Transcript Neonatal Abstinence Syndrome

Epidemic Spreading
Across
the Nation
Erica Wilson M.P.H.
Community Services Director
Tennessee Department of Health
East Region
(No Financial Disclosures)
Neonatal
Abstinence
Syndrome
What is it?
Neonatal abstinence
syndrome (NAS) is a term
for a group of problems a
baby experiences when
withdrawing from exposure
to narcotics.
What Causes It?
Almost every drug
passes from the
mother's blood stream
through the placenta to
the fetus. Illicit
substances that cause
drug dependence and
addiction in the mother
also cause the fetus to
become addicted.
What Happens to the Baby?
At birth, the baby’s
dependence on the
substance continues.
However, since the drug
is no longer available,
the baby’s central
nervous system
becomes overstimulated
causing the symptoms
of withdrawal.
http://youtu.be/2eP5EnFSG0c
What’s the
Incidence of
Neonatal
Abstinence
Syndrome?
• 626 cases in Tennessee as of 8/30/14
compared to 564 at same point in 2013
• Increase of 11%
Maternal County of
Residence by Region
October 25, 2014
# Cases
% Cases
Davidson
40
5.1
East
217
27.7
Hamilton
12
1.5
Jackson/Madison
2
0.3
Knox
80
10.2
Mid-Cumberland
69
8.8
North East
113
14.4
Shelby
32
4.1
South Central
26
3.3
South East
19
2.4
Sullivan
63
8.1
Upper Cumberland
88
11.2
West
22
2.8
Total
783
100.0%
• Exposure source trends in East TN vary from those
seen in all cases state-wide
Types of Prescription Only Exposures, NAS Cases,
East TN Region, Jan. 1 - Aug 30., 2014
4%
Replacement Therapy
16%
Pain Therapy
Psychiatric/Neurologic
Therapy
80%
Reported Cases of NAS, by County, East TN Region,
Jan. 1 - Aug. 30, 2014
45
42
40
35
Number of Cases
30
25
24
20
20
16
15
12
10
5
6
14
14
7
5
5
5
3
4
2
0
County
Highest rates based on
provisional county birth
estimates
Why is
Neonatal
Abstinence
Syndrome a
Concern?
The Baby
• Tragedy and suffering
of the babies and their
caregivers.
• With increased
likelihood of foster
care, families are torn
apart.
The Cost
• According to current
statistics in Tennessee, the
TennCare costs for a healthy
newborn were $4,237
compared to an average
cost of $66,973 for an infant
born dependent on drugs,
diagnosed with NAS.
The Future
• There may be other
economic, psychological
and physiological costs
associated with their
medical condition at birth
since it is not yet known
what challenges and
needs these infants will
have as they grow older.
What can we do in Public Health ?
• NAS became a reportable condition in TN on
January 1, 2013
• NAS Taskforce was formed July 11, 2013 –
Collaborative effort with East Region and Knox
• NAS/PPI Sub-committee was formed on
September 5, 2013
Primary Prevention
Initiative
LARC Pilot Project
East Region
The Process
• Collaboration
– Sheriff/Jail Administrator/Jail Nurse
• Education
– Partners (Pamphlet)
– Participants (PowerPoint and Pamphlet)
• Referrals (Referral/Follow-Up Form)
• Clinical Services
• Data Collection (Referral/Follow-Up Form)
High-Risk
Population
Outreach
NAS
Education
Session
Referral to
HD
Clinical Exam
at HD
Contraceptive
Placement
Pregnancy
Prevention in
Population at
High Risk for
NAS Child
Jail Settings
• 1/14/14 – first education session at Cocke County
• As of 10/29/14, 10 sessions have been held for a
total of 197 persons educated
– Cocke County Jail: 3 sessions, 49 participants
– Jefferson County Jail: 1 session, 40 participants
– Sevier County Jail: 6 sessions, 108 participants
• Anticipated referrals of the 197 = 99 (50.0%)
Referral Outcomes
• Of the 197 educated, 63 (32%) completed referral
to Cocke, Sevier, or Jefferson County HD
• Difference from number of anticipated referrals
(99) likely due to lag time between session and first
exam
• Females ranging in age 20 – 45 (avg. age: 27)
• Predominately non-Hispanic white
• Mostly residents of Sevier and Cocke County,
but a few from other areas:
County
Cocke
Davidson
Jefferson
Knox
Sevier
Out-of-State
Total
No.
14
1
1
1
24
2
43
Percent
32.6%
2.3%
2.3%
2.3%
55.8%
4.7%
100.0%
Patient History
Method of Birth Control
Contraceptive Placement
• 54/63 patients (85.7%)
received some form of
contraceptive
• Of the 9 that did not, 7 had
been released or
transferred before
placement could occur
• One patient was provided a
3 mos. supply of COCs
• One patient refused all
methods offered
(N = 54)
• Education levels
FOR HEALTH DEPARTMENT STAFF USE ONLY
CLERICAL
• Specific drug use
history including
during pregnancy
2. Is the client currently incarcerated for drug-related issues?
Yes No
4. Highest level of education completed:
Some Middle School
HS Diploma/GED
Some HS
Some College
Associates
Bachelors
Professional Degree
5. Is the client an established Health Department FP patient? Yes No
If Yes, list date of last visit: _______________ If last visit was >1 year ago, what was the reason?
Problem getting appt
Appt with another provider
Other (specify):__________________
Problem with BC method
Not important
6. Has the client ever had child(ren) previously or currently in State custody?
Yes No Refused to answer
7. Has the client ever had child(ren) born drug-dependent?
Yes No Refused to answer
If yes, how many?___________________
1. Has the client ever used prescription/non-prescription drugs?
If yes, which drugs? (check all that apply)
Marijuana
Meth/Methamphetamines
Cocaine/Crack/Coke
Ecstasy/E/Ex
Heroin
Oxy/Oxycontin
CLINICAL
• History of
unplanned
pregnancy
Yes No
3. For inmates, please verify the address listed above to determine if it is the facility address.
If it is, please also ask the client for their address prior to incarceration:
City:____________________ County:___________________ State:_________ Zip:____________
• FP barriers
– 28% of referrals were
previous FP patients
1. Was the client referred as a condition of probation/parole?
Yes
No
Refused to answer
Other (specify) ____________
2. Has the client ever used drugs during a pregnancy? Yes No Refused to answer Never pregnant
If yes, which drugs? (check all that apply)
Marijuana
Meth/Methamphetamines
Other (specify) ____________
Cocaine/Crack/Coke
Ecstasy/E/Ex
Heroin
Oxy/Oxycontin
3. Has the client ever had an unplanned pregnancy?
Yes
No
Refused to answer
Never pregnant
4. Is the client currently taking medications for chronic pain?
Yes
No
5. Is the client currently taking medications for anxiety?
Yes
No
6. What type of birth control is the client currently using?
Condoms
IUD
Other (specify)_______________________________
Pills
Nexplanon
None
Tennessee House Bill 1295
As enacted, provides that
a woman may be
prosecuted for assault for
the illegal use of a
narcotic drug while
pregnant, if her child is
born addicted to or
harmed by the narcotic
drug.
Long Acting Reversible
Contraceptives
The
“YOU CAN’T FORGET ME”
Methods
IUD
Effectiveness
Over 99 per cent
effective. Less than
two women in 100 will
get pregnant over five
years. Older IUDs
have less copper and
are less effective.
IUD
How it works
A small plastic and copper device is put into
the uterus. It stops sperm reaching an egg,
and may also stop a fertilized egg implanting
in the uterus.
How long it lasts
Can stay in 5–10 years depending on type but
can be taken out sooner.
IUD
How it affects periods
Your periods may be heavier or longer or
more painful.
How it affects fertility
When the IUD is removed your fertility will
return to normal.
IUD
How it is inserted/removed
A doctor or nurse practitioner will insert the
IUD. This takes 15–20 minutes. It can be
uncomfortable or painful and you may want to
use a local anesthetic. A doctor or nurse can
remove the IUD in a simple office visit.
IUD
Effectiveness
Over 99 per cent
effective. Less than
one woman in 100 will
get pregnant over five
years.
Mirena IUD
How it works
A small, T-shaped plastic device, which releases
the hormone progestin, is put into the uterus.
This thins the lining of the uterus to prevent a
fertilized egg implanting, thickens cervical mucus
to prevent sperm reaching an egg, and may stop
ovulation.
How long it lasts
Works for five years but can be taken out sooner.
Mirena IUD
How it affects periods
Your periods usually become lighter, shorter
and sometimes less painful. They may stop
altogether.
How it affects fertility
When the IUD is removed your fertility will
return to normal.
Mirena IUD
How it is inserted/removed
A doctor or nurse practitioner will insert the
IUD. This takes 15–20 minutes. It can be
uncomfortable or painful and you may want to
use a local anesthetic. A doctor or nurse can
remove the IUD in a simple office visit.
Implants
Effectiveness
Over 99 per cent
effective. Less than
one woman in 1,000
will get pregnant
over three years.
Implants
How it works
A small flexible rod is put under the skin of the
upper arm. It releases the hormone progestin. It
stops ovulation, thickens cervical mucus to stop
sperm reaching an egg, and thins the lining of the
uterus (womb) to prevent a fertilized egg
implanting.
How long it lasts
Works for three years but can be taken out sooner.
Implants
How it affects periods
Your periods may stop, be irregular or longer.
How it affects fertility
When the implant is removed your fertility will
return to normal.
Implants
How it is inserted/removed
A doctor or nurse practitioner numbs your skin
in the inner area of your upper arm with a
local anesthetic and inserts the implant. It
takes a few minutes and feels similar to
having an injection. To remove it, the doctor
or nurse uses a local anesthetic, makes a tiny
cut and gently pulls the implant out.
•
What if the LARC
can’t be placed
before my release?
Injection
Effectiveness
Over 99 per cent
effective. Less than
four women in 1,000
will get pregnant over
two years.
Injection
How it works
It releases the hormone progestin which stops
ovulation, thickens cervical mucus to prevent
sperm reaching an egg and thins the lining of
the uterus to prevent a fertilized egg
implanting.
How long it lasts
Lasts for 12 weeks.
Injection
How it affects periods
Your periods may stop, be irregular or longer.
How it affects fertility
Your periods and fertility may take time to
return after you stop using the injection.
Injection
How it is inserted/removed
The hormone is injected into a muscle, usually
in your buttocks. It can also be injected into
the arm. The injection cannot be removed
from the body so any side effects may
continue for as long as it works and for some
time afterwards.
Cost Savings
• Preventing the birth of one drug dependent
infant saves an average cost of $66,973.
• Preventing the birth of one drug dependent
infant in each of the counties in the East Region
would be a cost savings of $1,004,595.
• Preventing the birth of one drug dependent
infant in each of the counties in Tennessee
would be a cost savings of $6,362,435.
Questions
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Erica Wilson M.P.H.
Community Services Director
East TN Regional Health Office
[email protected]
(865) 909-9404 Ext. 103
Cell – (865) 337-4125