward said. “So, some women and clients in general walk in with that concern and stigma in their mind.”

Reaching women who live in more isolated areas, to let them even know services are available, can be challenging.

Yavapai County Community Health Services (YCCHS) is the regional health department for the area. One of its programs, Health Start, pairs pregnant teens and women with community health workers who are mothers themselves.

The Health Start counselors help mothers get access to medical and social services. They help with finding a doctor for prenatal care, applying for AHCCCS, the state’s Medicaid program, and WIC, a service specifically for low-income pregnant women and recent mothers. They can also help women find county-administered or charitable social services. Typically, they travel to pregnant mothers’ homes to provide the services. While there, if they see signs of drug abuse, they can help the women get into a program earlier, which has been shown to decrease risks.

“We’re seeing pregnant, high-risk moms in the community, who are low-income and non-English-speaking. The majority are moms with little resources,” said Stacey Gagnon, Maternal Child Health Section manager at YCCHS. “We provide information on baby care, feeding tips and sleeping tips. It’s your mother coming to your house and telling you how to do this.”

Gagnon said early detection and getting women into a program decreases the risk that the pregnant women end up arrested or jailed for drug-related crimes.

For those women who do not seek treatment and are not intercepted by state or county programs, jail is a common place for them to detox and discover that they’re pregnant, Gagnon said.

A 2016 report released by the Vera Institute of Justice and the Safety and Justice Challenge, two charitable organizations, showed that women make up the fastest-growing jailed population, and that 82 percent of women in jail have experienced drug or alcohol abuse or dependency.

Gagnon also administers a new county pilot program, where she visits pregnant female inmates at the Camp Verde Jail to educate them on what their birth experience in jail will be like, and to help get them resources when they’re released.

“Every pregnant woman we’ve talked to, their biggest fear is delivering in the jail and being shackled,” Gagnon said. “It’s inhumane to restrain them. It’s barbaric. Especially when they have no history of violence. Mostly drugs and theft. How violent could they possibly be?”

The Camp Verde Jail does not have MAT licensing to provide methadone to its inmates. If the jail has a pregnant and addicted inmate, she can be transferred to the Maricopa County Corrections system, where MAT is available.