Blog RSS https://www.vumc.org/childhealthpolicy/ en The lack of a national policy agenda for children during Covid-19 — and beyond — causes grave harm https://www.vumc.org/childhealthpolicy/news-events/lack-national-policy-agenda-children-during-covid-19-and-beyond-causes-grave-harm <span class="field field--name-title field--type-string field--label-hidden">The lack of a national policy agenda for children during Covid-19 — and beyond — causes grave harm</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/lettermc" typeof="schema:Person" property="schema:name" datatype="">lettermc</span></span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 08/31/2020 - 09:59</span> <a href="/childhealthpolicy/blog-post-rss/272" class="feed-icon" title="Subscribe to The lack of a national policy agenda for children during Covid-19 — and beyond — causes grave harm"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Stephen Patrick</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://www.statnews.com/2020/08/31/lack-national-policy-agenda-children-covid-19-harm/" target="_blank">https://www.statnews.com/2020/08/31/lack-national-policy-agenda-children-covid-19-harm/</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>As a neonatal intensivist, helping families and newborns in distress is part of my job. In the intensive care unit, the distress is obvious. Covid-19 is shining a light on distress in children and families that has been largely hidden.</p> <p>My colleagues and I recently published the results of the Vanderbilt Child Health Poll, <a href="https://pediatrics.aappublications.org/content/pediatrics/early/2020/07/22/peds.2020-016824.full.pdf" rel="noopener" target="_blank">a national survey</a> of more than 1,000 parents that was conducted in June 2020. We wondered how parents and children were coping with disruptions to their life because of Covid-19. We asked an array of questions ranging from how people’s mental health is faring to their use of nutritional support programs, such as the <a href="https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program" rel="noopener" target="_blank">Supplemental Nutrition Assistance Program</a> (SNAP).</p> <p>What we found unnerved me.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Mon, 31 Aug 2020 14:59:24 +0000 lettermc 272 at https://www.vumc.org/childhealthpolicy What Parents of Babies and Toddlers Need Right Now https://www.vumc.org/childhealthpolicy/news-events/what-parents-babies-and-toddlers-need-right-now <span class="field field--name-title field--type-string field--label-hidden">What Parents of Babies and Toddlers Need Right Now</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/lettermc" typeof="schema:Person" property="schema:name" datatype="">lettermc</span></span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 07/30/2020 - 14:58</span> <a href="/childhealthpolicy/blog-post-rss/253" class="feed-icon" title="Subscribe to What Parents of Babies and Toddlers Need Right Now"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Rahil D. Briggs</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://www.psychologytoday.com/za/blog/babies/202007/what-parents-babies-and-toddlers-need-right-now" target="_blank">https://www.psychologytoday.com/za/blog/babies/202007/what-parents-babies-and-toddlers-need-right-now</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>After months of various forms of quarantine and social distancing, families are stressed to the max. Those with babies and toddlers may be hurting the most due to younger children’s need for intensive caregiving. Moms, dads, and other caregivers are being asked to hold their fingers in the dam, and it’s threatening to burst.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Thu, 30 Jul 2020 19:58:17 +0000 lettermc 253 at https://www.vumc.org/childhealthpolicy Child care stress, hunger harming U.S. families during pandemic https://www.vumc.org/childhealthpolicy/news-events/child-care-stress-hunger-harming-us-families-during-pandemic <span class="field field--name-title field--type-string field--label-hidden">Child care stress, hunger harming U.S. families during pandemic</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/lettermc" typeof="schema:Person" property="schema:name" datatype="">lettermc</span></span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 07/29/2020 - 14:10</span> <a href="/childhealthpolicy/blog-post-rss/252" class="feed-icon" title="Subscribe to Child care stress, hunger harming U.S. families during pandemic"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Alan Mozes</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://www.upi.com/Health_News/2020/07/29/Child-care-stress-hunger-harming-US-families-during-pandemic/3961596028950/" target="_blank">https://www.upi.com/Health_News/2020/07/29/Child-care-stress-hunger-harming-US-families-during-pandemic/3961596028950/</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>With everyday life turned upside down, efforts to prevent the spread of <a href="https://www.upi.com/topic/COVID-19/" title="COVID-19">COVID-19</a> are taking a toll on the well-being and health of American families, a new poll reveals.</p> <p>More than 1,000 parents nationwide were surveyed in early June.</p> <p>"Without question, COVID-19 had a sudden and profound effect on families nationwide," said survey leader Dr. Stephen Patrick. He's director of the Center for Child Health Policy at Vanderbilt University School of Medicine in Nashville.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Wed, 29 Jul 2020 19:10:55 +0000 lettermc 252 at https://www.vumc.org/childhealthpolicy For-Profit Care Homes Are Deadlier. And More Science Journal News https://www.vumc.org/childhealthpolicy/news-events/profit-care-homes-are-deadlier-and-more-science-journal-news <span class="field field--name-title field--type-string field--label-hidden">For-Profit Care Homes Are Deadlier. And More Science Journal News</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/lettermc" typeof="schema:Person" property="schema:name" datatype="">lettermc</span></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 07/28/2020 - 15:03</span> <a href="/childhealthpolicy/blog-post-rss/254" class="feed-icon" title="Subscribe to For-Profit Care Homes Are Deadlier. And More Science Journal News"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Brian Owens</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://thetyee.ca/News/2020/07/28/Science-Journals-For-Profit-Care-Homes/" target="_blank">https://thetyee.ca/News/2020/07/28/Science-Journals-For-Profit-Care-Homes/</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Compiled by veteran medical journalist Brian Owens, this roundup of some of the newest science on the COVID-19 pandemic, straight from the scientific journals, is presented by Hakai Magazine in partnership with The Tyee.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Tue, 28 Jul 2020 20:03:55 +0000 lettermc 254 at https://www.vumc.org/childhealthpolicy Pandemic Takes Toll on Family Mental Health https://www.vumc.org/childhealthpolicy/news-events/pandemic-takes-toll-family-mental-health <span class="field field--name-title field--type-string field--label-hidden">Pandemic Takes Toll on Family Mental Health</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/lettermc" typeof="schema:Person" property="schema:name" datatype="">lettermc</span></span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 07/27/2020 - 15:12</span> <a href="/childhealthpolicy/blog-post-rss/256" class="feed-icon" title="Subscribe to Pandemic Takes Toll on Family Mental Health"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Elizabeth Hlavinka</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://www.medpagetoday.com/pediatrics/generalpediatrics/87775" target="_blank">https://www.medpagetoday.com/pediatrics/generalpediatrics/87775</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>As COVID-19 infections ravaged the country from March to June, parent and child well-being felt the ripple effects, according to a national survey.</p> <p>Among 1,011 parents who responded to the survey, 26.9% said their mental health had worsened, 14.3% said their children's behavioral health had declined, and 9.6% said both their mental health and their children's behavioral health had slumped, reported Stephen W. Patrick, MD, MPH, of the Vanderbilt Center for Child Health Policy in Nashville, and colleagues.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Mon, 27 Jul 2020 20:12:40 +0000 lettermc 256 at https://www.vumc.org/childhealthpolicy Vanderbilt Study Finds 1.5 Million More Kids Are Going Hungry Because Of The Pandemic https://www.vumc.org/childhealthpolicy/news-events/vanderbilt-study-finds-15-million-more-kids-are-going-hungry-because-pandemic <span class="field field--name-title field--type-string field--label-hidden">Vanderbilt Study Finds 1.5 Million More Kids Are Going Hungry Because Of The Pandemic</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/lettermc" typeof="schema:Person" property="schema:name" datatype="">lettermc</span></span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 07/27/2020 - 15:08</span> <a href="/childhealthpolicy/blog-post-rss/255" class="feed-icon" title="Subscribe to Vanderbilt Study Finds 1.5 Million More Kids Are Going Hungry Because Of The Pandemic"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Blake Farmer</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://www.wkyufm.org/post/vanderbilt-study-finds-15-million-more-kids-are-going-hungry-because-pandemic#stream/0" target="_blank">https://www.wkyufm.org/post/vanderbilt-study-finds-15-million-more-kids-are-going-hungry-because-pandemic#stream/0</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>The pandemic’s ripple effects have meant 1.5 million more kids are going hungry, according to a new study in the medical journal Pediatrics. The polling data puts numbers to a food insecurity problem that has been occurring out of sight.</p> <p>The study is based on national polling of parents with kids under 18. And roughly 2% said that since March, they have become unable to afford all the food they need.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Mon, 27 Jul 2020 20:08:42 +0000 lettermc 255 at https://www.vumc.org/childhealthpolicy CDC urge in-person learning, but offers little guidance for sick students or teachers https://www.vumc.org/childhealthpolicy/news-events/cdc-urge-person-learning-offers-little-guidance-sick-students-or-teachers <span class="field field--name-title field--type-string field--label-hidden">CDC urge in-person learning, but offers little guidance for sick students or teachers</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/lettermc" typeof="schema:Person" property="schema:name" datatype="">lettermc</span></span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 07/24/2020 - 15:20</span> <a href="/childhealthpolicy/blog-post-rss/258" class="feed-icon" title="Subscribe to CDC urge in-person learning, but offers little guidance for sick students or teachers"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Erika Edwards</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://www.nbcnews.com/health/health-news/cdc-urges-person-learning-little-guidance-sick-students-or-teachers-n1234805" target="_blank">https://www.nbcnews.com/health/health-news/cdc-urges-person-learning-little-guidance-sick-students-or-teachers-n1234805</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>The Centers for Disease Control and Prevention on Thursday released a long-awaited update to guidelines for getting children back into the classroom this fall, but it left many details of how to do so safely up to officials at the local level.</p> <p>"Let the individual jurisdictions see how the different strategies that we've put out can be best employed," Dr. Robert Redfield, director of the CDC, said during a call with reporters Friday.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Fri, 24 Jul 2020 20:20:28 +0000 lettermc 258 at https://www.vumc.org/childhealthpolicy CDC urges in-person learning, but offers little guidance for sick students or teachers https://www.vumc.org/childhealthpolicy/news-events/cdc-urges-person-learning-offers-little-guidance-sick-students-or-teachers <span class="field field--name-title field--type-string field--label-hidden">CDC urges in-person learning, but offers little guidance for sick students or teachers</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/lettermc" typeof="schema:Person" property="schema:name" datatype="">lettermc</span></span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 07/24/2020 - 15:17</span> <a href="/childhealthpolicy/blog-post-rss/257" class="feed-icon" title="Subscribe to CDC urges in-person learning, but offers little guidance for sick students or teachers"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Erika Edwards</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://www.msn.com/en-us/news/us/cdc-urges-in-person-learning-but-offers-little-guidance-for-sick-students-or-teachers/ar-BB179NLY?li=BBnba9O&amp;srcref=rss" target="_blank">https://www.msn.com/en-us/news/us/cdc-urges-in-person-learning-but-offers-little-guidance-for-sick-students-or-teachers/ar-BB179NLY?li=BBnba9O&amp;srcref=rss</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>The Centers for Disease Control and Prevention on Thursday released a long-awaited update to guidelines for getting children back into the classroom this fall, but it left many details of how to do so safely up to officials at the local level.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Fri, 24 Jul 2020 20:17:26 +0000 lettermc 257 at https://www.vumc.org/childhealthpolicy Study reveals inadequate Hepatitis C testing among Tennessee infants https://www.vumc.org/childhealthpolicy/news-events/study-reveals-inadequate-hepatitis-c-testing-among-tennessee-infants <span class="field field--name-title field--type-string field--label-hidden">Study reveals inadequate Hepatitis C testing among Tennessee infants</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/caseybc" typeof="schema:Person" property="schema:name" datatype="">caseybc</span></span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 02/26/2020 - 15:46</span> <a href="/childhealthpolicy/blog-post-rss/216" class="feed-icon" title="Subscribe to Study reveals inadequate Hepatitis C testing among Tennessee infants"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">VUMC Reporter</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://news.vumc.org/2020/02/14/study-finds-most-tennessee-infants-exposed-to-hepatitis-c-at-birth-are-not-later-tested-to-see-if-they-acquired-the-virus/" target="_blank">https://news.vumc.org/2020/02/14/study-finds-most-tennessee-infants-exposed-to-hepatitis-c-at-birth-are-not-later-tested-to-see-if-they-acquired-the-virus/</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>A recent study by researchers at Monroe Carell Jr. Children’s Hospital at Vanderbilt and the Vanderbilt Center for Child Health Policy found that in Tennessee, most infants exposed to hepatitis C virus at the time of birth are not tested later to see if they acquired the virus. Over the past few years, hepatitis C virus rates among pregnant women have grown substantially—likely a consequence of the country’s opioid crisis. The increase has largely gone unnoticed.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Wed, 26 Feb 2020 21:46:40 +0000 caseybc 216 at https://www.vumc.org/childhealthpolicy Mothers, Babies Overlooked in the Drug Crisis https://www.vumc.org/childhealthpolicy/news-events/mothers-babies-overlooked-drug-crisis <span class="field field--name-title field--type-string field--label-hidden">Mothers, Babies Overlooked in the Drug Crisis</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/lovellks" typeof="schema:Person" property="schema:name" datatype="">lovellks</span></span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 12/30/2019 - 11:09</span> <a href="/childhealthpolicy/blog-post-rss/192" class="feed-icon" title="Subscribe to Mothers, Babies Overlooked in the Drug Crisis"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Gaby Galvin</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://www.usnews.com/news/healthiest-communities/articles/2019-12-30/mothers-and-babies-often-overlooked-in-dealing-with-the-nations-drug-epidemic" target="_blank">https://www.usnews.com/news/healthiest-communities/articles/2019-12-30/mothers-and-babies-often-overlooked-in-dealing-with-the-nations-drug-epidemic</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>THE U.S. DRUG EPIDEMIC is evolving – and physicians say mothers and babies may be left behind in its latest wave.</p> <p>Pregnant women who are addicted to opioids often struggle to access treatment and services, and their challenges have received relatively little attention despite being a <a href="https://innovation.cms.gov/initiatives/maternal-opioid-misuse-model/" target="_blank"><u data-rte2-sanitize="underline">targeted group</u></a> in the nation's response to the opioid epidemic. Now, doctors say the emerging problem of <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2019.305412" target="_blank"><u data-rte2-sanitize="underline">polysubstance use</u></a> – when people use more than one type of drug, such as opioids and methamphetamine – is being overlooked among pregnant women, with unknown long-term consequences for mothers and babies alike.</p> <p>"We have put a lot of time and money and energy into opioids, which is awesome," says Dr. Katrina Mark, an OB-GYN and medical director of the University of Maryland Medical Center's women's health clinic. "But we really need to have a wider view and realize that a lot of these women with opioid use disorder have polysubstance use (issues), and even the ones who aren't using opioids are using other substances."</p> <p>West Virginia, for example, long considered an epicenter of the opioid crisis with one of the highest overdose death rates in the country, has been awarded <a href="https://www.hhs.gov/about/news/2019/09/04/state-opioid-response-grants-by-state.html" target="_blank"><u data-rte2-sanitize="underline">$70.7 million</u></a> in federal grants to combat the epidemic. Several hospitals have established separate neonatal intensive care units for babies suffering from opioid withdrawal, while in 2018, West Virginia became the first state-approved to authorize <a href="https://www.kff.org/report-section/opioid-use-disorder-among-medicaid-enrollees-snapshot-of-the-epidemic-and-state-responses-issue-brief/" target="_blank"><u data-rte2-sanitize="underline">centers that provide services</u></a> for these babies and their families <a href="http://wvmetronews.com/2018/02/13/wv-becomes-first-state-to-be-recognized-for-nas-treatment-centers/" target="_blank"><u data-rte2-sanitize="underline">through Medicaid</u></a>.</p> <p>In 2016, the state made it easier for hospitals to track opioid exposure among newborns. The following year, <a href="https://www.ncbi.nlm.nih.gov/pubmed/30287893" target="_blank"><u data-rte2-sanitize="underline">50.6 babies per 1,000 births</u></a> were born with neonatal abstinence syndrome, which occurs when an infant suffers opioid withdrawal as a result of the mother's use while pregnant, causing symptoms such as trembling, irritability and dehydration. Nationally, that rate was 7 per 1,000 in 2016, the most recent year for which data is available, according to the <a href="https://www.hcup-us.ahrq.gov/faststats/NASMap" target="_blank"><u data-rte2-sanitize="underline">Healthcare Cost and Utilization Project</u></a>.</p> <p>But now a new trend is apparent. After surging <a href="https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_12-508.pdf" target="_blank"><u data-rte2-sanitize="underline">in western states</u></a>, meth-related overdose deaths have been climbing in<b data-rte2-sanitize="bold"> </b>states <a href="https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm#data-tables" target="_blank"><u data-rte2-sanitize="underline">like West Virginia</u></a> in recent years, and it's unclear how mothers and babies have been affected.</p> <p>"I think opioids are the past, or are going to be soon, because there are so many treatment programs for them that I think we're trying to get a handle on it," says Dr. Stefan Maxwell, pediatrics chief at Charleston Area Medical Center's Women and Children's Hospital in West Virginia. "Meth seems to be more of a problem, and I'm concerned because I don't really know what that's going to lead to."</p> <p>In addition to opioids, West Virginia recently began tracking other substances babies were exposed to in utero, Maxwell says, but it will be six months to a year before that data is meaningful. Few other states, if any, have similar tracking tools, he says.</p> <p>Some data suggests the polysubstance abuse trend is occurring among mothers nationwide. Across the U.S. in 2018, 5.4% of pregnant women reported using any illegal drug in the last month, down from 8.5% in 2017, according to a federal health survey. That decrease – representing about 66,000 women – was driven in part by a 31.3% decline in the number of pregnant women who reported using opioids, from about 32,000 to 22,000. Yet pregnant women who said they had used meth doubled from 3,000 to 6,000.</p> <p>A <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2019.305412" target="_blank"><u data-rte2-sanitize="underline">survey of nearly 16,000 people</u></a> entering treatment for opioid use disorder between 2011 and 2018, meanwhile, showed an 85% uptick in the number of people who said they'd also used meth in the last month. More than 90% of people who used opioids had also used at least one other illegal drug.</p> <p>Adding to the concern is the fact that meth today, mostly imported from Mexico, is far more potent than two decades ago, experts say. Studies indicate women who use meth during pregnancy are more likely to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374990/" target="_blank"><u data-rte2-sanitize="underline">have infants</u></a> who are small for their gestational age and are born with low birth weight, but the stimulant's <a href="https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Methamphetamine-Abuse-in-Women-of-Reproductive-Age?IsMobileSet=false" target="_blank">long-term developmental effects</a> on babies are unclear. And when infants are born exposed to a mix of drugs, it's harder for providers to know what their risks are – and how to address them.</p> <p>"In the early newborn period, we can treat anything," says Maxwell, former chairman of the West Virginia Perinatal Partnership. "But the problem is, what happens when they are 5, 7, 9 years of age and going into school, and they've been exposed to these complex amounts of drugs in utero – how did that affect their developing brain?"</p> <p>Shifting drug use patterns are often first reflected in births, and pinning down the number of babies born exposed to specific substances could offer a fuller picture of the current status of the U.S. drug epidemic than the number of overdose deaths. That information gap means it's challenging for policymakers to allocate funding and develop programs to support these newborns and their families.</p> <p>"As we continually focus on the death side of (the drug epidemic), we don't understand the living side," says Dr. Daniel Ciccarone, a drug researcher and professor at the <a href="https://www.usnews.com/best-graduate-schools/top-medical-schools/university-of-california-san-francisco-04012"><u data-rte2-sanitize="underline">University of California-San Francisco School of Medicine.</u></a> "The living side of it – no matter how deadly the drug is – naturally is much bigger. It's the base of the pyramid."</p> <p>Policymakers are beginning to address the issue. The federal spending package finalized this month <a href="https://www.portman.senate.gov/newsroom/press-releases/final-fy-2020-funding-measure-includes-portmans-combating-meth-cocaine-act" target="_blank"><u data-rte2-sanitize="underline">includes legislation</u></a> that will allow states to use some of their billions in federal opioid funding to address the surge in meth and cocaine use, <a href="https://www.nytimes.com/2019/12/17/health/meth-deaths-opioids.html" target="_blank"><u data-rte2-sanitize="underline">The New York Times reported</u></a>.</p> <p>The Food and Drug Administration, meanwhile, recently <a href="https://www.fda.gov/news-events/fda-meetings-conferences-and-workshops/developing-novel-therapies-stimulant-use-disorder-12162019-12162019" target="_blank"><u data-rte2-sanitize="underline">held a conference</u></a> to discuss whether drugs could be developed to treat addiction to stimulants like cocaine and meth. Medication-assisted treatment – a combination of counseling and medication that blunts withdrawals – is the standard treatment for opioid addiction, and providers currently rely on behavioral therapies alone to treat other substance use disorders.</p> <p>"With opioids, you have medication-assisted treatment, which is great, and it works really well," Mark says. "It is effective, it is safe and we have good protocols for how to do that. But with a lot of the other drugs, like cocaine and methamphetamine, we don't have that, and so we're sort of lagging behind on exactly how to treat for those things."</p> <p>Addiction treatment for mothers is lagging in general. Just 19 states have drug treatment programs specifically for pregnant women, according to the <a href="https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy" target="_blank"><u data-rte2-sanitize="underline">Guttmacher Institute,</u></a> and it's not always accessible. Across West Virginia, Kentucky, North Carolina and Tennessee in 2017, opioid addiction treatment providers were less likely to take a new patient if she was pregnant, according to a <a href="https://www.ncbi.nlm.nih.gov/pubmed/29949454" target="_blank"><u data-rte2-sanitize="underline">Vanderbilt University study.</u></a></p> <p>Some opioid treatment programs, meanwhile, kick women out if they test positive for other substances, while stigma or fear of legal repercussions may also keep women from disclosing their drug use to providers. In 23 states, substance use during pregnancy is considered child abuse, according to Guttmacher.</p> <p>"I understand why those policies exist, but it also becomes a really big problem in that people that have polysubstance use can't find good treatment sometimes," Mark says.</p> <p>Screening women for drug use and helping them find accessible treatment early in – or before – pregnancy could help curb the number of babies born affected by substances like opioids or meth, Mark says. And Ciccarone notes that mothers and children should be one focus of a comprehensive plan to address the ever-shifting drug use patterns in the U.S.</p> <p>"All of a sudden, there's a small wave of affected babies, and, of course, that makes us concerned," Ciccarone says. "But it's part of the whole thing – that's why we call it a crisis because there's a lot of moving parts and a lot of places to be concerned about."</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Mon, 30 Dec 2019 17:09:20 +0000 lovellks 192 at https://www.vumc.org/childhealthpolicy Tennessee Receives Grant from Federal Government to Address Opioid Crisis https://www.vumc.org/childhealthpolicy/news-events/tennessee-receives-grant-federal-government-address-opioid-crisis <span class="field field--name-title field--type-string field--label-hidden">Tennessee Receives Grant from Federal Government to Address Opioid Crisis</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/lovellks" typeof="schema:Person" property="schema:name" datatype="">lovellks</span></span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 12/20/2019 - 11:59</span> <a href="/childhealthpolicy/blog-post-rss/193" class="feed-icon" title="Subscribe to Tennessee Receives Grant from Federal Government to Address Opioid Crisis"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">VUMC Reporter</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="http://news.vumc.org/2019/12/20/tennessee-receives-grant-from-federal-government-to-address-opioid-crisis/" target="_blank">http://news.vumc.org/2019/12/20/tennessee-receives-grant-from-federal-government-to-address-opioid-crisis/</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Nashville – The Centers for Medicare and Medicaid Services (CMS) <a href="https://nam05.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.cms.gov%2Fnewsroom%2Fpress-releases%2Fcms-awards-funding-combat-opioid-misuse-among-expectant-mothers-and-improve-care-children-impacted&amp;data=02%7C01%7Cholly.m.fletcher%40vumc.org%7C6236021ee1d1428452da08d784cffbfd%7Cef57503014244ed8b83c12c533d879ab%7C0%7C0%7C637123901131146292&amp;sdata=ZN%2FhrSEQaVefoMuKmfvZbDd4LxVWB1Sphi2dJkic2rU%3D&amp;reserved=0">announced today</a> that Tennessee is one of 10 states to receive the Maternal Opioid Misuse (MOM) Model grant.  The purpose of this Model is to assist states in combating the nation’s opioid crisis and address fragmentation in the care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder (OUD).</p> <p>The Division of TennCare will partner with Vanderbilt University Medical Center as part of the MOM program focusing on 26 rural and urban counties to improve the outcomes for women with opioid use disorder and their infants beginning in pregnancy and extending to one year postpartum.  This will include the coordination of clinical care and the integration of other services critical for health, well-being, and recovery can improve the quality of care and reduce costs for mothers and infants impacted by opioid use.</p> <p>“The Maternal Opioid Misuse Model grant from CMS is a tremendous opportunity to strengthen TennCare’s efforts against the opioid crisis,” said Victor Wu, MD, MPH, chief medical officer for the Division of TennCare. “TennCare has been working hard to tackle the opioid crisis in our state and we are deeply committed to providing high-quality clinical care, substance abuse treatment, and recovery services to pregnant women during and after their pregnancy. Partnering with Vanderbilt University through the CMS MOM program will give us even more options to be innovative, coordinated, and comprehensive in meeting the needs of our moms and infants impacted by the opioid epidemic.”</p> <figure id="attachment_286549"> </figure> <p>Through this partnership TennCare and Vanderbilt University Medical Center will work to engage women with opioid use disorder in treatment before and after pregnancy, maximize periods of maternal abstinence from illicit substances using evidence-based therapies, optimize the number of days an infant is with their biological mother by reducing infant hospital stays (birth, readmission, emergency department visits), and ensure connection to early intervention services for infants.  The grant amount is approximately $5.3 million for a five-year performance period beginning January 2020.</p> <p>“Nationwide, the opioid crisis continues to take a toll on pregnant women and their infants, but the systems to care for them are fragmented and inconsistent,” said Stephen Patrick, MD, MPH, MS, director of the Center for Child Health Policy and associate professor of Pediatrics and Health Policy at Vanderbilt University Medical Center. “We are thrilled to be partnering with TennCare, community and state partners to create a new model of care focused on the specific needs of pregnant women and infants that will extend beyond the hospital walls.”</p> <p>For additional information about the MOM Model, please visit: <a href="https://nam05.safelinks.protection.outlook.com/?url=https%3A%2F%2Finnovation.cms.gov%2Finitiatives%2Fmaternal-opioid-misuse-model%2F&amp;data=02%7C01%7Cholly.m.fletcher%40vumc.org%7C6236021ee1d1428452da08d784cffbfd%7Cef57503014244ed8b83c12c533d879ab%7C0%7C0%7C637123901131156284&amp;sdata=VP%2B23857Mq3Is%2BOwX9QLqGclgclkxOLPyqBaMQzXr%2FI%3D&amp;reserved=0">https://innovation.cms.gov/initiatives/maternal-opioid-misuse-model/</a>.</p> <p><strong>About TennCare</strong></p> <p><a href="https://nam05.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.tn.gov%2Ftenncare&amp;data=02%7C01%7Cholly.m.fletcher%40vumc.org%7C6236021ee1d1428452da08d784cffbfd%7Cef57503014244ed8b83c12c533d879ab%7C0%7C0%7C637123901131166278&amp;sdata=OOzVXTSUYXFC8RKkJBi8EPq6B%2Fxq7KTD8IoUjr%2BwB7k%3D&amp;reserved=0">TennCare</a> is the state of Tennessee’s Medicaid program which provides health insurance to approximately 1.4 million low-income Tennesseans including pregnant women, children, caretaker relatives of dependent children and older adults, and adults with disabilities.  With a satisfaction rating above 90 percent since 2009, TennCare provides health insurance, including long-term services and supports, through the use of managed care.</p> <p><strong>About Vanderbilt Center for Child Health Policy</strong></p> <p>The <u><a href="https://nam05.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.vumc.org%2Fchildhealthpolicy%2F&amp;data=02%7C01%7Cholly.m.fletcher%40vumc.org%7C6236021ee1d1428452da08d784cffbfd%7Cef57503014244ed8b83c12c533d879ab%7C0%7C0%7C637123901131166278&amp;sdata=WF7rAlvrMapCvCC8MU%2F1hJsOTEk7dbh7Oq5jDyFQNHg%3D&amp;reserved=0">Vanderbilt Center for Child Health Policy</a></u> strives to improve the well-being of children and families through research that transforms clinical care and public health policy. CCHP is a multidisciplinary Center comprised of teams with expertise in neonatology, pediatrics, obstetrics, health policy, biostatistics, economics, implementation science and public health from across Vanderbilt University and Medical Center. CCHP focuses on conducting and disseminating salient children’s health research, informing evidence-based policy, and building partnerships between clinicians, researchers, policymakers, and the public.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Fri, 20 Dec 2019 17:59:32 +0000 lovellks 193 at https://www.vumc.org/childhealthpolicy Opioid Litigation and Maternal-Child Health—Investing in the Future https://www.vumc.org/childhealthpolicy/news-events/opioid-litigation-and-maternal-child-health-investing-future <span class="field field--name-title field--type-string field--label-hidden">Opioid Litigation and Maternal-Child Health—Investing in the Future</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/lovellks" typeof="schema:Person" property="schema:name" datatype="">lovellks</span></span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 12/16/2019 - 12:02</span> <a href="/childhealthpolicy/blog-post-rss/194" class="feed-icon" title="Subscribe to Opioid Litigation and Maternal-Child Health—Investing in the Future"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Stephen W. Patrick, Corey S. Davis, Bradley D. Stein</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/2756331" target="_blank">https://jamanetwork.com/journals/jamapediatrics/article-abstract/2756331</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>In 2017, nearly 48 000 Americans died of opioid-related overdoses—a 6-fold increase since 1999.<sup><a data-tab-toggle=".tab-nav-references" href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/2756331#pvp190034r1">1</a></sup> The unprecedented increase in opioid-related harms is not limited to adults. The last 2 decades also saw surges in infants receiving diagnoses of neonatal opioid withdrawal syndrome<sup><a data-tab-toggle=".tab-nav-references" href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/2756331#pvp190034r2">2</a></sup> and foster care placements of young children because of parental substance misuse.<sup><a data-tab-toggle=".tab-nav-references" href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/2756331#pvp190034r3">3</a></sup> Numerous states and municipalities have recently sued opioid manufacturers and distributors, seeking to hold them accountable for lives lost and communities harmed by the crisis, including costs associated with infants receiving of diagnosis of neonatal opioid withdrawal syndrome. If these suits are successful, settlements and jury verdicts may stretch to hundreds of millions or even billions of dollars, ultimately resulting in one of the largest legal recoveries since the tobacco settlement in the 1990s. Unfortunately, most tobacco settlement funds have not funded tobacco cessation activities specifically or even public health initiatives generally.<sup><a data-tab-toggle=".tab-nav-references" href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/2756331#pvp190034r4">4</a></sup> It is essential that this mistake is not repeated and that funds from opioid litigation are equitably and responsibly allocated in a way that benefits those most affected and reduces the risk of future harm.</p> <p><a id="232653809"></a></p> <p>Mothers and Infants</p> <p><a id="232653810"></a></p> <p>While there is a substantial need to enhance efforts to prevent opioid misuse and increase harm reduction efforts for and treatment of individuals with opioid use disorder, the rise of the opioid crisis has also stressed an already fragmented and underfunded public system for maternal-child health, and many mothers and infants have fallen through the cracks. Recent federal efforts to improve opioid use disorder prevention and treatment are not commonly targeted to pregnant women and infants, and the few that are have limited scope or duration. For example, the US Substance Use Disorder Prevention That Promotes Opioid Recovery and Treatment for Patient and Communities Act included time-limited funding of $29 million for residential treatment programs for pregnant and postpartum women through 2023. Long-term structural investments beginning in pregnancy and extending through early childhood will pay societal dividends for generations to come. Settlements from the lawsuits filed against opioid manufacturers, distributors, and prescribers should preferentially invest in pregnant women and infants prenatally, at birth, and throughout the first year.</p> <p><a id="232653811"></a></p> <p>Prenatal</p> <p><a id="232653812"></a></p> <p>Connecting pregnant women with opioid use disorder to effective treatment is essential to reduce adverse pregnancy outcomes, including preterm birth and death. Most Americans with opioid use disorder, including pregnant women, do not receive evidence-based treatment. As the National Academies of Medicine recently highlighted,<sup><a data-tab-toggle=".tab-nav-references" href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/2756331#pvp190034r5">5</a></sup> for pregnant women, these benefits extend to the fetus. Compared with untreated opioid use disorder, women who receive medications for opioid use disorder are less likely to overdose and more likely to deliver at term and have higher-birth-weight infants. Despite these benefits, fewer than half of pregnant women participating in treatment programs receive medications for opioid use disorder.<sup><a data-tab-toggle=".tab-nav-references" href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/2756331#pvp190034r5">5</a></sup> Settlement dollars could be used to fund programs that connect pregnant women to treatment that offers medications for opioid use disorder, prenatal care, and wrap-around services. Programs should include a focus on training and incentivizing maternal community clinicians (eg, federally qualified health centers, family medicine physicians, and obstetricians) to prescribe buprenorphine and provide related supportive services. Focusing on federally qualified health centers and primary care clinicians, including nonphysician clinicians, could also mitigate disparities in access to treatment in rural communities where it is lacking most.</p> <p><a id="232653813"></a></p> <p>Birth</p> <p><a id="232653814"></a></p> <p>At birth, pregnant women and infants affected by the opioid crisis are faced with inconsistent care, and new mothers and infants are often separated by hospital transfer and care processes that place the infant in a neonatal intensive care unit. Recently, the Substance Abuse and Mental Health Administration released guidelines for the care of pregnant women and infants affected by the opioid crisis (<a href="https://store.samhsa.gov/system/files/sma18-5054.pdf">https://store.samhsa.gov/system/files/sma18-5054.pdf</a>), including effective screening for opioid use disorder, peripartum pain relief, and infant assessment; however, it is not clear if they are being followed. In addition, infants often do not need complex care in a neonatal intensive care unit and keeping new mothers with their infants likely improves breastfeeding and shortens length of hospital stay.<sup><a data-tab-toggle=".tab-nav-references" href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/2756331#pvp190034r6">6</a></sup> The challenge is particularly acute for women and infants affected by the crisis in rural communities,<sup><a data-tab-toggle=".tab-nav-references" href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/2756331#pvp190034r7">7</a></sup> which are often the hardest hit and have the fewest resources to support families struggling with opioid addiction. Lawsuit funds should target supporting care in local community hospitals, ensuring the consistency of care and support for hospitals and clinicians and social support for families, including fathers.</p> <p><a id="232653815"></a></p> <p>First Year</p> <p><a id="232653816"></a></p> <p>The immediate postpartum period is particularly high-risk for mothers with opioid use disorder and their families who face myriad challenges, including a heightened risk of relapse for mothers and developmental risks for infants. These risks are exacerbated by the lack of services and support focused on postpartum women and infants, as well problems accessing available services. Better coordinating posthospital care for the infant and mother, including ensuring enrollment in public systems, can help address these challenges. For example, many pregnant and parenting women who are eligible for assistance through the Women, Infants, and Children program are not enrolled, and while many infants exposed to opioids are eligible for early intervention services (eg, publicly funded developmental supports through the Program for Infants and Toddlers with Disabilities) to support healthy development, it remains unclear how frequently infants receive such services.</p> <p><a id="232653817"></a></p> <p>Continued maternal access to necessary health care for at least the first year of life is critical to ensure the infant has a healthy mother. Unfortunately, for some new mothers, even basic health insurance needs are unmet. For example, at 60 days post partum, Medicaid-enrolled women in non–Medicaid expansion states are at risk of losing health insurance coverage and, as a result, their access to opioid use disorder treatment and basic preventive health services, including contraception. States that have not expanded Medicaid could use settlement funds for such an expansion or to expand the pool of parenting women who are eligible for the program.</p> <p><a id="232653818"></a></p> <p>Further, our already overburdened child welfare system has struggled under an increased burden as the opioid crisis expanded. From 2011 to 2017, the number of infants in foster care grew by 10 000, mostly because of parental substance use. In West Virginia, more than 4% of the state’s infants are in the foster care system.<sup><a data-tab-toggle=".tab-nav-references" href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/2756331#pvp190034r3">3</a></sup> While the last several years have heralded unprecedented federal action to improve the child welfare system (eg, using state child welfare funding for prevention and connection to substance use treatment), states, local governments, and judges are struggling to implement these changes.<sup><a data-tab-toggle=".tab-nav-references" href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/2756331#pvp190034r3">3</a></sup> The changes, coupled with the influx of families, are a challenge for a system with a history of continual underfunding and staff turnover. Settlement dollars could target communities where child welfare systems have been disproportionately affected by the crisis to aid in implementing new federal laws, improve staff training and retention, and target training for family and drug court judges.</p> <p><a id="232653819"></a></p> <p>Conclusions</p> <p><a id="232653820"></a></p> <p>An effective community response to improve care for pregnant women and families affected by the opioid crisis will take a well-funded, coordinated effort. Funding should focus on immediate treatment needs as well as long-term strategies to improve the outcomes of those currently affected and should aim to reduce the number and severity of future effects. Doing so may be one of the best uses of opioid lawsuit funds, generating returns for affected individuals and communities for decades to come.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Mon, 16 Dec 2019 18:02:55 +0000 lovellks 194 at https://www.vumc.org/childhealthpolicy Many States Prosecute Pregnant Women for Drug Use. New Research Says That’s a Bad Idea. https://www.vumc.org/childhealthpolicy/news-events/many-states-prosecute-pregnant-women-drug-use-new-research-says-thats-bad-idea <span class="field field--name-title field--type-string field--label-hidden">Many States Prosecute Pregnant Women for Drug Use. New Research Says That’s a Bad Idea.</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/lovellks" typeof="schema:Person" property="schema:name" datatype="">lovellks</span></span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 12/05/2019 - 10:42</span> <a href="/childhealthpolicy/blog-post-rss/190" class="feed-icon" title="Subscribe to Many States Prosecute Pregnant Women for Drug Use. New Research Says That’s a Bad Idea."> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Emma Coleman</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://www.routefifty.com/health-human-services/2019/12/pregnant-women-drug-use/161701/" target="_blank">https://www.routefifty.com/health-human-services/2019/12/pregnant-women-drug-use/161701/</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p> </p> <h2>As the opioid epidemic surges, states have been cracking down on pregnant addicted women.</h2> <p>In November, a California woman who gave birth to a stillborn baby and admitted to using methamphetamine while she was pregnant was charged <a href="https://www.vox.com/identities/2019/11/8/20954980/stillbirth-miscarriage-murder-abortion-chelsea-becker-news" target="_blank">with murder</a>. The case touched a nerve, igniting a debate over whether mothers should be <a href="https://www.latimes.com/opinion/story/2019-11-21/meth-mother-stillbirth" target="_blank">held accountable</a> for their drug use or <a href="https://www.thecut.com/2019/11/woman-charged-with-murder-after-delivering-stillbirth.html" target="_blank">treated with compassion</a> for their addictions.</p> <p>California is one of the dozens of states with laws on the books that criminalize drug use during pregnancy, some of which have been passed in recent years in response to growing concerns about the opioid epidemic. Studies have found that the rate of children born with neonatal abstinence syndrome, a form of withdrawal, increased by <a href="https://www.drugabuse.gov/related-topics/trends-statistics/infographics/dramatic-increases-in-maternal-opioid-use-neonatal-abstinence-syndrome" target="_blank">more than 500%</a> between 2004 and 2014, and opioid overdoses have become a <a href="https://www.acog.org/-/media/Sections/MD/Public/MMRreport2015.pdf?dmc=1&amp;ts=20180807T2225153950" target="_blank">significant contributor</a> to <a href="https://insights.ovid.com/crossref?an=00006250-201612000-00006" target="_blank">maternal deaths</a> in some states.</p> <p>A <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2755304?utm_source=For_The_Media&amp;amp%3butm_medium=referral&amp;amp%3butm_campaign=ftm_links&amp;amp%3butm_term=111319" target="_blank">November study</a> published in the Journal of the American Medical Association tracked the rise of laws that criminalized taking drugs while pregnant, as well as classifying drug use during pregnancy as child abuse that could result in loss of custody rights or as grounds for a civil commitment. From 2000 to 2015, the number of states that implemented these policies rose from 12 to 25, while almost the same amount of states also began requiring health care professionals to report suspected drug abuse.  </p> <p>The study also tracked NAS rates in states that enacted what the study called “punitive policies” and those that did not, finding that the odds of a child being born with the syndrome were significantly higher in states that took the harsher approaches. The results suggested the women “are disengaging from the health care system in states where punitive policies regarding substance use during pregnancy have been enacted” and “missing key opportunities for interventions” due to fear of criminalization.</p> <p>Stephen Patrick, a professor of pediatrics and health policy at Vanderbilt University and an author of the report, said that their findings show that laws criminalizing drug use while pregnant or using addiction to terminate parental rights don’t work. “I think the question now is how we deal with the problem,” he said. “There isn’t one easy fix, and when state’s look for that, they end up with punitive policies.”</p> <p>For some lawmakers, taking a consequence-based approach seems like the only immediate option in the face of a crisis. In 2018, Kentucky <a href="https://apps.legislature.ky.gov/record/19rs/HB446.html" target="_blank">passed a law</a> that amended the state’s child welfare laws to include a consideration of parental drug use during pregnancy, following <a href="https://chfs.ky.gov/agencies/dph/dmch/Documents/DPHNASReport2016.pdf" target="_blank">reports</a> of the skyrocketing number of children in the state born with NAS—from just 46 babies in 2001, to 1,115 babies in 2016. </p> <p>Kentucky’s law, which is similar to <a href="https://theappeal.org/two-states-just-made-it-easier-to-take-babies-away-from-mothers-who-use-drugs-during-pregnancy-d6a6f426c6fe/" target="_blank">another passed</a> in Arizona that same year, requires the mother of a child born with NAS to enroll in drug treatment within 90 days and keep a regular schedule of postnatal care or else face termination of her parental rights. State Reps. David Meade and Joni Jenkins, the Republicans sponsors of the Kentucky measure, said that the “consequence” was intended to “encourage mothers to get help” with their addictions. “The epidemic of so many children being born straight into withdrawal from NAS is a growing plague on our society and cause for great alarm,” Meade and Jenkins <a href="https://www.kentucky.com/opinion/op-ed/article230373249.html" target="_blank">wrote in an op-ed</a>. “That is why we sought to incentivize parents to enter substance abuse treatment and recovery programs, in hopes that we can help save not only their children but their own lives as well.”</p> <p>In some jurisdictions, prosecutors are <a href="https://theappeal.org/montana-prosecutors-crackdown-on-pregnant-women-who-use-drugs-could-harm-women-s-health-7e81802a1105/" target="_blank">aggressively cracking down</a> on drug or alcohol use by women while pregnant. In one case, a prosecutor in Mississippi has used a state law that defines poisoning as child abuse to <a href="https://mississippitoday.org/2019/05/11/delivering-justice/" target="_blank">prosecute 20 cases</a> since 2015. </p> <p>Some prosecutors have said that their decisions <a href="https://drive.google.com/file/d/1nVAnWn-7R1K_lMnB0pjAVfHVSOanxldn/view" target="_blank">were influenced</a> by the life-altering effects of being born with NAS, a stance <a href="https://www.acog.org/-/media/Departments/Government-Relations-and-Outreach/NASToolkit.pdf" target="_blank">contested</a> by the American Congress of Obstetricians and Gynecologists. “The only time drug withdrawal is harmful is when it isn’t diagnosed immediately after birth,” Patrick said. It’s important that mothers are willing to tell medical professionals about drug use during pregnancy, he said, because problems arise when babies go home undiagnosed.</p> <aside> <p>The National Perinatal Association has cautioned against punitive mechanisms to encourage treatment, saying they can backfire, driving women to skip prenatal visits or have their baby outside a hospital. “The threats of discrimination, incarceration, loss of parental rights, and loss of personal autonomy are powerful deterrents to seeking appropriate prenatal care,” <a href="http://advocatesforpregnantwomen.org/Medical%20and%20Public%20Health%20Group%20Statements%20revised%20April%202018.pdf" target="_blank">reads a statement</a> from the group released in 2017. “Perinatal providers promote better practices when they adopt language, attitudes, and behaviors that reduce stigma and promote honest and open communication about perinatal substance use.”</p> </aside> <p>Several other organizations, including March of Dimes, Amnesty International, the American College of Obstetricians and Gynecologists, and the National Organization on Fetal Alcohol Syndrome have all similarly condemned legislation that may have a chilling effect on a pregnant mother’s willingness to seek out help. The American Medical Association, in their <a href="https://www.end-opioid-epidemic.org/recommendations-for-policymakers/#maternal" target="_blank">recommendations</a> for policymakers to end the opioid epidemic, said that “non-punitive public health approaches to treatment result in better outcomes for both moms and babies.”</p> <p>Patrick said making treatment more accessible should be the first step states take to get better outcomes. “There’s really been a focus on the supply side, and we’ve seen broad state approaches to deter opioid prescribing, but there hasn’t been a corresponding expansion of treatment,” he said. “We need to see more effective options, like methadone assisted treatment, particularly targeting pregnant women.”</p> <p>Some states have made strides in expanding treatment options. Texas, for example, has begun to <a href="https://hhs.texas.gov/services/mental-health-substance-use/adult-substance-use/pregnant-postpartum-intervention" target="_blank">offer health support</a> to pregnant and postpartum women with substance abuse issues, as well as providing access to <a href="https://hhs.texas.gov/services/mental-health-substance-use/adult-substance-use/adult-substance-use-women-children-residential-treatment" target="_blank">residential centers</a> where women and their new babies can receive treatment together.</p> <aside> <p>In Montana, state Sen. Diane Sands this year <a href="https://leg.mt.gov/bills/2019/billhtml/SB0289.htm" target="_blank">sponsored a new law</a> that provides pregnant women who seek addiction treatment protection from prosecution. “Being addicted is not a crime,” said Sands, a Democrat. “We wanted to send a clear message that if you come forward to ask for help, we’re not going to prosecute you or take away your child.”</p> </aside> <p>The bill passed unanimously in the Senate and overwhelmingly in the House, but Sands said she wasn’t surprised by the support, even though other states with Republican-controlled legislatures have tended to embrace more punitive approaches. Four years ago, the state launched a <a href="https://csgjusticecenter.org/jr/montana/media-clips/montana-launches-bipartisan-effort-to-review-criminal-justice-system/" target="_blank">bipartisan effort</a> to review the criminal justice system. The state has since also made efforts to reduce their rate of child removal to foster care, the <a href="https://chronicleofsocialchange.org/youth-services-insider/montana-with-second-highest-foster-care-rate-in-country-likely-delaying-on-family-first-act/33693" target="_blank">second-highest</a> in the nation, where <a href="https://www.youthdynamics.org/meths-impact-on-montanas-foster-care-system/" target="_blank">two-thirds of cases</a> are tied to drug abuse. “Our entire government has said we can’t go on like this. It’s not sustainable,” she said. “We had to come to grips with the reality of the numbers, and deal with the underlying causes of these overlapping problems.”</p> <p>Sands said the bill was meant to work in conjunction with other efforts to expand treatment options <a href="https://nbcmontana.com/news/local/new-health-program-supports-expectant-mothers-in-butte" target="_blank">across the state</a> to pregnant women and new moms with addictions. “We realized criminalization doesn’t help anyone,” Sands said. “Instead of charging more people, we need to divert them to treatment.”</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Thu, 05 Dec 2019 16:42:45 +0000 lovellks 190 at https://www.vumc.org/childhealthpolicy Project seeks to enhance opioid care for infants https://www.vumc.org/childhealthpolicy/news-events/project-seeks-enhance-opioid-care-infants <span class="field field--name-title field--type-string field--label-hidden">Project seeks to enhance opioid care for infants</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/lovellks" typeof="schema:Person" property="schema:name" datatype="">lovellks</span></span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 10/10/2019 - 11:03</span> <a href="/childhealthpolicy/blog-post-rss/191" class="feed-icon" title="Subscribe to Project seeks to enhance opioid care for infants"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Holly Fletcher</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="http://news.vumc.org/2019/10/10/project-seeks-to-enhance-opioid-care-for-infants/" target="_blank">http://news.vumc.org/2019/10/10/project-seeks-to-enhance-opioid-care-for-infants/</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>The number of opioid-exposed infants who were connected, along with their families, to outside resources upon discharge from the hospital surged in a recent six-month pilot.</p> <p>The initiative tracked the effect of a checklist designed to streamline and prioritize referrals among an infant’s hospital care team, according to a Vanderbilt University Medical Center study.</p> <p>Infants exposed to opioids and their families face a variety of obstacles and risks that can impede follow-up care, which is critical for long-term health and well-being.</p> <p>Team Hope, Vanderbilt’s hospital-wide initiative to improve the care of opioid-exposed infants, sought to standardize a protocol that would bridge infants’ families to outside resources.</p> <p>Before the checklist was implemented, 2.6% of infants had a fully completed pre-discharge bundle, which includes referrals to a primary care physician; early intervention services; an in-home nursing assessment and educational services; a development clinic if diagnosed with neonatal abstinence syndrome, and the gastroenterology or infectious disease clinic if exposed to hepatitis C virus.</p> <p>Six months after implementation of the checklist, 60.3% of qualified infants had completed the discharge bundle, according to a study published in a special issue of Hospital Pediatrics focused on newborns diagnosed with drug withdrawal after birth, also known as neonatal abstinence syndrome. The paper is one of three authored by members of the Vanderbilt Center for Child Health Policy in the issue.</p> <p>“The root of Team Hope’s mission is to change the paradigm from doctors directing care to helping families get what they need to be successful. In six months, we saw marked improvement in how well we were connecting these children to important resources,” said Travis Crook, MD, lead author.</p> <p>The pilot stemmed from Team Hope’s mission to improve the care of infants and families affected by opioid use by extending the opportunity for good health beyond the hospital walls, said Crook.</p> <p>Families face a variety of challenges ranging from substance use disorder and transportation to housing — all of which can complicate accessing care.</p> <p>The focus on completing a discharge checklist for every affected infant — a low-cost intervention — illustrates how coordination between a care team of physicians, social workers, nurses and patient advocates can bridge community resources.</p> <p>“Nationally, we know there are gaps in connecting families affected by the opioid crisis to services that could help them thrive,” said Stephen Patrick, MD, MPH, MS, director of the Vanderbilt Center for Child Health Policy and senior author.</p> <p>“At VUMC, we used a simple checklist, coupled with rigorous quality improvement methodology, to do a better job of connecting families to these important community resources. This work is one step forward in our journey to provide better care for our families.”</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Thu, 10 Oct 2019 16:03:30 +0000 lovellks 191 at https://www.vumc.org/childhealthpolicy Team Hope collects 35 pounds of medication at ‘Take Back Day’ event https://www.vumc.org/childhealthpolicy/news-events/team-hope-collects-35-pounds-medication-take-back-day-event <span class="field field--name-title field--type-string field--label-hidden">Team Hope collects 35 pounds of medication at ‘Take Back Day’ event</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/lovellks" typeof="schema:Person" property="schema:name" datatype="">lovellks</span></span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 05/13/2019 - 16:30</span> <a href="/childhealthpolicy/blog-post-rss/171" class="feed-icon" title="Subscribe to Team Hope collects 35 pounds of medication at ‘Take Back Day’ event"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Holly Fletcher</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="http://news.vumc.org/2019/05/09/team-hope-collects-35-pounds-of-medication-at-take-back-day-event/" target="_blank">http://news.vumc.org/2019/05/09/team-hope-collects-35-pounds-of-medication-at-take-back-day-event/</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>About 35 pounds of over-the-counter and prescription medication were collected on April 12 at a Drug Take Back event hosted by Team Hope, in collaboration with the Tennessee Poison Center and Vanderbilt University Police Department.</p> <p>Team Hope will host another take back event in October, continuing its initiative to provide a safe, convenient and responsible way of disposing of prescriptions, educate the public about medication abuse, and raise awareness about permanent collection boxes around campus.</p> <p>The collected medication was disposed of as part of the U.S. Drug Enforcement Administration’s National Drug Take Back Day on April 27.</p> <p>For more information, <a href="mailto:teamhope@vumc.org">contact Mary White, MPH, Coordinator of Team Hope</a>.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Mon, 13 May 2019 21:30:53 +0000 lovellks 171 at https://www.vumc.org/childhealthpolicy Opioid-dependent newborns in my West Virginia hometown point to a path out of drug crisis https://www.vumc.org/childhealthpolicy/news-events/opioid-dependent-newborns-my-west-virginia-hometown-point-path-out-drug-crisis <span class="field field--name-title field--type-string field--label-hidden">Opioid-dependent newborns in my West Virginia hometown point to a path out of drug crisis</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/lovellks" typeof="schema:Person" property="schema:name" datatype="">lovellks</span></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 03/05/2019 - 13:31</span> <a href="/childhealthpolicy/blog-post-rss/163" class="feed-icon" title="Subscribe to Opioid-dependent newborns in my West Virginia hometown point to a path out of drug crisis"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Stephen W. Patrick</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://www.usatoday.com/story/opinion/voices/2019/03/05/west-virginia-opioid-epidemic-infants-addiction-pregnancy-column/3054871002/" target="_blank">https://www.usatoday.com/story/opinion/voices/2019/03/05/west-virginia-opioid-epidemic-infants-addiction-pregnancy-column/3054871002/</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h3>Higher rates of newborn drug withdrawal shadowed communities experiencing economic decline. Solving the opioid crisis involves more than health care.</h3> <p>On a recent fall day, I became reacquainted with the unmistakable beauty of my West Virginia hometown. Bluefield is tucked in a valley with Big Walker Mountain setting its southeastern border, and nearly everywhere you look is breathtaking.</p> <p>On the surface, you might not expect to find a crisis brewing across America to be striking a rural town like Bluefield. But local economies are hurting, the opioid epidemic is growing, and together they are taking a toll on a surprising population — pregnant women and their babies.</p> <p>It doesn’t take much more than a stroll through downtown Bluefield or any number of Appalachian towns to see how the economic engine, once booming and driven by coal, has slowed. <a data-track-label="inline|intext|n/a" href="https://www.census.gov/quickfacts/fact/table/bluefieldcitywestvirginia/BZA115216">Bluefield’s population</a> today is just under 10,000, half of <a data-track-label="inline|intext|n/a" href="http://worldpopulationreview.com/us-cities/bluefield-wv-population/">what it was in 1950</a>.</p> <p>To me, those shuttered storefronts shed light on part of the opioid crisis.</p> <h3>Infants are casualties to our opioid epidemic</h3> <p>Even though my home state has been the undisputed epicenter of the opioid crisis, I was first introduced to it while working as a neonatologist in Michigan. I started seeing infants with opioid withdrawal, also called <a data-track-label="inline|intext|n/a" href="https://www.stanfordchildrens.org/en/topic/default?id=neonatal-abstinence-syndrome-90-P02387">neonatal abstinence syndrome</a>. Infants with the syndrome differ from most infants I care for who are born too early or with complex birth defects. While not nearly as sick, they are irritable, don’t sleep well, can have trouble eating, are jittery and do require medical care.</p> <p>My first reaction to treating infants with the syndrome was confusion and, if I’m honest, judgment. I wanted to understand what led so many women to use opioids during pregnancy.</p> <p>Neonatal abstinence syndrome can occur when babies are chronically exposed before birth to opioids, whether their mothers are using illegal drugs or prescribed medicines. Sometimes <a data-track-label="inline|intext|n/a" href="https://www.marchofdimes.org/pregnancy/prescription-opioids-during-pregnancy.aspx">mothers take an opioid like methadone</a> because it can be important to treating their addiction. These medicines also increase the likelihood their infants will be born at term.</p> <p>In studying the problem, it quickly became clear that the use of opioids by pregnant mothers could not be distilled down to their use at the time of delivery. Social and economic history needed to be taken into account.</p> <h3>West Virginia flooded with painkillers</h3> <p>There is no denying that <a data-track-label="inline|intext|n/a" href="https://www.nbcnews.com/news/us-news/dr-katherine-hoover-accused-fueling-west-virginia-s-opioid-crisis-n909366">overprescribing </a>is a culprit in West Virginia’s opioid crisis, beginning <a data-track-label="inline|intext|n/a" href="https://www.theguardian.com/society/ng-interactive/2016/may/25/opioid-epidemic-overdose-deaths-map">nearly 20 years ago</a>. At one point, McKesson Corp., a pharmaceutical distributor, <a data-track-label="inline|intext|n/a" href="https://www.wvgazettemail.com/news/health/drug-firm-poured-m-opioids-into-wv-town-in-just/article_d229b33b-c55a-5451-ab3f-b545476516d4.html">shipped more than 3 million pills</a> — almost 10,000 pills a day — over a 10-month period to Kermit, West Virginia, population 400. The combination of struggling rural economies with an overabundance of opioids was explosive. West Virginia’s <a data-track-label="inline|intext|n/a" href="http://www.govtech.com/em/disaster/Discharged-Dismissed-ERs-Often-Miss-Chance-to-set-Overdose-Survivors-on-Better-Path.html">overdose death rate is three times</a> the national average.</p> <aside itemprop="associatedMedia" itemscope="" itemtype="http://schema.org/ImageObject"><img alt="An infant, 10 days old, who was born addicted to Methadone. His mother had enrolled in a southern Indiana clinic to get clean from heroin. June 19, 2015." data-entity-type="" data-entity-uuid="" data-mycapture-sm-src="" data-mycapture-src="" itemprop="url" src="https://www.gannett-cdn.com/presto/2019/03/04/USAT/9f516380-d186-4c9b-9c6b-54b34f8a6ab4-a05_opioid_0822.JPG?width=540&amp;height=&amp;fit=bounds&amp;auto=webp" width="540" /> <p>An infant, 10 days old, who was born addicted to Methadone. His mother had enrolled in a southern Indiana clinic to get clean from heroin. June 19, 2015. (Photo: Alton Strupp, The Courier-Journal)</p> </aside> <p>The link between opioid prescriptions and overdose deaths is clear. The link between opioid prescriptions and my newborn patients was not. My colleagues and I initially focused our research on trying to understand the problem. We found that the number of Medicaid-covered infants diagnosed with neonatal abstinence syndrome had grown fivefold over <a data-track-label="inline|intext|n/a" href="https://www.ncbi.nlm.nih.gov/pubmed/29572288">the 10 years</a> from 2004 to 2014 — the rate was <a data-track-label="inline|intext|n/a" href="https://www.cnn.com/2016/12/12/health/heroin-opiates-babies-new-research/index.html">higher </a>in <a data-track-label="inline|intext|n/a" href="https://www.ncbi.nlm.nih.gov/pubmed/27942711">rural communities</a>. We explored links between <a data-track-label="inline|intext|n/a" href="https://www.ncbi.nlm.nih.gov/pubmed/25869370">women being prescribed opioids</a> in pregnancy and an infant’s risk of drug withdrawal. But as the opioid crisis evolved, this work increasingly seemed inadequate.</p> <p>At Vanderbilt University Medical Center we’ve taken care of more than 200 opioid-exposed infants in the last 18 months. When we take the time to truly listen to pregnant women using opioids, we uncover complicated narratives involving trauma and violence. It is clear that the opioid crisis was not just a health care problem. It is also a social problem, one that leads to newborns needing to be treated for drug withdrawal.</p> <p>Experiences in rural communities and conversations with families led our research group at the <a data-track-label="inline|intext|n/a" href="https://protect-us.mimecast.com/s/sI-XC5yw29hZAO3VktOvu-f?domain=protect2.fireeye.com">Vanderbilt Center for Child Health Policy</a> and the <a data-track-label="inline|intext|n/a" href="https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.rand.org%2Fhealth-care%2Fcenters%2Foptic.html&amp;data=02%7C01%7Cstephen.patrick%40vanderbilt.edu%7Cd7db8fa7385d41e9728708d68b85fc98%7Cba5a7f39e3be4ab3b45067fa80faecad%7C0%7C0%7C636849804923300432&amp;sdata=Pm3dTOB1ZGhwUAeZIDk8mVPS8Dcjfi8KaVEj70J%2BwYU%3D&amp;reserved=0">RAND Opioid Policy Tools and Information Center</a> to analyze the relationship between long-term economic downturns, particularly in rural communities, and higher rates of newborn drug withdrawal.</p> <h3>Opioid crisis is partly an economic crisis</h3> <p>From 2009 to 2015, we studied more than 6 million births in 580 counties across eight states, scrutinizing associations that included economic hardship and the county’s rate of neonatal abstinence syndrome.</p> <p>We found that higher rates of the syndrome shadowed an upward trend in long-term unemployment, particularly in remote, rural counties. Rural counties with the highest long-term unemployment rates had nearly five times the rate of prosperous metro counties, <a data-track-label="inline|intext|n/a" href="https://jamanetwork.com/journals/jama/article-abstract/2722771">according to our paper recently published</a> by the Journal of the American Medical Association.</p> <p>Bluefield is a good example of these findings. <a data-track-label="inline|intext|n/a" href="https://fred.stlouisfed.org/series/WVMERC0URN">The unemployment</a> rate in Mercer County, where Bluefield is located, is improving but has not fallen to where it was before the 2008 recession. Rates of neonatal abstinence syndrome are high. According to a state report, <a data-track-label="inline|intext|n/a" href="https://dhhr.wv.gov/bph/Documents/ODCP%20Reports%202017/NAS%20DATA%202017.pdf">nearly 3.5 percent</a> of infants born in Mercer County were diagnosed with drug withdrawal in 2017. That’s <a data-track-label="inline|intext|n/a" href="https://www.sciencedaily.com/releases/2018/03/180326110152.htm">more than four times</a> the national average.</p> <p>Of course, the medical interventions provided in hospitals and clinics are hugely beneficial in treating infants and their mothers affected by opioid use. But in listening to tales of life in small rural towns, we heard a need for a broader answer — one that addresses the need for economic development and social support that can help individuals in these communities lead healthier lives. </p> <p><em>Stephen Patrick is director of the Vanderbilt Center for Child Health Policy, attending neonatologist at Monroe Carell Jr. Children’s Hospital at Vanderbilt University and a research fellow with the RAND Opioid Policy Tools and Information Center.</em></p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Tue, 05 Mar 2019 19:31:42 +0000 lovellks 163 at https://www.vumc.org/childhealthpolicy Tennessee Issues First Maternal Mortality Report https://www.vumc.org/childhealthpolicy/news-events/tennessee-issues-first-maternal-mortality-report <span class="field field--name-title field--type-string field--label-hidden">Tennessee Issues First Maternal Mortality Report</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/lovellks" typeof="schema:Person" property="schema:name" datatype="">lovellks</span></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 02/19/2019 - 15:39</span> <a href="/childhealthpolicy/blog-post-rss/162" class="feed-icon" title="Subscribe to Tennessee Issues First Maternal Mortality Report"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">TN Department of Health</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://www.tn.gov/health/news/2019/2/19/tennessee-issues-first-maternal-mortality-report.html" target="_blank">https://www.tn.gov/health/news/2019/2/19/tennessee-issues-first-maternal-mortality-report.html</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>NASHVILLE – The Tennessee Department of Health today issued the first Maternal Mortality Review report, <em>Tennessee Maternal Mortality Review of 2017 Maternal Deaths</em>. This report describes the state of maternal mortality in Tennessee based on a comprehensive review of deaths of women who died while pregnant or within one year of pregnancy. The goal of this effort by the Tennessee Maternal Mortality Review Committee is to identify opportunities for preventing maternal deaths and promoting women’s health. The MMR committee determined 85 percent of all maternal deaths reviewed to be preventable.</p> <p>“We dedicate this report with deepest sympathy and respect to the memory of these women who died while pregnant or within a year of their pregnancies,” said TDH Commissioner Lisa Piercey, MD, MBA, FAAP. “We are grateful to the committee members who contributed to this report by reviewing information about these deaths and developing recommendations that can save lives.”</p> <p>The <em>Tennessee Maternal Mortality Review of 2017 Maternal Deaths</em> report is available online at <a href="https://www.tn.gov/content/dam/tn/health/documents/mch/MMR_Annual_Report_2017.pdf">www.tn.gov/content/dam/tn/health/documents/mch/MMR_Annual_Report_2017.pdf.</a></p> <p><strong>Substance Use, Mental Health and Violence Factors in Maternal Deaths</strong><br /> In 2017, 78 women in Tennessee died while pregnant or within one year of pregnancy. Substance use disorders and mental health conditions were often a contributing factor in these deaths. Substance use contributed to 33 percent of all pregnancy-associated deaths in 2017 and mental health conditions contributed to 18 percent of these deaths. The MMR Committee recommended increasing access to mental health and substance abuse treatment both during and for the year following pregnancy.</p> <p>“These numbers are a troubling indication of the reality that our state is facing in the areas of substance abuse and mental health,” said Tennessee Department of Mental Health and Substance Abuse Services Commissioner Marie Williams. “Our department has assertively worked to increase the treatment services that are available to women who have no means to pay. With state funding and federal grants, we have worked proactively to expand access so that more women with substance use disorder and mental illness get the treatment they need and live lives of recovery.”</p> <p>Violence was also noted as a significant contributing factor to maternal deaths.</p> <p>“Of all deaths reviewed, 14 percent of Tennessee’s maternal deaths in 2017 were the result of homicide, highlighting the need to address critical issues of maternal mortality including intimate partner violence,” said TDH Assistant Commissioner for Family Health and Wellness Morgan McDonald, MD, FAAP, FACP, co-chair of the MMR Committee. “Health systems and the public should be aware of the increased risk of violence and the availability of resources for women during the pregnancy and post-partum time periods.”</p> <p><strong>Defining Maternal Deaths</strong><br /> The Maternal Mortality Review Committee determines whether a woman’s death is pregnancy-related. A death is considered pregnancy-related if it occurred during pregnancy or within one year of the end of pregnancy due to a pregnancy complication, a chain of events initiated by pregnancy or the aggravation of a condition by the effects of pregnancy. More than one-quarter (28 percent) of maternal deaths were determined to be pregnancy-related. The top causes of pregnancy-related deaths in Tennessee in 2017 included embolism, cardiovascular and coronary conditions and hemorrhage.</p> <p>Sixty-three percent of Tennessee’s maternal deaths in 2017 were determined to be pregnancy-associated, but not related. A death is considered pregnancy-associated but not related if the pregnancy did not make a difference in the outcome. The top three causes of pregnancy associated, but not related deaths were overdose, motor vehicle accidents and violence.</p> <p><strong>Most Maternal Deaths are Preventable</strong><br /> A death is considered preventable if there was at least some chance of the death being averted by one or more reasonable changes to patient, community, provider, facility and/or systems factors.</p> <p>“The high percentage of maternal deaths considered preventable underscores the importance of identifying these deaths and seeking prevention opportunities,” said Maternal Mortality Nurse Coordinator Bethany Scalise, RN.</p> <p>The MMR Committee made recommendations for prevention for those deaths considered to be preventable. Recommendations include multi-disciplinary teams and coordination of care; establishment of protocols and standards of care; education; resources; public awareness and understanding of risk factors for patients and providers. The Department of Health is developing a maternity collaborative to assist with implementing these recommendations.</p> <p>The Tennessee Maternal Mortality Review Program was established in 2017 as a multidisciplinary committee to review pregnancy-associated deaths and determine how they can be prevented. The Maternal Mortality Review Committee includes representation from the fields of public health, obstetrics-gynecology, maternal and fetal medicine, anesthesiology, neonatology, pediatrics, nurse-midwifery, nursing, medical examiner, mental and behavioral health, domestic violence, hospital patient safety and the Tennessee Senate and House of Representatives.</p> <p>The mission of the Tennessee Department of Health is to protect, promote and improve the health and prosperity of people in Tennessee. Learn more about TDH services and programs at <a href="http://www.tn.gov/health">www.tn.gov/health</a>.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Tue, 19 Feb 2019 21:39:55 +0000 lovellks 162 at https://www.vumc.org/childhealthpolicy NAS rates influenced by mental health care access, unemployment https://www.vumc.org/childhealthpolicy/news-events/nas-rates-influenced-mental-health-care-access-unemployment <span class="field field--name-title field--type-string field--label-hidden">NAS rates influenced by mental health care access, unemployment</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/lovellks" typeof="schema:Person" property="schema:name" datatype="">lovellks</span></span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 01/30/2019 - 15:47</span> <a href="/childhealthpolicy/blog-post-rss/159" class="feed-icon" title="Subscribe to NAS rates influenced by mental health care access, unemployment"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Katherine Bortz</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://www.healio.com/pediatrics/neonatal-medicine/news/online/%7b1db2ab31-102b-43e7-9ea1-07ba9a9b6424%7d/nas-rates-influenced-by-mental-health-care-access-unemployment" target="_blank">https://www.healio.com/pediatrics/neonatal-medicine/news/online/%7b1db2ab31-102b-43e7-9ea1-07ba9a9b6424%7d/nas-rates-influenced-by-mental-health-care-access-unemployment</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>U.S. counties that have shortages of mental health care providers and higher rates of long-term unemployment also have higher rates of neonatal abstinence syndrome, or NAS, according to research published in <em>JAMA.</em></p> <p>“What is clear when I take care of infants and talk to their mothers is that while NAS isn’t particularly clinically complex, it can be socially complex,” <strong>Stephen W. Patrick, MD, MPH,</strong> assistant professor of pediatrics and health policy at Vanderbilt University and director of the Vanderbilt Center for Child Health Policy, told <em>Infectious Diseases in Children</em>. “The stories I hear from pregnant women are long stories of trauma and violence. This study was our first attempt to try to see what is happening beyond the hospital walls. Sometimes, we focus in on what’s happening at the bedside, but so much of NAS occurs outside of the hospital.”</p> <p>Patrick and colleagues conducted a retrospective, repeated cross-sectional study that assessed birth and economic data collected between 2009 and 2015 from 580 counties in Florida, Kentucky, Massachusetts, Michigan, New York, North Carolina, Tennessee and Washington. Additionally, the researchers examined the county-level 10-year unemployment rate and the availability of mental health and primary care clinicians.</p> <p>During the study period, 6,302,497 children were born and 47,224 NAS diagnoses were made (median rate = 7.1 cases per 1,000 hospital births; interquartile range [IQR] = 2.2-15.8).</p> <p>Patrick and colleagues calculated that the 10-year unemployment rate was 7.6% (IQR = 6.4%-9%), and nearly every year in every county (83.9%) had a partial or complete mental health care provider shortage.</p> <p>Further analyses revealed that NAS rates were higher in counties with mental health care provider shortages (unadjusted rates = 14 per 1,000 live births vs. 10.6 per 1,000 live births; adjusted incidence rate ratio [IRR] = 1.17; 95% CI, 1.07-1.27). The shortage of mental health care providers most affected the rate of NAS cases diagnosed in metropolitan counties (aIRR = 1.28; 95% CI, 1.16-1.40).</p> <p>Patrick said that there is a known correlation between untreated mental health disorders and opioid use. He suggested that improving access to mental health care providers may be “a way to help <a href="https://www.healio.com/pediatrics/neonatal-medicine/news/print/infectious-diseases-in-children/%7b80b081f5-f76d-4c04-9099-bc0fff800bbd%7d/combating-neonatal-abstinence-syndrome-amid-opioid-crisis" rel="noopener noreferrer" target="_blank">prevent NAS for years to come.</a>”</p> <p>The researchers said there was no relationship between NAS rates and primary care provider shortages, but they did find that NAS rates were correlated with long-term unemployment (unadjusted rate = 20.1 per 1,000 births vs. 7.8 per 1,000 live births; aIRR = 1.34; 95% CI, 1-1.23). This association had the greatest impact on remote, rural counties (aIRR = 1.34; 95% CI, 1.05-1.70).</p> <p>“For clinicians, I think we need to step back and not just think about the mother’s opioid or drug exposure but <a href="https://www.healio.com/pediatrics/neonatal-medicine/news/online/%7bff07f6b8-1af6-4d19-b9aa-67f91d5da1e4%7d/aap-calls-for-public-health-approach-to-treat-opioid-dependent-pregnant-women" rel="noopener noreferrer" target="_blank">the broader context</a>,” Patrick said. “For me, this resonates when I think about how to do trauma-informed care with pregnant women and how I can connect them to other resources that may be beneficial. This can feel completely overwhelming, and I think part of the goal of our paper was not to only focus on the medicine, but to begin the conversation to think about social determinants of health care.”</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Wed, 30 Jan 2019 21:47:09 +0000 lovellks 159 at https://www.vumc.org/childhealthpolicy Drug withdrawal in newborns linked to high unemployment rates https://www.vumc.org/childhealthpolicy/news-events/drug-withdrawal-newborns-linked-high-unemployment-rates <span class="field field--name-title field--type-string field--label-hidden">Drug withdrawal in newborns linked to high unemployment rates</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/lovellks" typeof="schema:Person" property="schema:name" datatype="">lovellks</span></span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 01/30/2019 - 15:24</span> <a href="/childhealthpolicy/blog-post-rss/158" class="feed-icon" title="Subscribe to Drug withdrawal in newborns linked to high unemployment rates"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Chloe Reichel</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://journalistsresource.org/studies/society/public-health/drug-withdrawal-newborns-opioids-nas/" target="_blank">https://journalistsresource.org/studies/society/public-health/drug-withdrawal-newborns-opioids-nas/</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>More newborn babies suffer from drug withdrawal in counties where there are shortages of mental health care providers, higher rates of long-term unemployment and higher proportions of manufacturing jobs, according to <a data-wpel-link="external" href="https://jamanetwork.com/journals/jama/fullarticle/2722771" target="_blank">new research published in <em>JAMA</em></a>.</p> <p>The study looks at rates of neonatal abstinence syndrome (NAS) — a form of withdrawal that newborns can experience if their mothers used drugs, including opioids, throughout pregnancy. As opioid use has increased in the United States, the number of infants born with NAS has increased, too. The authors write that the number of infants born with NAS in the U.S. jumped from 1.2 hospital births per 1,000 in the year 2000 to 8.0 per 1,000 in 2014.</p> <p>With this study, researchers were interested in determining the specific characteristics of counties that have particularly high rates of NAS.</p> <p>“What inspired us to do this work was actually my clinical work — taking care of newborns who have opioid withdrawal, and their families,” lead author <a data-wpel-link="external" href="https://pediatrics.mc.vanderbilt.edu/directory.php?did=13038" target="_blank">Stephen W. Patrick</a>, a pediatrician and professor of pediatrics and health policy at Vanderbilt University, said in a call with <em>Journalist’s Resource</em>. Patrick added that this outcome — NAS — “represents a whole slew of events that happened before they got to the delivery room.”</p> <p>“A better understanding of the association among community characteristics such as health care infrastructure and macroeconomic conditions and NAS is needed to inform community-level interventions aimed at improving opioid-related outcomes for these vulnerable populations,” the authors write.</p> <p>The researchers looked at 6,302,497 births occurring between 2009 and 2015 across 580 counties, both urban and rural, located in eight states — New York, Massachusetts, Kentucky, Tennessee, North Carolina, Washington, Florida and Michigan. They examined the associations between county-level NAS rates and the following factors: primary care and mental health care shortages and long-term unemployment rates.</p> <p>Here’s what they found:</p> <ul> <li>Counties with high 10-year unemployment rates also had high rates of NAS. Across the sample, unemployment rates ranged from 4.1 percent to 15.8 percent in 2015. In the highest unemployment quartile, rates of NAS were 20.1 per 1,000 hospital births, whereas in the lowest unemployment quartile, NAS rates were 7.8 per 1,000 births. Counties with high unemployment and NAS rates tended to be rural, and were concentrated in the following regions: rural Appalachia (parts of the states of Kentucky, New York, North Carolina and Tennessee), southeastern Massachusetts, northern Michigan and southwestern Washington.</li> <li>Considering the overlap between unemployment rates and the number of babies experiencing withdrawal at birth, the authors suggest that both prior and current economic hardship might contribute to NAS rates.</li> <li>Rural counties with a higher proportion of manufacturing jobs also had higher rates of NAS. The authors suggest that the risks of injury, disability and chronic pain associated with manufacturing industries — which in turn can lead to opioid use — might explain this association.</li> <li>There was no link between NAS rates and primary health care provider shortages. However, metropolitan counties experiencing mental health care provider shortages saw higher rates of NAS. In mental health care shortage areas, for every 1,000 hospital births, an average of 14.0 infants were born with NAS, compared with 10.6 per 1,000 births in areas where there were no shortages. Adults with mental health conditions are already <a data-wpel-link="external" href="https://www.ncbi.nlm.nih.gov/pubmed/28720623" target="_blank">three times as likely to use opioid painkillers</a> as compared to their peers without mental health disorders, the authors write, adding that “untreated and undertreated mental health disorders increase the risk of opioid misuse and abuse.” Mental health care provider shortages are widespread – between 2009 and 2015, the proportion of counties in the sample that were designated as <a data-wpel-link="external" href="https://bhw.hrsa.gov/shortage-designation/hpsa-process" target="_blank">mental health professional shortage areas</a> jumped from 79.5 percent to 88.2 percent.</li> </ul> <p><strong>Next steps for journalists and policy makers</strong></p> <p>“While the opioid crisis has gotten a lot of attention by the press, pregnant women and infants are often left out of the conversation,” Patrick said. He suggested journalists increase their coverage of the link among economic hardship, the opioid epidemic and maternal-child health. He also suggested an increased focus on rural communities, which have been hit hardest by these interrelated issues.</p> <p>On the policy side, Patrick suggested that economic revitalization programs similar to the Depression-era <a data-wpel-link="external" href="https://www.pbs.org/wgbh/americanexperience/features/surviving-the-dust-bowl-works-progress-administration-wpa/" target="_blank">Works Progress Administration</a> might help to address the long-term economic downturn at the root of the opioid epidemic.</p> <p>“To really solve the opioid crisis, you need to think beyond the hospital walls,” Patrick said.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Wed, 30 Jan 2019 21:24:45 +0000 lovellks 158 at https://www.vumc.org/childhealthpolicy Long-term Unemployment Linked to Increase in Babies Born with Drug Withdrawal https://www.vumc.org/childhealthpolicy/news-events/long-term-unemployment-linked-increase-babies-born-drug-withdrawal <span class="field field--name-title field--type-string field--label-hidden"> Long-term Unemployment Linked to Increase in Babies Born with Drug Withdrawal</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/childhealthpolicy/users/lovellks" typeof="schema:Person" property="schema:name" datatype="">lovellks</span></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 01/29/2019 - 16:04</span> <a href="/childhealthpolicy/blog-post-rss/161" class="feed-icon" title="Subscribe to Long-term Unemployment Linked to Increase in Babies Born with Drug Withdrawal"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Nashville Medical News</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://www.nashvillemedicalnews.com/long-term-unemployment-linked-to-increase-in-babies-born-with-drug-withdrawal-cms-2857" target="_blank">https://www.nashvillemedicalnews.com/long-term-unemployment-linked-to-increase-in-babies-born-with-drug-withdrawal-cms-2857</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Babies born after being exposed to opioids before birth are more likely to be delivered in regions of the U.S. with high rates of long-term unemployment and lower levels of mental health services, according to a study from researchers at Vanderbilt University Medical Center and the RAND Corporation.</p> <p>Studying more than 6.3 million births in a diverse group of eight states, the study found that rural counties plagued by long-term unemployment had significantly higher rates of babies born with neonatal abstinence syndrome as compared to urban counties with lower unemployment rates.</p> <p>Counties with shortages of mental health providers also had higher levels of neonatal abstinence syndrome as compared to other counties. The association was observed primarily in urban areas.</p> <p>The study, published in the Jan. 30 edition of the <em>Journal of the American Medical Association</em>, is the first to examine the association between long-term economic conditions, health care provider shortage areas and the incidence of neonatal abstinence syndrome, which can occur when babies are chronically exposed to opioids before birth.</p> <p>"The finding should open our eyes to the social complexities that lead to newborns being treated for drug withdrawal in our nation's hospitals," said Stephen W. Patrick, MD, MPH, MS, Director of the Vanderbilt Center for Child Health Policy and lead author of the paper. "The opioid crisis is not just a health care problem, it is also a social problem, and solutions will need to address the social needs of communities as well as the health care needs.</p> <p>"As Congress considers legislation, particularly those related to building infrastructure in rural communities, it should consider that these investments may also benefit the health of communities."</p> <p>Patrick and his colleagues have shown previously that one consequence of the nation's opioid epidemic has been a sharp increase in the number of newborns who show signs of withdrawal from opioids. From 2000 to 2014, the rate of neonatal abstinence syndrome rose from 1.2 cases per 1,000 hospital births to 8 cases per 1,000 births. In 2014, the average was one infant born every 15 minutes in the U.S. with neonatal abstinence syndrome.</p> <p>While poor economic conditions have been linked to opioid use, there had been no large-scale studies examining whether those issues also are associated with newborn exposure to the drugs.</p> <p>Researchers from Vanderbilt and RAND analyzed information about 6.3 million births from 2009 through 2015 in the 580 counties in Florida, Kentucky, Massachusetts, Michigan, North Carolina, New York, Tennessee and Washington. Those cases were compared to the 10-year unemployment rate for each of the counties, as well as factors about health care workforce levels.</p> <p>Counties with persistently elevated levels of unemployment had higher rates of neonatal abstinence syndrome. The rate of neonatal abstinence syndrome in the counties with the highest unemployment rate was 20.1 cases per 1,000 births, compared to 7.8 cases per 1,000 births in the counties with the lowest unemployment rates.</p> <p>The study also found higher rates of neonatal abstinence syndrome in counties with shortages of mental health workers, primarily in metropolitan counties. Counties with shortages of mental health workers experienced 14 cases of neonatal abstinence syndrome per 1,000 births as compared to rates of 1.6 cases per 1,000 births in other counties. There was no such association with physical health providers.</p> <p>"We know that individuals with mental health problems are more likely to use or be dependent on opioids," said Dr. Bradley D. Stein, MD, PhD, senior author of the study and Director of the RAND Opioid Policy Center. "Our findings suggest that until we can provide better access to effective mental health care, we face an uphill battle effectively addressing the opioid crisis."</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Tue, 29 Jan 2019 22:04:07 +0000 lovellks 161 at https://www.vumc.org/childhealthpolicy