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Epidemic Epidemic Spreading AcrossSpreading Across
the Statethe StateErica Wilson M.P.H.
Health Promotion Program DirectorEast Region
Neonatal Neonatal Abstinence Abstinence SyndromeSyndrome
What is it?What is it?
Neonatal abstinence syndrome (NAS) is a term for a group of problems a baby experiences when withdrawing from exposure to narcotics.
What Causes It?What Causes It?Almost every drug passes from the mother's blood stream through the placenta to the fetus. Illicit substances that cause drug dependence and addiction in the mother also cause the fetus to become addicted.
What Happens to the What Happens to the Baby?
At birth, the baby’s dependence on the substance continues. However, since the drug is no longer available, the baby’s central nervous system becomes overstimulated causing the symptoms of withdrawal.
What’s the What’s the Incidence of Incidence of
Neonatal Neonatal Abstinence Abstinence Syndrome?Syndrome?
• 626 cases in Tennessee as of 8/30/14 compared to 564 at same point in 2013
• Increase of 11%
Maternal County of Residence by Region August 30, 2014
# Cases % Cases
Davidson 31 5.0
East 179 28.6
Hamilton 7 1.1
Jackson/Madison 2 0.3
Knox 70 11.2
Mid-Cumberland 58 9.3
North East 89 14.2
Shelby 27 4.3
South Central 20 3.2
South East 10 1.6
Sullivan 43 6.9
Upper Cumberland 71 11.3
West 19 3.0
Total 626 100.0%
•East Tennessee continues to account for largest proportion of cases in the state (28.6%)
•3rd highest rate in the state (35/1000 births)
• Exposure source trends in East TN vary from those seen in all cases state-wide
Highest rates based on provisional county birth estimates
Why is Why is Neonatal Neonatal
Abstinence Abstinence Syndrome a Syndrome a
Concern?Concern?
The BabyThe Baby
• Tragedy and suffering of the babies and their caregivers.
• With increased likelihood of foster care, families are torn apart.
The CostThe Cost• According to current
statistics in Tennessee, the TennCare costs for a healthy newborn were $4,237 compared to an average cost of $66,973 for an infant born dependent on drugs, diagnosed with NAS.
The FutureThe Future• There may be other
economic, psychological and physiological costs associated with their medical condition at birth since it is not yet known what challenges and needs these infants will have as they grow older.
What can we do in Public Health ?
• NAS became a reportable condition in TN on January 1, 2013
• NAS Taskforce was formed July 11, 2013 – Collaborative effort with East Region and Knox
• NAS/PPI Sub-committee was formed on September 5, 2013
Primary PreventionPrimary PreventionInitiativeInitiative
LARC Pilot ProjectLARC Pilot Project
East RegionEast Region
The ProcessThe Process• CollaborationCollaboration
– Sheriff/Jail Administrator/Jail NurseSheriff/Jail Administrator/Jail Nurse
• EducationEducation– Partners (Pamphlet)Partners (Pamphlet)– Participants (PowerPoint and Pamphlet)Participants (PowerPoint and Pamphlet)
• Referrals Referrals (Referral/Follow-Up Form)(Referral/Follow-Up Form)
• Clinical ServicesClinical Services• Data Collection Data Collection (Referral/Follow-Up Form)(Referral/Follow-Up Form)
•1/14/14 – first education session at Cocke County
•As of 8/8/14, six sessions have been held– 4 at Sevier County Jail – 2 at Cocke County Jail
•119 total persons educated
•Anticipated referrals: 75 (63.0%)
•Females ranging in age 20 – 45 (avg. age: 27)
•Predominately non-Hispanic white
•Mostly residents of Sevier and Cocke County, but a few from other areas:County No. Percent
Cocke 14 32.6%Davidson 1 2.3%Jefferson 1 2.3%Knox 1 2.3%Sevier 24 55.8%Out-of-State 2 4.7%Total 43 100.0%
• Education levels
• FP barriers – 28% of referrals were
previous FP patients
• Specific drug use history including during pregnancy
• History of unplanned pregnancy
FOR HEALTH DEPARTMENT STAFF USE ONLY
CL
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ICA
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1. Was the client referred as a condition of probation/parole? Yes No 2. Is the client currently incarcerated for drug-related issues? Yes No 3. For inmates, please verify the address listed above to determine if it is the facility address.
If it is, please also ask the client for their address prior to incarceration: City:____________________ County:___________________ State:_________ Zip:____________
4. Highest level of education completed:
Some Middle School HS Diploma/GED Associates Professional Degree Some HS Some College Bachelors
5. Is the client an established Health Department FP patient? Yes No
If Yes, list date of last visit: _______________ If last visit was >1 year ago, what was the reason? Problem getting appt Appt with another provider Other (specify):__________________ Problem with BC method Not important
6. Has the client ever had child(ren) previously or currently in State custody?
Yes No Refused to answer 7. Has the client ever had child(ren) born drug-dependent?
Yes No Refused to answer If yes, how many?___________________
CL
INIC
AL
1. Has the client ever used prescription/non-prescription drugs? Yes No Refused to answer If yes, which drugs? (check all that apply) Marijuana Meth/Methamphetamines Other (specify) ____________ Cocaine/Crack/Coke Ecstasy/E/Ex Heroin Oxy/Oxycontin
2. Has the client ever used drugs during a pregnancy? Yes No Refused to answer Never pregnant If yes, which drugs? (check all that apply) Marijuana Meth/Methamphetamines Other (specify) ____________ Cocaine/Crack/Coke Ecstasy/E/Ex Heroin Oxy/Oxycontin
3. Has the client ever had an unplanned pregnancy? Yes No Refused to answer Never pregnant
4. Is the client currently taking medications for chronic pain? Yes No
5. Is the client currently taking medications for anxiety? Yes No 6. What type of birth control is the client currently using?
Condoms IUD Other (specify)_______________________________ Pills Nexplanon None
Cost SavingsCost Savings• Preventing the birth of one drug dependent Preventing the birth of one drug dependent
infant saves an average cost of $66,973.infant saves an average cost of $66,973.• Preventing the birth of one drug dependent Preventing the birth of one drug dependent
infant in each of the counties in the East infant in each of the counties in the East Region would be a cost savings of Region would be a cost savings of $1,004,595.$1,004,595.
• Preventing the birth of one drug dependent Preventing the birth of one drug dependent infant in each of the counties in Tennessee infant in each of the counties in Tennessee would be a cost savings of $6,362,435.would be a cost savings of $6,362,435.
LARC Pilot Update – LARC Pilot Update – September 10, 2014September 10, 2014
Cocke Sevier Comments
Number of Referrals Received
14 29 Total: 43
Potential Total Savings: 43 times $67,000.00 = $2.8 Mil
QuestionsQuestions
• Erica Wilson M.P.H.• Health Promotion Program Director• East TN Regional Health Office• [email protected]• (865) 909-9404 Ext. 103
