Report charts hike in Ohio newborns exposed to opioids

The condition is known medically as Neonatal Abstinence Syndrome (NAS). NAS is a set of symptoms associated with withdrawal from opioids and other drugs in infants whose mothers were taking these substances during pregnancy.

Symptoms can include low birthweight, seizures, excessive crying, breathing problems, eating and sleeping difficulties, and a variety of other problems, according to the report.

The report shows Ohio counties colored on a five-tier sliding scale related to the incidence of NAS per 1,000 births over a five-year average between 2009 and 2013.

Three counties have the highest rate – Pike, Scioto and Lawrence counties in southern Ohio. Only two counties have the next highest rate – Pickaway and Athens.

Babies born in Ohio’s Appalachian region are almost twice as likely as the average Ohio newborn to be diagnosed with NAS, the report said.

The rate of babies with NAS discharged from the hospital grew by 578 percent between the 2004-2008 and 2009-2013 time periods, according to the report. Nine of the top 10 counties with the highest rates of NAS in Ohio are in Appalachia, the report said.

“Babies with NAS often require longer hospital stays than other newborns so that they can receive treatment for withdrawal, which in turn increases hospitalization costs,” the report said.

Newborns with NAS spent almost 25,000 days in Ohio hospitals in 2013 with health-care expenses totaling nearly $100 million.

The new report, “Ohio’s Appalachian Children at a Crossroads,” looked at many aspects of childhood in Appalachia including poverty, health care and education.

The issue of NAS was discussed at a roundtable meeting at the Athens Community Center Sept. 23, with Dr. Joe Gay from Health Recovery Services in Athens, and registered nurse Pam Born, of OhioHealth O’Bleness Hospital, giving a presentation on the issue.

Gay and Born discussed an initiative to provide help for mothers with addiction issues and a program called Maternal Opiate Medical Support (MOMS).

Gay provided an overview of the growth of opiate abuse in Ohio, noting that this includes not only the abuse of the illegal drug heroin, but also what are known as prescription opioids, which are prescribed for pain management and including Oxycontin, Percocet, Vicodin, Demerol, Morphine and Fentanyl, among others.

Gay said that while these drugs manage pain, they also produce a euphoria in users that is highly addictive. He shared statistics showing that unintentional drug overdoses in Ohio have skyrocketed, as have admissions for opiate-addiction treatment. 

“In Ohio we have had a tsunami of opiate use,” he said, adding that in 2000 there were 427 overdose deaths and in 2015 there were 3,050.

The number of people being treated has gone from 7 percent of those seeking drug and alcohol addiction help to 37 percent.

“Right now there are more people being treated for opiate problems in the state system than for alcohol problems,” he said.

Gay said that the MOMS program includes maternal care, pre-natal care, care of the infant at birth to address NAS, post-natal care, and continuing support and addiction treatment for the mother.

“One of the big dangers to infants when their moms are addicted is the fetus being subjected to withdrawal,” he said. “When women are addicted to opiates, opiates dominate their life. There isn’t much room for anything else, including their unborn child.”

If the woman can be stabilized with medication, the mother often starts bonding with the unborn child and health-care professionals can begin to offer behavioral-based treatment as well.

Boyd said the NAS crisis was identified in 2012, and a coalition was formed between Athens Medical Associates Obstetrics and Gynecology, HRS, Ohio University’s Heritage College of Osteopathic Medicine, and University Medical Associates.

The coalition has focused on innovative care. Despite the high poverty in Athens County, she said, state leaders began to notice statistics showing pregnant women in the county were demonstrating earlier entry into prenatal care, lower prematurity rates, higher birth weights and lower NAS scores.

The Ohio MOMS Project was formulated as a $4.2 million pilot program aimed at addressing NAS, she said. The three-year project provided services for about 200 mothers and babies at four sites in the state, including in Columbus, Cincinnati, Cleveland and at HRS in Athens.

The project saw positive outcomes, Boyd said, with OU-HCOM’s Family Navigator Program finding that 87 percent of babies born to high-risk women who are addicted meeting all outcomes for health birth.

Though the three-year pilot project is over and enrollment in the Ohio MOMS Project closed, Boyd said, the local collaboration will continue.

She said tool-kits have been developed to help physician groups duplicate best practices.

“It takes a village,” Boyd said. “The MOMS Collaborative in Athens will continue to face the opiate challenge together.”