Opiate Abuse and the Growing Impact on Maternal and Child Health in West Virginia

Christina Mullins, Director Office of Maternal, Child and Family Health Bureau for Public Health October 23, 2017

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Overview

• Describe the epidemic in West Virginia. • Discuss the collaborative relationships used to develop the Drug Free Moms and Babies Project. • Provide an overview of key strategies and results. • Discuss lessons learned.

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1 Drug Overdose Rates by State US Resident Overdose Deaths by State, 2015

14.7

13.8 8.6 21.2 12.0 10.6 14.2 15.5 8.4 13.6 NH – 34.3 16.4 20.4 VT – 16.7 10.3 26.3 MA – 25.7 6.9 20.4 29.9 RI – 28.2 23.4 14.1 19.5 15.4 41.5 CT – 22.1 11.3 11.8 17.9 12.4 NJ – 16.3 29.9 DE – 22.0 15.8 MD – 20.9 19.0 19.0 22.2 25.3 13.8 15.7 DC – 18.6 12.3 15.7 12.7 9.4 19.0

16.0 16.2 West Virginia # 1 41.5 deaths per Age‐Adjusted Rate Per 100,000 Population 100,000 11.3 6.9 – 12.7 16.4 – 21.2 US Rate – 16.3 Data Source: CDC Wonder 12.8 – 16.3 21.3 – 41.5 2 Mullins

West Virginia vs. United States

2001‐2015 Resident Drug Overdose Mortality Rate West Virginia and United States

WV 45 41.5

40 36.3 35.5 35 32.0 32.2 28.9 30 25.9 25.7 22.3 22.4 25 20.4 Per 100,000 18.8 20 15.1 12.9 15 11.5 16.3 14.7 13.2 13.1 13.8 10 11.5 11.9 11.9 11.9 12.3 10.1 8.2 8.9 9.4 5 6.8 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Data Source: WV Health Statistics Center, Vital Surveillance System and CDC Wonder Rates are adjusted by age to the 2000 US Standard Million. 3 Mullins

2 Maternal and Child Health Impact

Neonatal ICUs at Capacity

Lack of Increasing Available Numbers of Treatment Children in Centers Foster Care

Increased Increased Substance Enrollment in Abuse Early Identified in Intervention Infant Deaths

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CoIIN

Infant Mortality Innovation and Improvement Network (CoIIN) • SIDS/SUID/Safe Sleep . Improve safe sleep practices. • Smoking Cessation . Reduce smoking before, during and/or after pregnancy. • Prevention of preterm and early term births . Increase appropriate utilization of 17‐P OH progesterone and/or reduce early elective deliveries.

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3 Substance Abuse Trends – Select Indicators 1,000

900

800

700

600 OCME Cases x 10 Opioid Deaths 500 Foster Care/0‐35 Mths NAS Revenue (in Millions) 400

300

200

100

6 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Standardized Definition • In September 2014, West Virginia neonatologists and pediatricians met with coders and members of the Perinatal Partnership to develop a standardized definition for neonatal withdrawal and guidance on documenting exposure and withdrawal in newborns. o Neonatal Abstinence Syndrome (NAS) includes neonatal withdrawal from many substances, not just opiates; o It is exposure with clinical symptoms; and o It is not limited to those cases that require pharmacological treatment.

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4 Intrauterine Substance Exposure

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Initial Challenges

Data Infrastructure Expertise

Treatment Options

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5 Critical Partneships

Public Health

Perinatal Medicaid Partnership

Behavioral Social Health Services

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Perinatal Partnership

• Founded in 2006 to bring together individuals and organizations involved in all aspects of perinatal care. • The Partnership formed the Substance Use in Pregnancy Committee to: o Make policy recommendations; o Identify best practices; and o Develop a collaborative and coordinated approach to best meet the needs of this high risk population.

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6 Funders

• Claude Worthington Benedum Foundation • West Virginia Department of Health and Human Resources o Bureau for Behavioral Health and Health Facilities o Bureau for Public Health, Maternal Child and Family Health

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Drug Free Moms and Babies

Prevention Early Intervention

Integrated and Comprehensive Care

Addiction Treatment Recovery Support Services

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7 Hancock

Brooke

Ohio WVU OB‐GYN Marshall Department

Wetzel Monongalia Pleas- Morgan ants Tyler Marion Berkeley Preston Mineral Jeff- Taylor Dodd- Harrison Hampshire erson ridge Wood Ritchie Barbour Tucker Grant Wirt Hardy Lewis Upshur Shenandoah Cal- Gilmer houn Mason Jackson Community Health Thomas Memorial Randolph Roane Hospital Braxton Pendleton

Putnam Webster Cabell Kanawha Clay Nicholas Pocahontas Lincoln Wayne Boone Fayette Greenbrier Mingo Logan Greenbrier Physicians Raleigh Clinic, Inc. Sum- Wyoming mers Monroe

McDowell Mercer

Mullins WV Drug Free Moms and Babies Sites

Key Aspects

• Uniform Screening • Integrated and Comprehensive Care • Long‐Term Follow‐Up • Program Evaluation • Provider Outreach

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8 Results

Availability of Improved Increased Case Identification Collaboration Management

Increase in 429 Participants Self‐Referrals

72‐95% Negative for Illicit Substance at Delivery

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Lessons Learned

• Requires investments in time, flexibility, and patience. • Trust takes time and affects early enrollment. • Transportation and childcare are significant barriers. • Co‐morbidities are common and complicate treatment. • Coordinating care with physicians in private practice is difficult. • Following women past the postpartum period is challenging. • Recovery coaching services are often hard to locate and may be difficult to manage. • Sustainability plans should be incorporated early.

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9 Contact Information

Christina Mullins, Director West Virginia Department of Health and Human Resources Bureau for Public Health Office of Maternal, Child and Family Health 350 Capitol Street, Room 427 Charleston, WV 25301 Email: [email protected] Phone: 304‐356‐4392

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