Opioid addiction treatment for mothers and babies
Mental Health Matters
When in Rome do as the Romans do,” or so the saying goes. Well, I’m visiting Boston at the moment, and Boston is arguably the worlds medical mecca. While there are excellent medical facilities throughout the developed world there is really no other place with the same concentration of world class medical care and innovative care systems.
Which brought me to a talk sponsored by the Boston University Medical Center (BMC) about pregnant addicted mothers and Neonatal (or newborn) Abstinence Syndrome (NAS).
BMC is a publicly funded hospital supported by federal subsidies, state money, and large philanthropic donations.
News headlines these days regularly report stories about record high opioid related deaths which have quadrupled in the past decade. There are now more opioid related deaths than deaths due to automobile accidents. And there are now more heroin overdose deaths than deaths from other opioids.
Over the last dozen or so years the largest increase in heroin usage occurred in women. Less well known is the more or less silent epidemic of heroin usage in pregnant women.
The incidence of heroin use in pregnant women has more than tripled; histories of emotional trauma and mental illness are particularly prevalent in this population. Opioid Use Disorder (OUD) now occurs at a frequency of 5.6 per 1,000 births in the United States. And only 10% of people with OUD get any treatment.
Some 85% of pregnancies in women with OUD are unintended. What to do?
In 2014 Tennessee became the first state to specifically criminalize illicit drug use during pregnancy. Eighteen states now consider substance abuse during pregnancy to be a form of child abuse subject to legal sanctions and eighteen states now require health-care professionals to report suspected prenatal use of illicit substances.
So, opioid use disorders are rising at an alarming rate, particularly in women of childbearing age. And these women, already stigmatized because of their drug use, are less likely to seek care during pregnancy because of their fear of legal consequences. This, in turn, produces dramatically escalating costs, both social and economic, for the mothers and their infant children, and for the rest of us.
Enter a fact based innovative care program at Boston Medical Center for addicted pregnant mothers.
First, some numbers. In Massachusetts 2% of all infants are born addicted; the length of hospital stay for each such newborn is some 22 days at a cost of $93,000 per baby. These addicted newborns are usually treated with medications for Neonatal Abstinence Syndrome, the withdrawal syndrome seen in neonates of addicted mothers. Moreover, NAS accounts for 3% of all admissions to Neonatal Intensive Care Units.
The new, research based care program, called Project Respect, includes addiction expertise, mental health and social services care and works as follows: First, at admission addicted pregnant mothers are transitioned from heroin to methadone. Then, after birth, the baby stays with the mother for 100% of their hospitalization in a newly designated unit. This group is then compared with the usual treatment program in which mothers are discharged after birth and visit their in hospital infants who are treated for opioid withdrawal.
When mothers were with their infants 100% of the time, theoretically providing nurturance, and skin contact, the hospital stay was on average 9 days shorter, and babies required 8 fewer days of opioid withdrawal therapy. Financial savings were tens of thousands of dollars per childbirth, translated into millions of dollars per year.
It is concluded that by providing humane, warmly supportive medical care to addicted pregnant women and nurturing, high touch care to their addicted newborns that care is more efficient, more effective, and likely to lead to fewer long term negative health consequences for both mother and child. And conversely, that criminalizing the behavior of addicted pregnant women negatively impacts the mother and the baby.
Are there implications for treatment of the adult addict population? You bet. They include, 1-Provide Medication Assisted Treatment (MAT) on demand. 2-Coordinate MAT with supportive outpatient care, individual and group therapies, retraining or vocational services and day care for the more severely impacted.
Virtually every reputable research study concludes that behavioral disorders are best treated with a combination of medication and supportive services. Addiction treatment is no different.
So, maybe cutting the budget of the world’s leading medical research institute, The National Institutes of Health, is not a good idea. After all, funding medical research in patient care delivery has a huge potential financial payoff by developing more efficient and effective delivery systems.
Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. He can be reached for comment at firstname.lastname@example.org.
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