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Big jump in PA maternal and neonatal hospital stays, need for treatment, due to opioid crisis

baby withdrawal treatment opioids neonatal abstinence syndrome drug withdrawalAddiction treatment programs in Pennsylvania generally give pregnant women first priority in access to treatment. But with the opioid crisis straining already limited budgets and program resources across the Commonwealth, more access to treatment, housing, care management, and specialized programming for mothers is needed to meet demand, according to presenters at a Maternal Care Coalition forum.

Presenters at the Philadelphia program, held in September, described the impact of the opioid crisis on maternal health to a packed room of several hundred healthcare, social services, and public health providers. Local experts presented on barriers to care, funding challenges, and best practices in medication treatment and mentoring services for pregnant and parenting women, including a moving presentation from a mother in recovery, who gave birth to a baby in jail while imprisoned due to consequences of her drug addiction. 

Now we have new data to inform policy-makers about the increasing impact of the opioid epidemic on our healthcare system in Pennsylvania. The extra costs for hospital stays connected to maternal substance use are soaring.

The increase in pregnant mothers using opioids like heroin or prescription pain medications means more babies are being born with a physical dependence that requires treatment, according to a new report by an independent state agency that studies healthcare costs in Pennsylvania: the PA Health Care Cost Containment Council (PHC4). These babies often need to stay longer in the hospital to be treated for symptoms of withdrawal.

Rates of babies in hospital neonatal units (NICUs) needing withdrawal treatment have increased four-fold from 2003 to 2013 nationwide, according to a 2015 study. The research released by PHC4 shows similar increases in newborns needing more intensive treatment in the Commonwealth.

Neonatal hospital stays connected to substance use disorders (SUD’s) increased by 250% from 2000 to 2015 in Pennsylvania. This increase in hospital days fpr babies needing extra care cost an extra $20.3 million, most paid by state and federal taxpayers, since the majority of the mothers were on Medicaid (78% of the maternal stays that were related to SUDs and 38% of other maternal stays.) Our rural western and northeastern counties had the highest rates of SUD-related maternal stays. 

Maternal hospital stays were up by 510%, and of those connected to SUDs in 2015, 51.9% involved opioids, costing an additional $1.8 million. Some positive news: maternal stays related to alcohol decreased 36% and those related to cocaine decreased 61% in the 2015 data.

We do not know what percentage of the mothers in this data might have been in medication-assisted treatment (MAT) with buprenorphine or methadone. In other words, their use of opioids was prescribed appropriately and medically monitored. The research brief doesn't break down maternal opioid use to show if it was illicit or prescribed. But in the context of the current opioid epidemic, we know that illicit use has increased at unprecedented rates and is a key driver of increased hospital costs, along with the growth in prescribing of opioids for pain management.

Treatment with prescribed methadone or buprenorphine, along with counseling and behavioral support, is clinically indicated for a mother who wants to stop illicit opioid use while pregnant, because going into withdrawal if she stopped abruptly could cause her to miscarry. Unfortunately, some of the babies of mothers on prescribed MAT may have withdrawal symptoms that need to be treated and will require a longer stay in the NICU, but the health risks to the mother and baby in a relapse to heroin use, or during a sudden withdrawal from opioid use, are significant and possibly life-threatening.

A note about appropriate language for neonatal drug withdrawal  

Almost all the media reports about this data that I saw (but not the PHC4 research brief) referred to addicted babiesin their coverage. While the journalists and headline writers may be adopting a commonly used term-- it's just wrong to describe babies with withdrawal symptoms as “addicted.”Babies with neonatal abstinence syndrome, or drug withdrawal, do not have the compulsive behavior that is a defining aspect of addictive disorders; rather, they are physically dependent and require medically-managed withdrawal. Clinically inaccurate, emotionally laden language in stories about substance use disorders increases the stigma that people with substance use disorders face -- stigma that often deters them from seeking help. 



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