In just slightly more than nine months this year, more babies in Tennessee have been born dependent on drugs their mothers took during pregnancy than in all of 2011. By the first week of October, 643 babies were born dependent, compared with 629 for all of 2011.
“At the current rate this epidemic is progressing, we are projecting more than 800 drug dependent newborns by the end of this year,” said TDH Commissioner John Dreyzehner, MD, MPH. “This is a preventable condition that can be largely eliminated; preventing addiction, thoughtful treatment and preventing unintended pregnancy are the most productive conversations we can have right now.”
“Our data show the majority of these births involved a mother taking medicine prescribed by a health care provider,” Dreyzehner continued. “We need improved conversations between women of childbearing age and their doctors about waiting for a safer time and preventing an unintended pregnancy while the mother is in medically-necessary treatment and referral to treatment that includes addressing this for women using these powerful drugs illicitly.”
In reviewing reportable information of mothers delivering drug dependent newborns thus far this year, data show:
• 42.1 percent used only substances prescribed to them for legitimate treatment
• 20.4 percent used a mix of prescribed and non-prescribed substances
• 33.4 percent used substances obtained through illegal sources
• 4.0 percent were unable to provide the exact source of substances
Because there are important and not fully understood questions about what challenges and needs these infants will have as they grow older, there may be other economic, psychological and physiological costs associated with their medical condition at birth. According to most current statistics in Tennessee, the TennCare costs for a healthy newborn were $4,237. The average cost for an infant born dependent on drugs, diagnosed with neonatal abstinence syndrome, NAS, was $66,973.
In September, the Food and Drug Administration responded to requests from Tennessee officials and others to announce it was implementing its most prominent position in labeling: a boxed warning. The warning is intended to increase awareness about the relationship between some powerful narcotics, NAS, and a subset condition of NAS known as neonatal opioid withdrawal syndrome, NOWS.
While FDA-approved labeling of these pain relievers already describes the effects on newborns of exposure to these drugs while in the mother's womb and warns against use by women during pregnancy and labor and while nursing, the new labeling will provide more details. It is also intended to elevate awareness about the need for caution when prescribing to women of childbearing age.
The problem of drug-dependent newborns is complex, stemming from the larger substance abuse epidemic. Tennessee has a combination of measures to reduce the rate of newborns dependent on drugs and affected by neonatal abstinence syndrome. Clinicians are now required to report NAS cases and the state has a Controlled Substance Monitoring Database that identifies who is prescribing and using certain medicines that can cause the condition. It also allows clinicians to quickly identify patients who go to many doctors to feed an addiction or to sell drugs to others.
The online database helps doctors know a patient’s prescription history, helping to combat overprescribing problems. It also aids clinicians in having conversations with their patients about planning for a pregnancy or preventing one as well as treatment options.
“Women of child-bearing age who are pregnant or become pregnant while they are also using or abusing drugs need to know that treatment is available to them,” said Tennessee Department of Mental Health and Substance Abuse Services Commissioner E. Douglas Varney. “This would apply to women who are using illegal drugs or even prescription drugs; they and their prescribers need to know what the risks are to themselves and their babies. Treatment is effective and it has been shown to help the mother and child live a long, healthy life.”
To see weekly updates on newborns dependent on drugs in Tennessee, click here.
The 2013 data is available on a weekly basis because NAS is now required to be reported in Tennessee. Previously, statistics were available only through hospital discharge data or Medicaid claims data, which may not be available for up to 18 months.