43
New federal law addresses problems related to prenatal opioid use
YOUNGSTOWN
Each year in the Mahoning Valley, dozens of newborn babies enter the world and, within a couple of days, begin to experience the uncomfortable symptoms of opioid withdrawal.
That condition, called neonatal abstinence syndrome – or NAS – is the focus of the “Protecting Our Infants Act of 2015,” which U.S. President Barack Obama signed into law this week.
The bill was cosponsored by all of the Valley’s congressional representatives: U.S. Reps. Tim Ryan of Howland, D-13th, and Bill Johnson of Marietta, R-6th, as well as U.S. Sens. Sherrod Brown, a Democrat from Cleveland, and Rob Portman, a Republican from the Cincinnati area.
The law requires the U.S. Department of Health and Human Services to review its activities related to prenatal opioid use; develop a strategy to address gaps in research and duplication among federal programs; and conduct a study and come up with recommendations for prevention and treatment of prenatal opioid - use disorders, among other provisions.
“Because prevention and treatment efforts vary widely from state to state, the new law will help identify evidence-based approaches to care for these babies and their mothers,” said Michael Botticelli, director of the White House Office of National Drug Control Policy, in a release.
The law is a response to an increase in the incidence of NAS; one study indicates that the number of infants in the U.S. displaying symptoms of drug withdrawal increased fivefold between 2000 and 2012.
In the Valley, medical professionals noticed that trend starting in 2007, said Dr. Elena Rossi, neonatologist and associate chairwoman of pediatrics at Akron Children’s Hospital Mahoning Valley, in an interview earlier this year.
Over the last eight years, her team has developed a standardized practice for NAS cases that begins before the babies are born.
Rossi sees between 60 to 100 infants each year that are in need of the highest level of treatment for NAS, which is medication-management. There are many other NAS cases in which medication is not required, she said.
“The signs and symptoms are crying, crying, crying – inconsolably; poor feeding; poor sleeping, fever,” she said. “When we see these symptoms in a newborn, we have to find a way to relieve these symptoms.”
In those more-extreme cases, withdrawal symptoms typically are managed with morphine, in combination with other treatments.
The origins of NAS cases vary, Rossi said, from mothers who use illicit drugs such as heroin, to mothers who use prescribed medications such as methadone or buprenorphine to manage an opioid-use disorder. Mothers who combine opioids with other medications pose the greatest risk to babies, she said.
Since Rossi’s team first began to deal with opioid withdrawal in infants, they have reduced the average length of treatment from roughly 25 days to 14 and have seen a leveling off in the number of babies in need of medication management. They have observed better outcomes as medication-assisted treatment for substance abuse has shifted toward buprenorphine, and away from methadone.
“We get very good results most of the time,” she said, noting that the greatest danger is when parents do not seek treatment for newborns experiencing withdrawal symptoms.
“Untreated neonatal abstinence syndrome is a very ugly thing for the baby, for the family, and the risk of death is real,” she said.
She also cautioned that pregnant women should not stop medication-assisted treatment.
“Some women really want to get off the Subutex [brand name for buprenorphine] while they’re pregnant,” she said. “They actually self-decrease the dose, and the message that I’d like to give is to not do that. The environment for the infant is not safe if the mother stops the medication abruptly, or weans herself off.”