Opioid use in pregnancy poses additional dangers news timeswv.com antiemetic tablets

Data from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that substance use exposure was 5.9 percent in the state in 2013, meaning it affected about 60 infants for every 1,000 births, Leonard said. The assistant professor of obstetrics and gynecology at the WVU School of Medicine added that the data also shows neonatal abstinence syndrome (NAS) was prevalent in 3.3 percent of births in the state.

Leonard is well-versed in issues with opioid use in pregnancy, as she is currently the principal investigator on the statewide Drug-Free Mom and Baby Project. In refuting the statistics provided by SAMHSA, she presented additional information about rates of substance abuse in pregnancy and NAS.

About eight or nine years ago, when hospitals in the state saw there were several pregnant women with a substance abuse problem, and neonatal withdrawal was on the rise, Leonard said eight hospitals in the state, including West Virginia University, did an umbilical cord study.

For about four months, they collected segments of cord from every newborn delivered in those hospitals, and then had them tested for illicit substances and alcohol.

“That showed that actually the rate was more like 19 percent during that time, or one-third of babies born in West Virginia at those eight hospitals were exposed to drugs or alcohol,” Leonard said, adding that the most-common substance identified was THC or marijuana, followed by opioids.

Through this partnership, it was discovered that many hospitals weren’t coding or weren’t coding correctly for NAS or substance use in pregnancy, she said, adding that some people also weren’t diagnosing NAS correctly. So the partnership trained doctors and nursing staff to know what the definition of NAS was. They also devised a program to have nurses put in data on infants at the time of birth, including information like if the mother is using an illicit substance, is in a treatment program, or is a smoker, Leonard said. This information began being put in a database in October 2016, so while Leonard said it’s brand-new, it will be very useful information.

“What we found was that the intrauterine substance exposure for all women in West Virginia according to our new data is actually more like 14 percent,” she said, adding that they still feel this number is underrated, but the most accurate number to-date. “The overall incidence of NAS in our state right now is 5.3 percent.”

Since the 1970s, methadone has been the treatment of choice, and many states use it, Leonard said; however, in West Virginia, buprenorphine or buprenorphine and naloxone are used instead, because they are covered by Medicaid. Methadone historically was not covered by Medicaid in the state, she said.

At the WVU hospital, babies exposed in-utero to opioids are kept for the first five days of their life, “whether they have meet the criteria of NAS or not, because they may not see the withdrawal symptoms for several days after delivery,” Leonard said.

Hospital costs are also typically higher for infants affected by NAS, as their hospital stays are several times longer than non-affected infants. Leonard said that the costs vary by the hospital, but at WVU, the average length of stay for a baby with NAS is seven to 18 days, and at $500 to $700 per day, the cost of hospitalization could be between $9,000-$12,600.

The goal for WVU’s program is: “develop, evaluate, document and replicate programs that support healthy baby outcomes by providing prevention, early intervention, treatment and recovery services for pregnant women and postpartum women with substance use disorders.”

Women are screened for substance use, Leonard said in describing WVU’s program, and if they screen positive, there is intervention and a referral for treatment that can include case management, counseling, peer recovery coaching, medication-assisted treatment, educational workshops, drugs screens and an incentive program for taking part.

WVU’s program has been renamed the ACE Project, Leonard said, and is designed for expectant mothers who need extra support and guidance in dealing with their substance abuse. It is offered for any patient of the hospital with a history of or current substance use, including tobacco. When they take part in the program, the women agree to drug screens, attending treatment center appointments and prenatal appointments, as well as meetings with a recovery coach.

WVU just started its program last month and has had 84 participants. Leonard said right now, 10 are pregnant, 17 are postpartum, and many haven’t followed up due to reasons like relapse, incarceration, moving to a higher level of care, moving out of the area, or just being out of contact.

Program participants have access to a recovery coach 24/7, she said, as well as additional educational and community resources. A patient liaison helps participants sign up for things like WIC, or refers them to other services, and they’re also assisted with applying and accessing resources available through the state.

“We also do our own monthly group meetings outside of the hospital,” Leonard said, adding that the women will meet at a local restaurant and often bring their kids. “We’ve had a lot of women that have said that this was the first time in a long time that they’d done something socially that didn’t involve drugs or alcohol and it felt really good to them to sit down with other pregnant women having the same problem and just kind of talk things out in a safe place.”

Data has been analyzed for the Drug-Free Mom and Baby programs at the four different sites, and Leonard said they’ve found the program is “reaching really high-risk, medically underserved women.” She added that there are high percentages of participants with low education, low income, and unplanned pregnancies.

From all four sites, 354 women completed the program: 194 joined during their first trimester, and of those, 80 percent tested positive in a urine drug screening for a drug other than what they were prescribed. There were 297 participating during their second trimester, and 48 percent of those tested positive for non-prescribed drugs in a drug screen. Third-trimester participants numbered 354, and of that amount, only 24 percent tested positive for non-prescribed drugs, with 21 percent of participants testing positive at the time of delivery.