Blog RSS https://www.vumc.org/childhealthpolicy/ en 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 Vanderbilt Study Spots Economic Link With Drug-Dependent Newborns https://www.vumc.org/childhealthpolicy/news-events/vanderbilt-study-spots-economic-link-drug-dependent-newborns <span class="field field--name-title field--type-string field--label-hidden">Vanderbilt Study Spots Economic Link With Drug-Dependent Newborns</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 - 15:52</span> <a href="/childhealthpolicy/blog-post-rss/160" class="feed-icon" title="Subscribe to Vanderbilt Study Spots Economic Link With Drug-Dependent Newborns"> 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.nashvillepublicradio.org/post/vanderbilt-study-spots-economic-link-drug-dependent-newborns#stream/0" target="_blank">https://www.nashvillepublicradio.org/post/vanderbilt-study-spots-economic-link-drug-dependent-newborns#stream/0</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Places with high rates of joblessness also seem to have outsized problems with drug-dependent newborns. That's the central finding in a new Vanderbilt study published in the Journal of the American Medical Association on Tuesday.</p> <p>Researchers looked at 6.2 million births across eight states, including Tennessee. And for those exposed to opioids in the womb, the map matches up very closely to long-term unemployment rates.</p> <p>The lead author, neonatologist Stephen Patrick, says the findings should alter the discussion about how to respond to so-called neonatal abstinence syndrome. He says reducing the rates of opioid exposure among infants is not just about controlling the drug supply.</p> <p>"As we think about how do we build up communities, I think it's part of where we need to be thinking about economic development as a potential way to improve the health of communities," Patrick says.</p> <p>The study (<a href="https://jamanetwork.com/journals/jama/article-abstract/2722771">read here</a>) also found that drug-dependent newborns were more common in counties with a shortage of mental health and addiction treatment options.</p> <p>Patrick says he was inspired to direct his research toward these macro issues because the women he works with at Vanderbilt almost always have a far more complicated story than simply stumbling into a drug habit and accidentally getting pregnant.</p> <p>"There are long histories of trauma, lack of opportunity in terms of unemployment, multiple other factors that occur far outside the health care system," he says. "And that's really what made us want to go down this line of work."</p> <p>Researchers in the Vanderbilt Center for Child Health Policy have built an interactive map with rates of drug-dependent newborns for each county in the relevant states. Here's a<a href="https://www.vumc.org/childhealthpolicy/nas"> link</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, 29 Jan 2019 21:52:06 +0000 lovellks 160 at https://www.vumc.org/childhealthpolicy Melania Trump meets with families with babies dependent on drugs during Vanderbilt hospital visit https://www.vumc.org/childhealthpolicy/news-events/melania-trump-meets-families-babies-dependent-drugs-during-vanderbilt-hospital-visit <span class="field field--name-title field--type-string field--label-hidden">Melania Trump meets with families with babies dependent on drugs during Vanderbilt hospital visit</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, 09/27/2018 - 16:59</span> <a href="/childhealthpolicy/blog-post-rss/104" class="feed-icon" title="Subscribe to Melania Trump meets with families with babies dependent on drugs during Vanderbilt hospital visit"> 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">Yihyun Jeong</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://www.tennessean.com/story/news/2018/07/24/melania-trump-wife-vanderbilt-medical-center-nashville-childrens-hospital-drug-addicted-babies/825672002/" target="_blank">https://www.tennessean.com/story/news/2018/07/24/melania-trump-wife-vanderbilt-medical-center-nashville-childrens-hospital-drug-addicted-babies/825672002/</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Melania Trump arrived in Nashville on Tuesday to visit Monroe Carell Jr. Children’s Hospital at Vanderbilt to be briefed on babies born dependent on drugs. </p> <p>Trump blew bubbles with pediatric patients and got down on kid-level to play trains after attending a roundtable on treatment options for infants of opioid-addicted mothers born in conditions of withdrawal.</p> <aside itemprop="associatedMedia" itemscope="" itemtype="http://schema.org/ImageObject"><p>First lady Melania Trump, right, hugs a child in a playroom during a visit to Monroe Carell Jr. Children's Hospital at Vanderbilt in Nashville, Tenn., Tuesday, July 24, 2018. The first lady was promoting her "Be Best" campaign to help children. (AP Photo/Darlene Superville) (Photo: Darlene Superville, AP)</p> </aside><p>Crouching down to play with 4-year-old patient Essence Overton, Trump complimented the child's painted nails. “Yours are all different colors. I like that,” she said.</p> <p>The first lady's two-hour visit was part of her "Be Best" initiative to keep children healthy and happy.</p> <p>Melania Trump traveled to Nashville, Tenn. on Tuesday, to promote her "Be Best" campaign. She visited children and their families at a children's hospital in her first domestic trip to highlight the initiative. </p> <p>Trump landed in Nashville at about 2 p.m. and was greeted by Rep. Marsha Blackburn, who shook her hand and had a brief conversation. Trump also shook hands with an Air Force officer before her motorcade headed to the hospital.</p> <p>Trump participated in a roundtable discussion about neonatal abstinence syndrome (NAS) with the hospital's Chief of Staff Dr. Margaret Rush and Center for Child Health Policy Director Dr. Stephen Patrick, among others. </p> <p>"(Trump) is impressed by their goal here of keeping mothers and children together. She asked them to let her know how she can best use her role to help," Trump's spokesperson Stephanie Grisham said.</p> <p>According to Grisham, Trump asked what kind of support the mothers are offered once they leave the hospital. She wanted to know how long the support system remains in place and if it is extended to fathers as well.</p> <p>After the nearly 20 minute discussion, Trump visited privately with families who have infants in the NICU diagnosed with NAS. She gifted pink, blue and white fleece blankets with the White House seal embroidered in the corner.</p> <p>Essense, the girl with colorful nails, got a pink blanket — her favorite color — to match her pink dress.</p> <p>Trump talked in length with a couple, while holding their 8-day-old baby. The mother told Trump that she plans to stay healthy now that she has a child, according to Grisham</p> <p>The baby is doing well and will be in the hospital for four or five more days. </p> <p>“It’s (great) any time a First Lady comes to Vanderbilt, and Vanderbilt Children’s Hospital is such an amazing, important asset to our community,” said John Ingram, a prominent Vanderbilt University donor who serves on the school’s board of trust. “To have somebody high-profile like that come and put it in the spotlight, it’s only good.</p> <p>“We live in such a partisan world, but it’s nice to have a First Lady come to Vanderbilt Children’s Hospital and highlight something that’s really a wonderful asset," said Ingram, who did not attend  the event. </p> <p>Vanderbilt University Medical Center and Vanderbilt University are separate entities. A spokesman for Vanderbilt University said Chancellor Nicholas S. Zeppos, who serves on the medical center board, was out of town Tuesday and could not attend the first lady's visit.</p> <h2>Scope of Tennessee's problem</h2> <p>Tuesday's visit isn't the hospital's first visit from the White House.</p> <p>In 2014, Michael Botticelli, the White House's drug policy director at the time, visited the hospital to learn about the <a data-track-label="inline|intext|n/a" href="https://www.tennessean.com/story/news/health/2014/04/25/best-babies-born-drug-addicted-mothers/8170555/">faculty's urgent investigation into how best to treat drug-dependent babies</a>.</p> <p>Melania Trump launches her long-awaited first-lady initiative, "Be Best," focusing on issues that children confront.</p> <p>Tennessee is dealing with a rising number of overdose deaths amid a struggle with opioid abuse and misuse that health officials dub an epidemic. Alongside the rising overdose death rate is an increase in the number of babies being treated for drug abuse.</p> <p>Babies born to addicted mothers are filling neonatal intensive care units in Tennessee faster than the health care system can figure out how to treat them. <a data-track-label="inline|intext|n/a" href="https://www.tennessean.com/story/money/industries/health-care/2016/11/26/nashville-startup-strives-protect-babies-opioid-abuse/94281458/">The number of babies in withdrawal has increased tenfold</a> from 1999 to 2010, for instance.</p> <p>Last year, the state recorded 1,090 cases of infants born suffering from neonatal abstinence syndrome. </p> <p>The cases result of maternal substance abuse, namely of opioids, during pregnancy that causes infants born in withdrawal, according to the state. </p> <p>Seventy-five percent of those infants were exposed to at least one prescription medication, with or without concomitant exposure to an illicit drug. Seventy percent were exposed to medication-assisted treatment for substance use disorders, according to the Tennessee Department of Health.</p> <p>The average cost to deliver a drug-dependent baby is $62,000, compared with $4,700 for a healthy child. Taxpayers bear the brunt of this cost — most of these babies and their mothers are on TennCare, the state's health insurance program for the poor.</p> <h2>Understanding addiction</h2> <p>Tennessee has made its mark in trying to understand what<a data-track-label="inline|intext|n/a" href="https://www.tennessean.com/story/opinion/2017/01/16/what-opioids-doing-tennessee-babies/95964242/"> triggers the symptoms in babies going through opioid and nicotine withdrawal</a>. Researchers at the hospital are looking for ways to reach out to and treat pregnant women with addictions.</p> <p>The standard treatment is for a doctor to transfer the mother to a less harmful opioid, such as methadone or buprenorphine, and monitor its use. </p> <p>While those medications can still cause a baby to withdraw, the odds improve. Mothers put on this therapy have 60 percent of delivering a healthy baby compared with a 30 percent to 40 percent of women who don't receive treatment, health officials say.</p> <p><a data-track-label="inline|intext|n/a" href="https://www.tennessean.com/story/news/investigations/2014/06/13/drug-dependent-babies-challenge-doctors-politicians/10112813/">Middle Tennessee is a crucible for a roiling controversy about how to cope with the epidemic of babies undergoing drug withdrawal</a>, with elected officials offering solutions of their own.</p> <p>Lawmakers passed the Safe Harbor Act in 2013 to give pregnant women priority access to treatment programs and to protect their custody rights as they try to get clean.</p> <p id="article-body-p-last"><em>Includes reporting from USA TODAY NETWORK - Tennessee reporters Yihyun Jeong, Joey Garrison and Michael Collins.</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> Thu, 27 Sep 2018 21:59:12 +0000 lovellks 104 at https://www.vumc.org/childhealthpolicy Early discharge of NAS infants prolongs treatment https://www.vumc.org/childhealthpolicy/news-events/early-discharge-nas-infants-prolongs-treatment <span class="field field--name-title field--type-string field--label-hidden">Early discharge of NAS infants prolongs treatment</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, 09/25/2018 - 10:47</span> <a href="/childhealthpolicy/blog-post-rss/95" class="feed-icon" title="Subscribe to Early discharge of NAS infants prolongs treatment"> 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">Christina Echegaray </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/2018/05/17/early-discharge-of-nas-infants-prolongs-treatment/" target="_blank">http://news.vumc.org/2018/05/17/early-discharge-of-nas-infants-prolongs-treatment/</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Infants who are diagnosed with drug withdrawal after birth who are treated with medication as outpatients at home are treated three times longer than infants treated solely as inpatients, according to a new Vanderbilt study.</p> <p>Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome that occurs shortly after birth, and can occur when an infant is exposed to an opioid during the pregnancy.</p> <p>The study, “Outpatient Pharmacotherapy for Neonatal Abstinence Syndrome,” also found that the infants with NAS treated as outpatients were more likely than their inpatient counterparts to have more repeat visits to the emergency room in the six months post-discharge. The findings were published in <em>The Journal of Pediatrics</em>.</p> <p>Outcomes for infants treated as outpatients compared to those treated solely in the hospital are largely unknown, and there is no standard protocol for this treatment. Infants who have drug withdrawal are commonly treated with a medication, such as morphine, to control their clinical signs of withdrawal. Infants who require treatment for the syndrome can be in the hospital for several weeks.</p> <p>Vanderbilt researchers sought to examine how outpatient treatment affected length of stay, length of treatment, emergency department utilization and hospital readmissions compared to treatment as an inpatient. To conduct the study, researchers examined hospital billing and vital records data of 736 infants with a confirmed diagnosis of NAS from medical record review who were enrolled in TennCare, Tennessee’s Medicaid program, from 2009 to 2011.</p> <p>“Infants with neonatal abstinence syndrome can have long hospital stays. In order to get infants home quicker, some hospitals began discharging infants home on medications to complete weans, but there is no evidence to guide this practice,” said Faouzi Maalouf, MD, a former fellow in neonatology at Vanderbilt University Medical Center.</p> <p>NAS continues to be a growing concern and problem in the United States, with one infant born with drug withdrawal symptoms every 15 minutes, accounting for more than $500 million in hospital costs each year.</p> <p>Improving the efficiency of medical care for this population has emerged as a priority for hospital systems.</p> <p>“Discharging infants with NAS home on medications may shorten their hospital stays, but our study raises the concern that this may prolong their treatment — some more than six months. While medically expedient, as pediatricians we have to ask ourselves if this is the best way to care for this vulnerable population,” said senior author Stephen Patrick, MD, MPH, director of the Vanderbilt Center for Child Health Policy and assistant professor of Pediatrics and Health Policy in the Division of Neonatology with Monroe Carell Jr. Children’s Hospital at Vanderbilt.</p> <p>Infants experiencing withdrawals are irritable, can have feeding and breathing problems, and are more likely to be born with low birthweight. To help with those symptoms, infants are sometimes treated with courses of pharmacotherapy, most commonly morphine or methadone. Phenobarbital, a type of sedative, is sometimes used as a therapy for infants with NAS, though possible long-term cognitive effects are a concern.</p> <p>The study showed that of the 736 infants with NAS about 72 percent, or 532, were treated with medication, and nearly half of those patients on pharmacotherapy were discharged home on outpatient medications, most commonly with phenobarbital.</p> <p>While infants discharged home with medication had a shorter length of stay in the hospital, 11 days versus 23 for the inpatients, they stayed on medication for about 60 days — about 41 days longer than babies who were inpatients.</p> <p>“Communities throughout the U.S. are experiencing a rapid rise in infants diagnosed with NAS. As we work to improve outcomes for pregnant women and infants affected by the opioid epidemic, we need a coordinated approach that considers the implications of our treatment plans throughout the pregnancy through childhood,” said Patrick.</p> <p>Other Vanderbilt authors of the study include: William Cooper, MD, James Slaughter, DrPH, and Judith Dudley, BS.</p> <p>Funding for this study was provided by the National Institutes of Health’s National Institute on Drug Abuse under grant K23DA038720. N</p> <p> </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, 25 Sep 2018 15:47:37 +0000 lovellks 95 at https://www.vumc.org/childhealthpolicy Study reveals opioid patients face multiple barriers to treatment https://www.vumc.org/childhealthpolicy/news-events/study-reveals-opioid-patients-face-multiple-barriers-treatment <span class="field field--name-title field--type-string field--label-hidden">Study reveals opioid patients face multiple barriers to treatment</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, 09/25/2018 - 10:45</span> <a href="/childhealthpolicy/blog-post-rss/94" class="feed-icon" title="Subscribe to Study reveals opioid patients face multiple barriers to treatment"> 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">Christina Echegaray </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/2018/07/12/opioid-patients-barriers-treatment/" target="_blank">http://news.vumc.org/2018/07/12/opioid-patients-barriers-treatment/</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>In areas of the country disproportionately affected by the opioid crisis, treatment programs are less likely to accept patients paying through insurance of any type or accept pregnant women, a new Vanderbilt study found.</p> <p>While the opioid crisis has escalated across the U.S., there has been growing concern that treatment capacity has not kept pace. In 2016, more than 42,000 Americans died of an opioid-related overdose, more than any year on record. Opioid agonist therapies, like buprenorphine and methadone, have been shown to reduce risk of overdose death, and for pregnant women with opioid use disorder this benefit extends to the baby — making it more likely the infant will be born at term and with higher birthweights.</p> <p>Vanderbilt researchers focused on four Appalachian states — Tennessee, Kentucky, North Carolina and West Virginia — that have among the highest rates of opioid use in the country and are more affected by opioid overdose deaths. In their study published in the journal <em>Substance Abuse</em>, researchers found that only about 50 percent of opioid treatment providers took any insurance, and there was also a huge variance among the states in programs that accepted Medicaid.</p> <p>While 83 percent of treatment programs in West Virginia accepted Medicaid insurance, only about 13 percent of programs in Tennessee accepted Medicaid. Additionally, the study found that while 91 percent of programs were accepting new patients, only 53 percent of outpatient buprenorphine programs would treat pregnant women.</p> <p>“This work sheds further light on a critical public health problem facing pregnant women and their children and the importance of connecting pregnant women to the right resources,” said senior author William Cooper, MD, MPH, vice chair the Department of Pediatrics and Cornelius Vanderbilt Professor of Pediatrics and Health Policy.</p> <p>Researchers conducted a survey of opioid agonist therapy providers, opioid treatment programs that provide methadone and outpatient buprenorphine providers between April and May 2017, in the four predominately Appalachian states. The programs and providers were identified from a public listing provided by the Substance Abuse and Mental Health Administration.</p> <p>“We know that opioid agonist therapies work but only a fraction of people that have opioid use disorder are actually getting them. With this study, we wanted to know if there were structural issues in terms of providers, or insurance type, or being pregnant itself, that may be a reason for that barrier,” said Stephen Patrick, MD, MPH, MS, director of the Vanderbilt Center for Child Health Policy, assistant professor of Pediatrics and Health Policy in the Division of Neonatology at Monroe Carell Jr. Children’s Hospital at Vanderbilt.</p> <p>Surveyors asked the programs if they were accepting new patients or if they were accepting pregnant patients for treatment. Other questions centered on insurance requirements, including if programs accepted Medicaid, private insurance or self-pay.</p> <p>The survey found that cash payments for treatment ranged from $20 to $175 for treatment intakes; $35 to $245 per week for outpatient buprenorphine treatment; and $49 to $160 per week for methadone treatment. Another finding of the study was that when pregnant women are accepted to opioid use disorder treatment programs they had shorter wait times than others with the disorder.</p> <p>“We need to know why. Why is it that so many providers only take cash and why so few in some states take Medicaid? Then we need to craft policy solutions that increase the likelihood that people with opioid use disorder are able to get the evidence-based treatment that they need,” Patrick said.</p> <p>“At the end of the day, the people who have opioid use disorder, particularly pregnant women, need the treatment that we know is evidence based. We know many aren’t getting it and we are still seeing record highs of overdose deaths.”</p> <p>Funding for the study was provided by the National Institutes of Health’s National Institute on Drug Abuse under grant K23DA038720.</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, 25 Sep 2018 15:45:17 +0000 lovellks 94 at https://www.vumc.org/childhealthpolicy Integrated, multidisciplinary approach key to opioid fight: panel https://www.vumc.org/childhealthpolicy/news-events/integrated-multidisciplinary-approach-key-opioid-fight-panel <span class="field field--name-title field--type-string field--label-hidden">Integrated, multidisciplinary approach key to opioid fight: panel</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, 09/21/2018 - 17:26</span> <a href="/childhealthpolicy/blog-post-rss/85" class="feed-icon" title="Subscribe to Integrated, multidisciplinary approach key to opioid fight: panel"> 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">Bill Snyder</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/2018/07/26/integrated-multidisciplinary-approach-key-to-opioid-fight-panel/" target="_blank">http://news.vumc.org/2018/07/26/integrated-multidisciplinary-approach-key-to-opioid-fight-panel/</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>No single approach will end the epidemic of fatal overdoses caused by addiction to opioid painkillers and heroin that is ravaging this country, the U.S. Assistant Secretary for Health, Adm. Brett Giroir, MD, warned Tuesday during a panel discussion in a packed lecture hall at Vanderbilt University Medical Center.</p> <p>“There is no silver bullet but there’s a lot of silver buckshot,” Giroir said. “Really integrated, multidisciplinary, holistic kinds of approaches are critically important. We thought we could cure pain by giving a pill. You can’t cure addiction by giving a pill either.”</p> <p>Giroir, a pediatric critical care physician who oversees the Office of the Surgeon General and the U.S. Public Health Service Commissioned Corps, said he came to VUMC to learn more about the treatment of neonatal abstinence syndrome (NAS), drug withdrawal symptoms experienced by newborns exposed to opioids in the womb.</p> <p>He said that when he asked officials of the American Academy of Pediatrics to point him to leaders in the field, they told him, “Go to Vanderbilt.”</p> <p>“There are a lot of other great places and we’ll be going to them, but you are clearly a leader,” Giroir continued.</p> <p>The hourlong discussion featured Stephen Patrick, MD, MPH, assistant professor of Pediatrics and Health Policy and a national expert on NAS; Bonnie Miller, MD, MHHC, Senior Associate Dean for Health Sciences Education; and A.J. Reid Finlayson, MD, associate professor of Psychiatry.</p> <p>The discussion, moderated by Tennessee Deputy Commissioner for Public Health Michael Warren, MD, was sponsored by VUMC, the Vanderbilt University School of Medicine and by the Vanderbilt Center for Child Health Policy, which Patrick directs.</p> <p>“We’ve seen a massive increase in pregnant women with opioid use disorder, and that’s disproportionately occurring in rural areas,” Patrick said. Yet few can obtain the treatment they need because of lack of insurance and other financial barriers.</p> <p>In addition, “many of these women have complicated histories of psychiatric disorders, severe trauma, which I think predisposes people to use these drugs,” said Finlayson, an expert on treating opioid addiction.</p> <p>“I’m a real proponent of long-term treatment.”</p> <p>Miller acknowledged that the opioid epidemic began with the well-intentioned desire by physicians to relieve pain.</p> <p>“As a surgeon, I can tell you how difficult it is to round on your patients and they’re in pain,” she said. “And we were told you don’t get addicted.”</p> <p>That is changing. Miller described efforts at Vanderbilt and throughout Tennessee to change the way doctors are trained, and to encourage physicians to change their prescribing practices.</p> <p>Giroir outlined a five-point strategy for confronting the epidemic: strengthening public health data reporting and collection; advancing pain management to decrease the inappropriate use of opioids; improving access to prevention and recovery services; enhancing the availability of overdose-reversing medicines; and supporting cutting-edge research.</p> <p>“We have to have reimbursement at the core of this,” he added. “If we don’t reimburse for the right things … we lose.”</p> <p>The U.S. Department of Health and Human Services is working on the problem. In the coming months, Giroir said, “you’re going to see dramatic changes in … how we’re tailoring reimbursement systems to support holistic-centered care.</p> <p>“We shouldn’t be paying for doing more procedures,” he said. “We should be paying for … the integration of services, and releasing the creative energies of places like this.”</p> <p>Giroir concluded his remarks by congratulating all those “who are working on the front lines to advance the knowledge, but also (Vanderbilt) University, for prioritizing and allowing the academicians and clinicians to have the freedom to work on this. Thank you really sincerely for what you do.”</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, 21 Sep 2018 22:26:01 +0000 lovellks 85 at https://www.vumc.org/childhealthpolicy Team Hope program’s mission is to enhance care for newborns with NAS https://www.vumc.org/childhealthpolicy/news-events/team-hope-programs-mission-enhance-care-newborns-nas <span class="field field--name-title field--type-string field--label-hidden">Team Hope program’s mission is to enhance care for newborns with NAS</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" typeof="schema:Person" property="schema:name" datatype="">Visitor</span></span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 07/26/2018 - 08:00</span> <a href="/childhealthpolicy/blog-post-rss/88" class="feed-icon" title="Subscribe to Team Hope program’s mission is to enhance care for newborns with NAS"> 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">Christina Echegaray </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/2018/07/26/team-hope-programs-mission-is-to-enhance-care-for-newborns-with-nas/" target="_blank">http://news.vumc.org/2018/07/26/team-hope-programs-mission-is-to-enhance-care-for-newborns-with-nas/</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>A collaborative program across units at Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt is changing the way nurses and doctors care for newborns diagnosed with drug withdrawal symptoms at birth, also known as neonatal abstinence syndrome (NAS).</p> <p>The program, called Team Hope, is funded with a grant from the Memorial Foundation and support from VUMC and Children’s Hospital leadership. The interdisciplinary team is comprised of health care specialists from the Newborn Nursery, the Neonatal Intensive Care Unit and the acute care unit at Children’s Hospital along with Child Life, social workers and lactation consultants.</p> <p>Their mission: to improve the care of the opioid-exposed mother-baby dyad through multifaceted, family-centered approach. The team seeks to keep mothers and babies together after birth and move them out of an intensive care setting when possible.</p> <p>Previous Vanderbilt research revealed that standardizing hospital care policies across institutions for infants diagnosed with drug withdrawal symptoms at birth reduces their length of treatment and hospitalization. However, with many health care institutions caught off guard by the alarming and rapid rise in the number of infants born with NAS, the study showed that fewer than half of participating hospitals had policies to standardize care for affected infants.</p> <p>In the United States, one infant is born every 15 minutes with withdrawal symptoms after being exposed to opioids before birth.</p> <p>Team Hope has instituted evidence-based practices in the care of these infants to improve their outcomes, decrease length of stay and improve consistency of care for opioid-exposed infants.</p> <p>“We have found that current models that exist to care for babies with drug withdrawal symptoms are not adequate. These infants get separated from their mom, are put in a noisy NICU with other crying infants, and that separation and environment makes withdrawal worse,” said Stephen Patrick MD, MPH, director of the Vanderbilt Center for Child Health Policy and assistant professor of Pediatrics and Health Policy in the Division of Neonatology with Children’s Hospital.</p> <p>“We’ve changed that model of care. When these babies who are exposed to opioids have a long stay, they go to a general inpatient floor, unless they have other complications, and moms and babies can room together. We promote bonding and breastfeeding with a dedicated lactation consultant and Child Life specialist. We engage the family and coordinate volunteers on how to help the baby improve.”</p> <p>Drug withdrawal symptoms can occur shortly after birth in infants exposed to opioids while in the womb.</p> <p>Compared to other infants, those with drug withdrawal are more likely to experience respiratory complications and feeding difficulty, be born with low birth-weight and have longer lengths of stays in the hospital following birth.</p> <p>“Team Hope was born out of a desire to provide better care not just for our infants affected by NAS, but for their families too,” said Travis Crook, MD, assistant professor of Pediatrics, Hospital Medicine and clinical lead for Team Hope.</p> <p>“What makes Team Hope so special is the rare combination of passion, expertise and effort. The broad range of representation and expertise coupled with the desire to truly improve the care for these patients has created a culture change and brought about a community spirit to transforming Vanderbilt into a national center of excellence for NAS,” Crook said.</p> <p>With Team Hope, the goal is to reduce those symptoms and complications with multidisciplinary support.</p> <p>“In my experience caring for infants with opioid exposure, I have seen how important it is to have an engaged family. Team Hope offers additional support services for families that will lead to better outcomes for their babies,” said Anna Morad, MD, director of the Newborn Nursery.</p> <p>For an infant and family to qualify for Team Hope intervention, the infant must be born at 35 weeks or later, have been exposed to opioids in utero and not have another medical condition, like breathing difficulty, which would lead to a NICU admission. Early data collection since Team HOPE launched in fall 2017 proves to be promising, with more than 100 newborns meeting the eligibility criteria, and only 17 percent requiring treatment with morphine for NAS.</p> <p>For all Team Hope infants, the average length of stay was five days, while infants diagnosed with NAS had an average length of stay of 12 days. While readmission after discharge is not uncommon for NAS infants, none of the Team Hope infants were readmitted within seven days post-discharge.</p> <p>Other Team HOPE members include Erin Munn, MS, CCLS, Child Life specialist; Michelle McPherson, RN, lactation consultant, and Mary White, MPH, program manager. But the team extends well beyond the core group, and includes a diverse cross-section of disciplines, backgrounds as nurses, physicians, child welfare workers and beyond.</p> <p>They meet every two weeks for case conferences, to analyze their standards of care and ensure consistency in care, as well as to identify evidence-based practices that have been particularly effective in their care model.</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, 26 Jul 2018 13:00:00 +0000 Visitor 88 at https://www.vumc.org/childhealthpolicy