Health

Opioids: Treatment rates high for pregnant women

Opioids: Treatment rates high for pregnant women

A new report from the Centers for Disease Control and Prevention said more than 48 out of every 1,000 women who come into a hospital to give birth in Vermont has opioids in their system.

The study, “Opioid Use Disorder Documented at Delivery Hospitalization” collected data from 28 states from 1999 to 2014, during which national rates of opioid use disorder increased 333 percent.

The study also showed Maine, New Mexico, West Virginia and Vermont showed the highest average annual rate increases ranging from 2.5 to 5.4 opioid-use disorder diagnoses for every 1,000 delivery hospitalizations every year.

Vermont’s rate of 48.6 women with opioid diagnoses per 1,000 arriving at hospitals for childbirth was the highest of the 28 states studied.

“If someone is opiate dependent, you will have symptoms of withdrawal if you don’t have it,” Craig said.

This differs drastically from someone who is exposed to opiates, which may, and often does indicate, that the mother has already started treatment for opioid addiction, Craig said.

Which does not necessarily mean the infant is born opioid dependent.

It may be an indication of a bright future.

“We know from the work we’ve done in Vermont, four out of five of those infants were born to women in treatment,” said Vermont Health Commissioner Mark Levine. “A lot of the newborns are discharged very quickly with few mild symptoms, which is testimony to the fact that their mothers are in treatment. We make sure our system of care for those newborns is as attentive as it needs to be.”

A study titled “Neonates Exposed to Opioids in Vermont” released in April 2017 said the number of infants diagnosed as being “exposed to opioids,” then labeled as having neonatal abstinence syndrome, increased from 2008 to 2015.

But that number began to plateau in 2013.

The study indicated that in 2012, the national average length of stay for an infant diagnosed with neonatal abstinence syndrome, orNAS, was 16.5 days, where in Vermont, the average stay was 7.4 days.

Which means more infants are being diagnosed, but having to stay for shorter periods of time.

Early intervention

Ben Truman, public health communication officer for the Vermont Department of Health, said the most recent numbers collected show signs that Vermont is on the road to recovery.

“For 2016, that figure dropped approximately 17 percent to 28.3 per 1,000 live births,” Truman said. “Back to near 2011 level.”

Levine said the high numbers in the CDC report reflect a treatment system that’s becoming more successful as women are screened and taken in for treatment for opiate addiction before their children are born with NAS.

“The fact that we have 48 out of every 1,000 births means the OB/GYN community are screening the women appropriately,” Levine said. “We’re getting those mothers into treatment. By the time those babies are born, we know (the mothers) had an opiate abuse disorder, and they may already be on treatment.”

As pregnant women come in for their appointments with their primary care professional, Levine said, they are routinely screened using SBIRT — Screening, Brief, Intervention, Referral to Treatment.

“It identifies risky behaviors, allows for intervention then and there,” Levine said. “We’re making sure we’ve identified all women at risk, and most women are pretty honest. Most people are very interested in helping their baby, so they start the process of treating her while pregnant. We know that process leads to better outcomes.”

The treatment usually involves buprenorphine, a partial agonist opioid that has a less maximal effect than a full agonist, like methadone or heroin, which have stronger and longer-lasting effects, according to the Substance Abuse and Mental Health Services Association.

As medically assisted therapy continues, the drug is administered in higher and higher doses, until the opiate effects level off at moderate doses which creates what is called a “ceiling effect,” lessening the chances of misuse, dependency and side effects, SAMHA said.

Levine said the drug is completely safe to use on pregnant women.

“It has no dangerous effects to the child,” Levine said. “Most of these kids do fine. It’s so treatable. And they’re in a hospital already at the time they’re identified. The prognosis for the kids is wonderful. It’s serious, but it’s certainly not something that’s going to potentially harm them long term.”

Craig said nationally, 20 percent of all children born with neonatal abstinence syndrome have to be treated for their symptoms, which can include irritability, difficulty feeding, tremors, sleeping problems, and seizures.

At RRMC, however, that number is 12 percent, where Craig said the goal is to keep the child and the mother together while both are undergoing treatment.

“We watch them for a full five days, and we make sure they’re feeding well and staying in their rooms,” Craig said. “If you can keep them with close contact, they’re less likely to show symptoms. We treat with small amounts of morphine at regular intervals. Once symptoms are alleviated, we start decreasing the dose, and babies are out of the hospital within 10-15 days.”

Craig said even if the mother in treatment is breastfeeding, there’s no risk of harm to the child.

“Breast milk is very protective,” Craig said. “It’s safe to use if the mother is taking prescribed doses of opiates.”

 

The bigger picture

One hundred and one Vermonters died of overdoses last year, Levine said, and the national death toll continues to climb.

Because the experts say the battle to save is a decades-long war cloaking its victims in shame and isolation.

“The crisis has been going on a long time,” Levine said. “The government is late. You need time for the programs to be set up and it takes time to have effect, because the nature of addiction is so strong. Most of the programs for prevention take a number of years to work and are just beginning to get funded.”

Levine said it was the worst possible scenario that opened the door to more funding.

“The real game-changer, is that so many people have died of overdoses,” he said. “Overdose death has exceeded car accidents, HIV … it’s a stark reality that we’re facing. We’re talking 40-50,000 deaths in a year nation-wide.”

Craig said when she was going through nursing school in the late ’70s and early ’80s, the only reason any narcotics were sent home with a patient was if they had a terminal cancer diagnosis.

But then in the mid-’80s, Craig said hospitals started discharging patients with narcotics.

“We were originally motivated by the idea that people can recover better at home,” Craig said. “We were sending people home with way too much medication compared to what they’d get in the hospital.”

Craig said she remembers how, at that time, pharmaceutical companies representatives used to be able to come into hospitals, buy staff members meals, and pitch a “great new product.”

Which put narcotics directly into the hands of everyday people who had no idea how dangerous the substances could be.

“We’re seeing the results in our culture now,” Craig said. “Then the narcotics were in the community. It wasn’t just heroin — it was the medicine prescribed. Heroin is a cheaper way for people addicted to prescription opioids to get the product.”

One of the first steps to combating the opioid crisis, she said, is understanding the disease of addiction and how it isolates it’s victims, keeping them from the health care they need.

“We have to take the blame away from the addicted person in order to bring them into care,” Craig said. “They’re already so full of self-loathing, that they can’t look at themselves straight-faced.”

kate.barcellos@rutlandherald.com