Neonatal Abstinence Syndrome

Let’s make West Virginia a great place to be a kid! Issue Brief No. 4 • 2018

Every Kid Counts in WV Neonatal Abstinence Syndrome “One of the greatest challenges we face is access to behavioral health services for women who are pregnant along with the management of the social determinants of health to which they are exposed. Let’s not forget the real opportunity is upstream with prevention and treatment for pregnant women who suffer from this terrible disease of substance use disorder. We must dedicate our talent and resources to ensure women are able to deliver a baby who gets a well-deserved fresh start at life free from the effects of withdrawal. The risk to our future is great. It takes the entire community to wrap the necessary services around this patient population. Our ultimate goal is to eradicate NAS!”

–Andrew Weber, CAMC Women and Children’s Hospital Vice President & Administrator WV KIDS COUNT Board President

A publication of West Virginia KIDS COUNT, funded with support from the Claude Worthington Benedum Foundation

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West Virginia KIDS COUNT provides trusted data about the well-being of children and builds alliances to advocate for what kids need across the Mountain State. We provide state legislators, public officials and child advocates with reliable data, policy recommendations and tools needed to advance sound policies that benefit West Virginia’s children and families. We are a part of a national KIDS COUNT network through the support of the Annie E. Casey Foundation.

“The Drug Free Moms and Helping Moms and Babies Affected by Substance Use Babies program is succeeding in identifying women in pregnancy Every 15 minutes a baby in the United States is To address this devastating crisis, the West Virginia with substance use disorders born with neonatal abstinence syndrome (NAS), a Perinatal Partnership developed the Drug Free Moms condition caused by exposure to opioids and other and Babies program to help pregnant women with and ensuring they receive the substances before birth.(1) The affected babies may be substance use disorders have healthier outcomes for care they need to deliver healthy born prematurely, have low birthweight, have feeding them and their babies. The comprehensive, integrated babies.” difficulties, suffer from irritability, seizures, and/or program provides a broad range of services, including -Janine Breyel experience significantly longer hospital stays.(2) health, treatment, social and recovery support Project Director, Substance Use in services. Pregnancy Initiatives From 2004-2014, the rate of infants diagnosed with West Virginia Perinatal Partnership NAS rose 433% in the United States.(1) Largely driven The Drug Free Moms and Babies program was made by the opioid epidemic, this national crisis hit hardest possible through the generous support of the Claude W in West Virginia. Our state has the highest rate of Benedum Foundation and the West Virginia Department NAS with a rate of 5% which is more than six times of Health & Human Resources, Bureau for Behavioral the national average.(3) Health and Health Facilities and the Office of Maternal, Child and Family Health. 1

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cope with things NAS causes many symptoms affecting a number While substance use in pregnancy can lead to of the baby’s systems, including gastrointestinal, multiple and costly health and social problems that I wasn’t able central nervous system, respiratory and autonomic for both mother and baby, West Virginia has systems. Specifically, babies with NAS often have the implemented many initiatives to address the issue. to cope with following symptoms: Over the last several years, the state has seen improvements in screening for substance use • jitteriness in pregnancy, developed a standardized criteria before. If it is • fussiness for diagnosing NAS, and developed a statewide • high pitched inconsolable crying reporting system so that these babies are identified wasn’t for PC, I • loose watery stools at birth. • disorganized and weak sucking would probably • spitting up Since 2012, the Drug Free Moms and Babies • sweating program of the West Virginia Perinatal Partnership still be homeless • sensitivity to light, sound and touch has sought to provide integrated and comprehensive • stuffy nose services for pregnant women with substance use and probably • sneezing a lot disorders (SUD) to help with healthier outcomes wouldn’t have • yawning a lot for both moms and their babies. custody of my son.” -Mary, Pregnancy Connections participant (Drug Free Moms and Babies at Thomas Health)

Started in 2012 as a pilot project in four sites across birth rate -- the program was expanded to seven the state, the Drug Free Moms and Babies program additional sites in the state. Recent additional funds identifies women in pregnancy with substance use will allow the program to expand to five more sites. disorders and ensures they receive needed maternity Importantly, 16 of the 24 hospitals that deliver babies care, behavioral health care and other social support in WV will have access to integrated programs for services. For those women with an opioid addiction, pregnant and postpartum women through the Drug medication assisted treatment (MAT) is provided. Free Moms and Babies program.

The program addresses the use of all harmful Women participating in these programs will have substances, including tobacco, and is not limited to only access to a broad range of health, treatment, social illegal substances. Screening, Brief Intervention and and recovery support services. The program identifies Referral to Treatment (SBIRT) is a key feature of the all women’s needs that will help her have a healthy program, as is long-term follow-up. pregnancy and healthy baby, not just her healthcare or substance abuse treatment needs. Program participants In 2018, after promising results of the pilot project are provided help in accessing nutrition, housing, demonstrated a significant decrease in drug use and transportation, vocational/educational training, and improved birth outcomes -- such as a lower preterm family planning services.

Map Provided by: WV Office of Maternal, Child & Family Health in collaboration with WVU Birth Score. 2 3

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Almost every substance a pregnant woman takes As would be expected, lack of sleep, eating “Pregnancy can be passed on to her baby. This means that the difficulties and other symptoms make it difficult for “The program has 100% changed my life. I was pregnant, homeless and I “A Baby is baby may be impacted by the caffeine, alcohol, drugs, a newborn to thrive. Connections (PC) nicotine, medications and other substances that the had no hope. I’m in a really good place now. My baby is 9 months old now. born with woman consumes during her pregnancy. Because there is no way to know which babies will has changed my go through withdrawal, babies who are exposed to He’s super healthy and super happy. The doctor says he is meeting all his a need to Depending upon the substance used in pregnancy, certain drugs before birth are kept at the hospital the baby may become dependent on the to be observed after delivery. A scoring system, milestones. Now my life is pretty awesome. I never thought I would be where life and my two substance(s) the mother uses. Once the baby is measuring the presence and severity of symptoms, be loved – born and the source of the substance is cut-off, is used to determine a diagnosis of NAS. Babies I’m at today.” son’s lives for the the baby may experience the physical symptoms with severe symptoms may require medication to and never of withdrawal. This is called Neonatal Abstinence help manage their withdrawal. Those with severe -Sara, Drug Free Moms and Babies participant better. It’s made Syndrome (NAS) or neonatal withdrawal. There withdrawal symptoms may spend between two outgrows it.” is no way to know which babies will experience to three months in the hospital weaning from the –Frank A. Clark me be able to withdrawal or how severe the symptoms will be. medications needed to manage their symptoms. cope with things NAS causes many symptoms affecting a number While substance use in pregnancy can lead to of the baby’s systems, including gastrointestinal, multiple and costly health and social problems that I wasn’t able central nervous system, respiratory and autonomic for both mother and baby, West Virginia has systems. Specifically, babies with NAS often have the implemented many initiatives to address the issue. to cope with following symptoms: Over the last several years, the state has seen improvements in screening for substance use • jitteriness in pregnancy, developed a standardized criteria “For all the before. If it is • fussiness for diagnosing NAS, and developed a statewide • high pitched inconsolable crying reporting system so that these babies are identified things my wasn’t for PC, I • loose watery stools at birth. • disorganized and weak sucking hands have would probably • spitting up Since 2012, the Drug Free Moms and Babies • sweating program of the West Virginia Perinatal Partnership held the best still be homeless • sensitivity to light, sound and touch has sought to provide integrated and comprehensive • stuffy nose services for pregnant women with substance use by far is you.” and probably • sneezing a lot disorders (SUD) to help with healthier outcomes –Unknown wouldn’t have • yawning a lot for both moms and their babies. custody of my son.” -Mary, Pregnancy “A baby fills a Connections participant (Drug Free Moms and Babies place in your at Thomas Health) heart you never knew was empty.” –Unknown

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Despite significant gains in meeting the needs of While the Drug Free Moms and Babies (DFMB) pregnant and parenting women with substance use programs have been successful in reaching medically disorders and their children, too many families in underserved, high-risk populations and reducing West Virginia KIDS COUNT West Virginia are not getting the care they need. illicit substance use, they are supported through provides the most trusted data Lack of substance use treatment services, especially grant funding. The complexity of our health care about the well-being of children and builds alliances to advocate for pregnant women, remains a problem, particularly service delivery and financing system means that for what kids need. in rural areas. Stigma is often a barrier even when programs are not guaranteed sustainable financing services are available. Sustaining and expanding through reimbursement. Despite good outcomes, Drug Free Moms and Babies programs so that the continuation of DFMB programs is not all pregnant women can access the maternity, guaranteed once grant funding runs out. Contact Us behavioral health, recovery and social support If you have any questions or Ensuring a comprehensive system of care for the services they need remains a challenge. would like more information babies affected by substance use before birth is about our organization, you While there is hope that the opioid epidemic another challenge. The state has made great strides can email us at: may be leveling off, (for example, drug overdose in identifying these babies. The challenge now is to [email protected] deaths are not rising at the same percentage as work on the development of a system that makes or communicate through in years past), new drugs of abuse are emerging. sure these families get the services they need, the other options below. Methamphetamines in particular seems to be specialized health care needs of infants are met and making a comeback. that no family falls through the cracks. Too often One Creative Place families leave the hospital without the ability to Charleston, WV 25301 Tobacco use in pregnancy continues to be a access the services they need – sometimes these widespread, persistent problem, and is linked to a babies are put into foster care, and other times the Office 304.345.2101 variety of poor health outcomes for both mom and families return to a rural area where services are Mobile: 304.541.7553 baby, including prematurity and Sudden Unexplained limited. Infant Death (SUIDS). It also makes the symptoms References of NAS worse for those babies experiencing Although West Virginia has been hit particularly withdrawal. hard by the opioid epidemic, as evidenced by 1) “Incidence and Costs of Neonatal Abstinence Syndrome alarmingly high rates of overdose deaths and NAS, Among Infants With Medicaid: Stigma prevents many from getting the help they promising programs have been implemented to 2004–2014”, Pediatrics, March 2018, Tyler N.A. Winkelman, need. Pregnant women in particular are often address these problems. The Drug Free Moms and Nicole Villapiano, Katy B. ashamed and may be reluctant to seek help. Babies program is succeeding in identifying women Kozhimannil, Matthew M. Davis, Stephen W. Patrick Fear of losing custody of their baby and other in pregnancy with substance use disorders and children prevent many women from asking for ensuring they receive the care they need to deliver http://pediatrics.aappublications. org/content/early/2018/03/21/ help. Substance use disorders and treatment are healthy babies. peds.2017-3520 not well understood, so even those women who are in treatment often still face discrimination and 2) JAMA, May 9, 2012. Patrick, S., et. Al, “Neonatal Abstinence judgment by health care professionals and others in Syndrome and Associated Health their community. Care Expenditures, U.S. 2000- For more information, check out the 2009 West Virginia Perinatal Partnership website: 3) “Capturing the Statewide https://wvperinatal.org/initiatives/substance- Incidence of Neonatal use-during-pregnancy/ Abstinence Syndrome in Real Time: The West Virginia Experience” Umer, Amna, et.al., Pediatrics Research. October 4, 2018.

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