Over the past decade, the opioid epidemic has come more into the limelight as politicians and media begin to recognize the catastrophic impact it has had on our communities. In 2017, the Department of Health and Human Services declared the Opioid Crisis a state of public emergency and announced a plan to combat the problem that was killing over 130 people every day.
According to statistics from the HHS, data from 2016 and 2017 suggest that over 11 million people in the country misused prescription opioids and over 2 million people had an opioid use disorder. Increased prescription of opioid medications and prescription painkillers has lead to this problem spiraling out of control to the point we are at today. Deaths from opioids began to rise in the early 2000’s as the United States consumed 85 percent of the oxycodone and 99 percent of the hydrocodone in the world, despite only having 5 percent on the global population.
While there are efforts being done to attempt to curb the epidemic, no major results have been seen yet. The problem has become so severe that children, and even newborns are feeling the effects. Neonatal Abstinence Syndrome has become more prevalent among newborn children as the opioid crisis continues to grow. In fact, babies that are born with the syndrome have increased five fold from 2000 to 2009.
What is Neonatal Abstinence Syndrome?
Every 25 minutes a baby is born suffering from opiate withdrawal. In 2012 an estimated 21,732 babies were born with the syndrome.
Increased presence of the syndrome means increased hospital stays. Newborns with NAS spent an average of 16.9 days compared to 2.1 days for newborns born without the syndrome. This equates to an increase of more than $63,000 in hospital bills.
Since the advent of the opioid epidemic in the early 2000’s, the number of Neonatal Abstinence Syndrome diagnosis in newborns has skyrocketed.
But what is exactly does this syndrome do?
Neonatal Abstinence Syndrome from Opioids is a multi-system disorder that affects the neurological and gastrointestinal systems of the body. NAS is the result of chronic exposure to opioids that infants are receiving while in the womb.
Each baby born with the syndrome suffers from different symptoms depending on the exact situation that they are facing. However, some common symptoms that come with the syndrome include:
- Excessive crying
- Fever and unstable temperature
Babies that are born premature have a lower risk of withdrawal symptoms or have less severe symptoms and they can recover more quickly. However, it should be noted that women who use drugs may be less likely to seek prenatal care which can increase the risks for her and her baby.
There are treatment options that are effective for babies suffering from NAS. However, treatment is entirely dependent on the baby’s specific situation. But one option for treatment is medication from the same family of drugs as the baby is withdrawing from, which are used to control the withdrawal and gradually wean the baby off the drug.
According to the Journal of the Oklahoma State Medical Association, opioid use can have disastrous effects on brain development. Multiple researchers have reported developmental and behavioral problems in infants with prenatal drug exposure. However, outcomes are difficult to predict as they often depend on the complex nuances and experiences that lead to drug addiction in the first place.
Opioid Use During Pregnancy
As prescription drugs took off throughout the 2000’s and 2010’s, prescriptions and abuse of the painkillers lead to more deaths across the country. According to The American College of Obstetricians and Gynecologists (ACOG), opioid use in pregnancy has grown parallel along with the epidemic.
In 2012, health care providers in the country wrote more than 259 million prescriptions for opioids, twice as many as in 1998 and the rate of death associated with opioids rose nearly 400 percent between 2000 and 2014.
Because opioids can be effective in reducing pain signals in the body, they have been an obvious choice for pregnant women who are experiencing pain in the abdomen and other areas. However, opioids have the negative side effects of causing serious changes to the metabolism, nervous system, and pleasure receptors in the brain.
Opioid use during pregnancy is something that has been evaluated in a number of studies. Many of these early reports did not show an increase risk of birth defects for exposure to oxycodone and other opioids.
Overall, the concern associated with a potential small increased risk of birth defects among pregnant women who use opioids as prescribed is incomparable to the clear risks that come from ongoing misuse and abuse of opioids by pregnant women.
Pregnant women with opioid use disorder often suffer from mental health conditions including:
- Post-traumatic stress disorder
- History of trauma
There are a number of risks that taking opioids during pregnancy can cause besides NAS, including:
- Neural tube defects
- Congenital heart defects
- Preterm delivery
- Stunted Growth
However, many women need to take medicine during pregnancy, and some need opioid pain medication specifically. A few preventative measures can be taken to minimize the risks associated with using opioids during pregnancy.
A few of these measures include taking opioids for the shortest time possible, carefully following prescription instructions, and taking the lowest possible dose that will help.
The Problem in Oklahoma
We’ve already discussed how the Opioid Crisis has affected the country, but some states have gotten him harder than others. Oklahoma is one state in particular that has seen a its citizens disproportionately affected by the crisis.
According to a report done by the Journal of the Oklahoma State Medical Association in 2015, Oklahoma healthcare providers wrote the equivalent of one opioid prescription for every Oklahoman, a rate that was 30 percent higher than the national average. Once someone who was being prescribed opioids can no longer obtain their prescription, they may turn to cheaper alternatives that are available, such as heroin.
In the four-year period between 2012 and 2016, heroin overdose deaths in the state more than doubled.
However, even the statistics related to prescription drugs specifically are troubling.
In 2012 an average of 2.5 opioid prescriptions were filled per pregnant woman in the state. One woman even filled 29 prescriptions during her pregnancy. According to the Oklahoma Health Care Authority, the two most commonly prescribed opioid for pregnant women were hydrocodone and oxycodone, making up over 82 percent of prescriptions.
Similarly, in according to a healthcare provider in the state, the rate of NAS in 1000 live births increased by 450 percent from 2008 to 2014.
More recent statistics from the Final Report done by the Oklahoma Commission on Opioid Abuse said that the number of drug-exposed newborns is consistently rising and was expected to double in 2017 to over 1000.
“After birth, these babies have high-pitched cries, are inconsolable, and shake violently as a result of the withdrawal they experience,” the report said. “In addition, their hospital stays are weeks longer than that of healthy newborns and the medical costs are, on average, more than ten times higher. While we are aware that the problem exists, experts advised us that there is a lack of uniform data available to comprehensively study NAS.”
As a result of the increasing using of heroin and other opioids, it was determined that treating pregnant women with Medication-Assisted Treatment (MAT) using drugs like methadone or buprenorphine is safer than illicit drug use.
MAT is used to help abusers stop and wean off opioids during their pregnancy, this is important because abrupt discontinuation of opioids can result in preterm labor and even fetal death.
However, not all pregnant mothers have access to MAT options and there is some worry that methadone can also impact a pregnancy if it is overused.
Children and Opioids
Along with newborns, the state believes that the epidemic is also having an effect on young children who are becoming increasingly exposed to prescription medications.
In their report, the Oklahoma Commission on Opioid Abuse found that there is a lack of substance abuse prevention education in schools and while some school implement drug test, most lack the funding and capabilities to implement evidence-based prevention programs.
They also pointed out the lack of sober living dorms that are available on college campuses.
The commission recommended that the state should explore educational pilot programs for middle school and high school students that focuses on the risks of opioid addiction.
It also suggested that middle school and high school athletes and coaches should be trained on the risk of addiction to pain medications after sports injuries and encourage the use of early intervention tools.
What is Being Done
Obviously, the Opioid Crisis has hit the country hard, killing tens of thousands every year and impacting millions more, including newborns and children.
There have been a number of measures implemented by the federal government and advocacy groups to raise awareness and education related to the opioid epidemic. Recently there has even been increased focus on specific aspects of the opioid crisis, including NAS.
In 2017, the National Institutes of Health saw that need for more research and education related to this nuanced issue and decided to fund a new study that would evaluate treatment options for newborns with NAS from opioids.
The study, called Advancing Clinical Trials in Neonatal Opioid Withdrawal Syndrome (ACT NOW), will evaluate the risk and severity of neonatal opioid withdrawal syndrome using clinical assessment. It is a collaborative effort between the NIH and other professional medical departments.
“Public health and research communities cannot overlook the opioid epidemic’s effects on pregnant women and their infants,” said NICHD Director Diana W. Bianchi, M.D. “ACT NOW will supplement research on opioids and pregnancy outcomes by addressing critical gaps on how best to treat and manage opioid withdrawal syndrome in newborns.”
Specifically in Oklahoma, there are certain measures that have been taken in order to reduce the effects that are being seen from the opioid crisis and Neonatal Abstinence Syndrome. For example, there have been a number of changes to opioid prescribing laws in order to reduce the access that individuals have to them.
Oklahoma has one of the highest prescription rates across the country. In 2017, the state had a prescription rate of 88.1 prescriptions per 100 people. However, this number has been decreasing over the past few years, perhaps in part to the increasing number of prescription law changes that have been implemented.
Some of these changes include:
- Denying prescriptions to people who have pleaded guilty to crimes related to controlled substances
- Denying prescription to any individual who has abused drugs in the past five years
- Drug providers are periodically required to evaluate patients on their likelihood of abuse
The state has also filed lawsuits against many pharmaceutical manufacturers, distributors, and doctors for their role in the opioid crisis. The lawsuit says that the opioid companies downplayed the risk associated with opioids and overstated the benefits.
The state also established the Oklahoma Commission on Opioid Abuse which was made to look at the current effects and consequences of the opioid epidemic in the state and to provide some recommendations on how to best go about finding a solution to the problem.
The Opioid Crisis in Oklahoma has had a detrimental effect on the country. It kills tens of thousands of people annually and affects millions more, including children and newborns. Increased prescriptions and opioid use in the country has coincided with an increase in infants born with Neonatal Abstinence Syndrome from opioids. Along with NAS, opioid use during pregnancy can lead to other major problems for the newborn. There have been measures passed by the federal government and local state laws enacted in Oklahoma to curb the opioid epidemic but major results are yet to be seen. At Landmark Recovery, a drug rehab and alcohol rehab facility in Oklahoma City, we are dedicated to healing the individuals who have become victims to the opioid abuse epidemic in the country.
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