Drug overdoses have claimed the lives of 1,981 people in Michigan in 2015, almost half from opioid overdose — and now opioid addiction is a rapidly growing crisis among pregnant women and their babies, a group of health care leaders said today.
Expectant mothers and their children are increasingly in need of services to address this problem. Maternal opioid use is on the rise. Every 25 minutes a baby is born in the U.S. suffering from opioid withdrawal, according to the National Institute on Drug Abuse. Michigan health care organizations are developing new programs, services and recommendations to address the opioid addiction among women and their children.
“As I've cared for women and their children, before, during, and after childbirth, I've seen firsthand the devastation opioid addiction leaves in its wake,” said Michigan State Medical Society's President Cheryl Gibson Fountain, MD, who is a practicing OB-GYN in Grosse Pointe Park. “I'm proud that Michigan physicians are on the literal frontlines of a war against opioid abuse. While we've raised a lot of awareness about the crisis over the last few years -- and even taken some big, important steps towards addressing it -- it's more important than ever we redouble our commitment to solutions that work.”
Cases of infants born with neonatal abstinence syndrome (NAS) stemming from their mother’s opioid misuse in utero soared nearly 800 percent in Michigan from 2004 to 2014. Infants with NAS often experience withdrawal symptoms, including low birth weight and prematurity, feeding difficulties, tremors and extreme irritability, vomiting and diarrhea, seizures and breathing problems. Opioid exposure also can cause premature birth, birth defects, increased risk of sudden and unexplained infant death and problems with development and behavior.
To address the care that NAS babies receive at the hospital, the Michigan Neonatal Intensive Care Unit (NICU) Quality Collaborative was established. The collaborative is a group of neonatal intensive care units across the state working to standardize care for NAS babies, supported by the Michigan Department of Health and Human Services (MDHHS).
“The collaborative’s top priority was establishing guidelines to ensure infants and their mothers receive continuous care to reduce withdrawal symptoms,” said Dr. Padmani Karna, neonatologist at Sparrow Hospital and Professor at Michigan State University. “The Michigan NICU Quality Collaborative Centers have been successful in reducing withdrawal symptoms and have decreased duration of stay for NAS infants by two to three days since implementation.”
MDHHS has established the Healthy Moms, Healthy Babies initiative to improve the health of mothers using opioids and is participating in the federal Substance Abuse and Mental Health Services Administration (SAMHSA) policy academy to improve outcomes for pregnant women. MDHHS’ Children’s Services Agency also is implementing new policy, training and system changes to meet the needs of children and families.
At the local level, programs are reaching families in the areas of the state with the highest per-‐capita incidents of opioid addiction. Services such as the Nurse-‐Family Partnership, a home visiting program supported by state and federal funding through MDHHS, is serving a high-‐risk population of first-‐time, low-‐income mothers in communities such as Detroit, Flint and Kalamazoo. The voluntary program pairs nurses with expectant and new mothers struggling with a myriad of obstacles including opioid addictions.
To help combat opioid misuse statewide, MDHHS is playing a key role in the Prescription Drug and Opioid Abuse Task Force. MDHHS received a $16.37 million federal grant to enhance prevention and treatment efforts.
“This is a complex issue,” said Dr. Debra Pinals, MDHHS Medical Director of Behavioral Health and Forensic Programs. “However, through ongoing efforts to strengthen networks for prevention, identification and treatment, we aim to help reduce opioid-‐related deaths and make treatment more available for those who need it, particularly amongst vulnerable populations such as pregnant women and their children.”
Dominick Pallone, executive director of Michigan Association of Health Plans, warned that changes to the Affordable Care Act (ACA) being discussed by Congress could keep opioid misuse services and programs from reaching those who need them most. Some of those changes could allow states to opt out of requiring insurance companies to offer affordable insurance to patients with pre-‐existing conditions, including opioid addictions, leaving them without access to care and the services Michigan health care organizations are providing.
“The House-‐passed repeal of the Affordable Care Act would mean cuts to Medicaid and the Healthy Michigan Plan that covers nearly 675,000 residents,” Pallone said. “This would endanger those with pre-‐existing addictions, making fighting the opioid epidemic more difficult, especially for pregnant women and children.”