Moms on Meds
description
Transcript of Moms on Meds
Moms on MedsSubstance Abuse During Pregnancy:
Jennifer Anderson Maddron, M.D.
Prescription Painkiller Overdoses. July 2013 • Approximately 18 women die every day
of a prescription painkiller overdose in the US. More than 6,600 deaths in 2010
• Deaths from prescription painkiller overdoses among women have increased more than 400% since 1999, compared to 265% increase among men
• Prescription painkillers are involved in 1 in 10 suicides among women.
• For every woman who dies of a prescription painkiller overdose, 30 go to the ER for painkiller misuse or abuse
• “Prescription Painkiller Overdoses”. (2013). Retrieved on August 4, 2013, from http://www.cdc.gov/vitalsigns/PrescriptionPainkillerOverdoses/
Prescription painkiller overdose deaths are a growing problem among women
2010 National Survey on Drug Use and Health
4.4% of pregnant women reported use of an illicit substance within the past 30 days
Substance Abuse and Mental Health Services Administration. Results from the 2010 National Survey on Drug Use and Health: summary of national findings. NSDUH Series H-41. HHS Publication No. (SMA) 11-4658. Rockville (MD) SAHMSA: 2011
Deliveries at LeConte Medical Center
2011 2012 2013 (through June)0
200
400
600
800
1000
1200
938 Births 960 Births
98 Moms+ UDS 62 Moms
+ UDS
25 Mec +babies 25 Mec +
babies
465 Births
15 Moms +UDS
5 Mec +babies
81 Babies + UDS 51 Babies
+ UDS 13 Babies+ UDS
NICU Transfers To East Tennessee Children’s Hospital
2011 2012 2013 (through June)
0
5
10
15
20
25
30
35
40
TotalDrug Related
38 Transfers
19 Drug RelatedTransfers
34 Transfers
13 Drug Related Transfers
14 Drug RelatedTransfers
17 Transfers
82%50% 40%
Maternal Complications of Substance Abuse
• Many barriers exist for pregnant substance abusers
• Lifestyle issues may result in pregnant women engaging in high risk behavior– Prostitution– Sharing of IV needles– Intimate Partner Violence– Theft and other criminal
activities
Maternal Complications of Substance Abuse
Confounding variables of substance abuse• Socioeconomic status• Ethnicity• Access to prenatal care• Poly-substance abuse
Substances Most Commonly Abused During Pregnancy
• Tobacco• Alcohol• Marijuana• Opiates• Cocaine• Benzodiazepines• Amphetamines• Hallucinogens
Opioid Addiction• Oxycodone• Hydrocodone• Methadone• Roxicodone• Heroin• Fentanyl• Meperidine• Hydromorphon
e• Propoxyphene
Opioid use in Pregnancy: Maternal Complications
• Altered Mental Status• Somnolence• Respiratory Depression• Death• IV Use may result in
– Hepatitis B & C– HIV– Skin infections– Endocarditis– Sepsis
Opioid Effects on PregnancyAntenatal Complications
• Preterm Delivery• Growth Restriction• Low Birth Weight• Placental Abruption• Fetal Death
Neonatal Effects• Neonatal Abstinence
Syndrome (NAS)
Neonatal Abstinence Syndrome (NAS)
Constellation of withdrawal symptoms Central Nervous System
Inconsolability, high-pitched crying, skin excoriation, hyperactive reflexes, tremors, seizures
Gastrointestinal System Poor feeding, excessive sucking, feeding intolerance, loose or watery stools
Autonomic/metabolic Sweating, nasal stuffiness, sneezing, fever, tachypnea, mottling
Treatment options
• Holistic Multidisciplinary Approach to treatment of Neonatal Abstinence Syndrome– Non-pharmacological
• Cuddler• Environmental • Diet
– Pharmacological• Narcotics• Non-narcotics
Pharmacological
Treatment• Approximately 67% of babies
– Are weaned from opioid in about 20 days
– Do not require adjuvant treatment– Stay in the NICU approximately 24
days
• Approximately 33% of babies– Require weaning time of 60 days
(range up to 155 days)– Require adjuvant treatment with up to
two additional medications– Stay in the NICU for about 68 days
(some up to 155 days)
Mother’s TennCare status at time of delivery for NAS children
TennCare cost associated with treatment of NAS infants
Treatment of Substance Abuse During Pregnancy
Screening• Universal Screening of all
women before and during pregnancy
• Identify women currently using illicit substances & women at risk
• Toxicology testing: Urine Drug Screens
Intervention• Multidisciplinary approach
needed to address Physical, Psychological and social issues– Obstetrical and Neonatal Care– Addiction Medicine Specialist– Mental Health Services– Social Services
Treatment of Opioid Addiction in Pregnancy
• For Opioid addicted Pregnant patients:– Detoxification
• Relapse rates are high and dangerous
– Opioid Replacement Therapy• Methadone versus Buprenorphine
– Alcohol and Drug Counseling– Treatment of Co-existing Mental
Health Disorders
Treatment of Opioid Addiction in Pregnancy
• “Comprehensive care provided at one location is cost effective and produces better outcomes for both mother and child.”Early Start Program at Kaiser
Permanente, CaliforniaPatients who were screened, assessed and
treated had lower rates of preterm delivery, low birth weight, and neonatal-assisted ventilation
Wong, S. (2011, April). Substance Use in Pregnancy. Journal of Obstetrics and Gynaecology Canada. 33(4): 367-384
American College of Obstetrics & Gynecology Committee Opinion in 2004
wrote that “using a protocol for universal screening, brief intervention, and referral to treatment…results in a mean net savings of $4644 in medical expenses per mother/ infant pair.”
Treatment Cost Considerations
One year in prison
$51-$73/day $25,900
Outpatient $15/day x 120 days
$1,800
Intensive Outpatient
9 hrs/week x 6 months maintenance
$2,500
Methadone Maintenance
$13/day x 300 days
$3,900
Short term residential treatment
$130/day x 30 days + $400 x 25 weeks
$4,400
Long term residential treatment
$49/day x 140 days
$6,800Reference: Position Paper on Drug Policy published by the Physician Leadership on National Drug Policy January, 2000. Data source: Center for Substance Abuse Treatment, Federal Bureau of Prisons. 1997 National Treatment Improvement Evaluation Study
Annual treatment cost for a person with drug addiction
Pregnancy is an ideal time to provide intervention to women with substance abuse problems, as motivation to modify harmful behavior is increased.