NeoTox

4New Data on the Use of Umbilical Cord Tissue to Identify Newborn Drug Exposure

8A New Paradigm in Communities Caring for and Protecting Substance Exposed Newborns

10National Heroin Use on the Rise

Clarity in Newborn Toxicology | v.6 i.2

Comforting the AfflictedA West Virginia

community advocates for

the smallest victims of

drug exposure.

Spring/Summer

2015

2 Spring/Summer 2015 NeoTox

Letter from the editor

A VOICE FOR THOSE WITH NONE

The tragedy of newborns suffering from in utero substance exposure brings us together from all walks of life to protect and care for the those whose lives are just beginning.

It is difficult not to have bad days doing the work that we do at USDTL. We are a perinatal drug testing lab, and by definition it is our job to identify infants that have been exposed to substances of abuse. It is our job to be the bearers of bad news, and that can sometimes be a burden on one’s well being.

Yet, someone has to take on that job. A newborn cannot speak out on their own behalf. They cannot present their own evidence against abuse, or advocate for their own care and treatment, or tell us where the pain lies. So, we do it for them, and take the bad days with the good, and hope that we’re doing right by these children and their families.

We don’t do this alone, not by far, and there are many moments where we get to be amazed by the community of people we are a part of. In this issue of NeoTox you get to meet a group of folks in West Virginia who are doing amazing work in the care and defense of substance exposed newborns. They are setting a new standard of care for infants suffering from neonatal abstinence syndrome, and their work is worth knowing about.

We are trying to do our part, too. In 2007 we developed umbilical cord testing for in utero substance exposure as an alternative to meconium testing. U-cord testing has shown its incredible utility in so many ways, and now, almost a decade later, the data are conclusive: u-cord testing works. It’s how we do our part for the care and protection of new life.

When it comes down to it, the reason organizations like Lily’s Place in West Virginia, or USDTL, or the many other groups trying to make a difference in this “industry” do it, is just this - making a difference for the smallest patients among us without a voice of their own. Because, the worst of our bad days are never so terrible as the least painful of theirs.

Thanks for reading,Michelle Lach, Editor-in-Chief

3USDTL

NeoToxSpring/Summer 2015volume 6issue 2

Michelle Lach, MSIMCEditor-in-Chief

Joseph Salerno, MSManaging & Design Editor

Dru Wagner, MAGraphic Designer

NeoTox is a quarterly news magazine of science, data, and news about perinatal toxicology and substance exposure issues. It is our mission to distil the technical world of toxicology, drug testing, and addiction science into plain words. If you have suggestions for topics you would like to know more about, let us know.

editor@usdtl.com

1700 S. Mount Prospect Rd.Des Plaines, IL, 60018847.235.2367

© 2015 USDTL, Inc. All Rights Reserved.

USDTL.com

Table of Contents

4

REAL TIME DATA | Irene Shu, Ph.D., DABCC and

Joseph Jones, M.S., NRCC-TC

Umbilical cord testing has seen increasing use over the last decade for the detection of in utero drug exposure. New data from a three month survey of umbilical cord drug testing results sheds light on the deposition of substances of abuse and their metabolites in umbilical cord tissue.

8

ADVOCATES FOR THE VOICELESS | Kendyll

Van Zandt, Kiabeth Santos, and Joseph Salerno, M.S.

A West Virginia community comes together to begin the long journey of healing for newborns suffering from drug withdrawal.

13

DATA IN ACTION

CESAR FAX: Percentage of National Treatment Admissions for Heroin at Highest Level; Admissions for Other Opiates May Be Leveling Off.

14

NATIONAL POSITIVITY RATES

USDTL quarterly national results for drug and alcohol testing in umbilical cord and meconium specimens.

Cover photo from iStock.

4 Spring/Summer 2015 NeoTox

REAL TIME DATA

Umbilical cord testing has seen increasing use over the last decade for the detection of in utero drug exposure. New data from a three month survey of umbilical cord drug testing results sheds light on the deposition of substances of abuse and their metabolites in umbilical cord tissue.

by Irene Shu, Ph.D., DABCC and Joseph Jones, M.S., NRCC-TC

Neonatal abstinence syndrome (NAS) is a growing concern in the United States. The number of newborns exhibiting NAS withdrawal symptoms increased 10-fold from 1995 to 2009.1 From 2004-2013, Neonatal Intensive Care Unit (NICU) admissions due to NAS increased 285%.2 As well, the length of stay in the NICU for NAS related treatment increased from 13 to 19 days.2 According to the 2012 National Survey on Drug Use and Health, at least 5.9% of pregnant women use illicit drugs while pregnant and 8.5% of pregnant women drink during pregnancy, including 2.7% who report risky drinking behavior.3 Additionally, one in six pregnant women smoke during pregnancy.4 Withdrawal symptoms in newborns may result from any of these substances.

Toxicological testing of newborn samples helps to identify precise causes of withdrawal in neonates.

Umbilical cord tissue is a highly advantageous specimen to test for in utero alcohol or substance exposure. In contrast to urine, umbilical cord provides a longer detection window, and is much easier to collect than both urine and meconium.

Umbilical cord testing has seen increasing use since 2007, however, data on the deposition of drugs and metabolites in umbilical cord as a result of in utero drug exposure is limited.

USDTL undertook a systematic analysis of umbilical cord samples submitted to our lab for 13-panel drug analysis from July through November of 2014 (5 months). The 13-panel test identifies the following drugs and their metabolites: amphetamines (AMP), cocaine (COC). opiates (OPI), cannabinoids (THC), phencyclidine (PCP), barbiturates (BARB), benzodiazepines (BZP), methadone (MTD), propoxyphene (PPX), oxycodone (OXY), meperidine (MEP), tramadol (TRAM), and buprenorphine (BUP).

All umbilical cord samples were screened by an enzyme linked immuno-sorbent assay (ELISA) method. Presumptive positive samples were then

confirmed by either liquid chromatography-tandem mass spectrometry (LC-MS/MS: AMP, COC, OPI, BARB, BZP, MTD, PPX, OXY, TRAM, BUP) or gas

chromatography-mass spectrometry (GC-MS: THC, PCP, MEP) methods to identify and quantify drugs and metabolites.

During the 5-month period, 6,578 umbilical cord samples were received for 13-panel drug

In contrast to urine, umbilical cord provides a longer detection window, and is much easier to collect

than both urine and meconium.

5USDTL

testing, 3,256 (49.5%) of which were screened negative. Cannabinoids and opioids were the most commonly seen drug types in positive umbilical cord samples. The five most prevalent drug classes that the specimens confirmed positive for were cannabinoids (15.0%), opiates (13.1%), buprenorphine (11.6%), oxycodone (4.9%), and methadone (3.5%). (Figure 1, page 6)

Single drug class use was the most common result among drug positive specimens, although multiple drug class use was still significant. Of the total tested specimens for 13-panel drugs, 33.9% (2,334/6,578) tested positive for a single drug class, 8.6% (589/6,578) tested positive for two drug classes, and 2.7% (186/6,578) tested positive for three or more drug classes. Multiple drug class use for the five most commonly seen drug classes is shown in figure 1 (page 6). Note that although overall prevalence of AMP and COC positive results is 2.3-2.4% among the 13-panel tested samples, the prevalence increases to 6.9% among the opioid (opiates, buprenorphine, oxycodone, or methadone) positive samples. The concomitant presence of opioids and stimulants may delay the onset of withdrawal symptoms which complicates the patient care strategy.

Maternal heroin use was indicated in 97 samples positive for morphine that also have quantifiable 6-MAM and/or meconin. 6-MAM is a heroin metabolite, and meconin is a metabolite of the illicit heroin contaminant, noscapine. The latter heroin marker allowed us to identify 9 heroin exposed newborns in the absence of 6-MAM results, which constitutes 9.3% (9/97) of the cases.)

There were only 70 samples that tested positive for both hydrocodone and hydromorphone. Almost all of the confirmed buprenorphine positive samples had norbuprenorphine as the predominant analyte, and 47.9% of those did not have the parent drug above quantitation limit. On the other hand, oxycodone was the predominant analyte for that drug class over its metabolite oxymorphone.

Methadone was present at higher concentrations than its metabolite EDDP, however, unlike hydrocodone, buprenorphine and oxycodone, both the parent drug and metabolite were almost equally occurring.

Whether the parent drug or its metabolite is the predominant form in umbilical cord varied between drugs, and no consistent pattern among drug classes was discernible. It is unknown whether the observed drug/metabolite ratios are associated with maternal versus fetal pharmacokinetic profiles. That type of research is difficult to conduct due

to obvious ethical reasons. Beyond that, however, these data demonstrate that umbilical cord is a suitable, and in several ways advantageous, alternative to urine and meconium testing for in utero drug exposure.

References1. Hudak, M.L. and Tan, R.C. (2012). Neonatal Drug

Withdrawal. Pediatrics, 101(6), 1079-1088.

2. Tolia, V.N., Patrick, S.W., Bennett, M.M., Murthy, K.,

Sousa, J., Smith, P.B., and Clark, R.H. (2015). Increasing

Incidence of the Neonatal Abstinence Syndrome in U.S.

Neonatal ICUs. The New England Journal of Medicine,

372, 2118-2126.

3. Results from the 2012 National Survey on Drug

Use and Health: Volume 1. Summary of National

Findings (Office of Applied Studies, NSDUH Series

H-46, HHS Publication No (SMA) 13-4795). Rockville,

MD: Substance Abuse and Mental Health Services

Administration, 2010.

4. Tobacco Use and Pregnancy. Centers for Disease

Control and Prevention. Retrieved from http://www.

cdc.gov/reproductivehealth/tobaccousepregnancy/

Figure 1 for this article follows on page 6. Illustrated by Dru Wagner.

The concomitant presence of opioids and stimulants may delay the onset of withdrawal symptoms which complicates the patient care strategy.

THC15.0%

OPI13.1%

BUP11.6%

OXY4.9%

MTD3.5%

BZP2.6%

AMP2.4%

COC2.3%

BAR1.9%

MEP1.5%

TRA1.1%

PPX0.01%

PCP0.0%

15%

0%

12%

9%

6%

3%

Multiple Drug Use in Umbilical Cord Testing Samples

Each set of dots represents all positive results for the indicated drug class. Grey dots ( ) signify 1% of single-drug use. Each colored dot ( ) signifies 1% of co-occurring drug use. Dots indicating co-occurring use are color matched to the drug classes

shown in the bar graph below.

Posi

tivi

ty R

ate

by S

ingl

e D

rug

Cla

ss

Figure 1

THC OPI BUP

OXY MTD

6 Spring/Summer 2015 NeoTox

THC15.0%

OPI13.1%

BUP11.6%

OXY4.9%

MTD3.5%

BZP2.6%

AMP2.4%

COC2.3%

BAR1.9%

MEP1.5%

TRA1.1%

PPX0.01%

PCP0.0%

15%

0%

12%

9%

6%

3%

Multiple Drug Use in Umbilical Cord Testing Samples

Each set of dots represents all positive results for the indicated drug class. Grey dots ( ) signify 1% of single-drug use. Each colored dot ( ) signifies 1% of co-occurring drug use. Dots indicating co-occurring use are color matched to the drug classes

shown in the bar graph below.

Posi

tivi

ty R

ate

by S

ingl

e D

rug

Cla

ss

Figure 1

THC OPI BUP

OXY MTD

USDTL 7USDTL

ADVOCATES FOR THE VOICELESS

A West Virginia community comes together to begin the long journey of healing for newborns suffering from drug withdrawal.

by Kendyll Van Zandt, Kiabeth Santos, and Joseph Salerno, M.S.

8 Spring/Summer 2015 NeoTox

Life is a crazy journey. You never know where you’re going to end up, but you do your best to walk the right path and get yourself to a good place in life. You struggle. You lose, you win. You try to stay engaged and have a positive effect on your own outcome, to be present in your own journey. You do what you can.

It’s the beginning of our life that is the tricky part. That’s the part we have no control over. For some, that is unfortunately the worst part of all.

Just west of Charleston, West Virginia, on the south bank of the Ohio River, you’ll find a town called Huntington. There’s a place there where good people are trying to undo bad beginnings. It’s called Lily’s Place.

Lily’s Place (www.lilysplace.org) is a non-profit infant recovery center run by volunteers and supported by donations. National leaders in the care of newborn infants suffering from neonatal abstinence syndrome (NAS) and withdrawal symptoms of in utero drug exposure, Lily’s Place began welcoming NAS troubled infants into its care in 2014. “The community has rallied around these babies,” says neonatologist Dr. Sean Loudin, Medical Director of Lily’s Place, “So many people in the surrounding areas have shared their time and money to assist us with making our visions become

reality.” The withdrawal symptoms of the babies at Lily’s Place are painful, and withdrawal can last 4-6 weeks or in some extreme cases as long as three months. Lily’s Place is a unique facility established to help infants struggle their way through a bad beginning with as much comfort and care as possible.

In early 2015, Kendyll Van Zandt and Kiabeth Santos, Development Managers at USDTL, received a phone call from Rhonda Edmunds, Director of Nursing for Lily’s Place. Rhonda talked about the overflow of NAS infants at Cabell Huntingon Hospital (CHH) in Cabell County, West Virginia, the need for creating a relaxed environment for babies suffering from drug withdrawal, and how Lily’s Place grew out of that need. She invited Kendyll and Kiabeth to Lily’s Place, where they could spend time touring the facility and volunteering as cuddlers. They took Rhonda up on her offer.

KiabethIt’s March 16th, a Monday, just after the dinner hour

for most families, and we’re driving down 7th Avenue in Huntington. The sun is almost gone for the day as we drive past Lily’s Place to get familiar with the area. The neighborhood is not glamorous. Despite what some are

9USDTL

calling a revival in Huntington, this neighborhood, like the infants we will see tomorrow, is still showing signs of withdrawal from the decline of the steel industry in the 1970s and 80s. Several homes look shattered and abandoned, despite that they are still occupied. A food bank sits directly across from Lily’s Place, and a few doors down you’ll find a men’s shelter. It is very different from what I’m used to back home.

After our tour of the area, we stop at the local Kroger grocery store to pick up supplies for donation to Lily’s Place tomorrow: diapers, wipes, cleaning supplies, baby laundry detergent, paper towels, and folders to help with their record keeping. On our way to the hotel I’m feeling excitement about tomorrow, but I have so many questions going into this. I can’t help but wonder why mothers put their babies through this ordeal. Why don’t’ they seek help earlier and spare their children the pain? I fall asleep that night with the questions still rolling through my head.

West Virginia itself has the highest rate of death from drug overdose of all 50 states.1 A continuing rise in heroin use is a particular concern, with an increase of more than 700% in heroin overdose deaths between 2001 and 2012.2 A 2009 West Virginia study of 8 hospitals found a 19.2% incidence of in utero drug and/or alcohol exposure.3 For Cabell County and CHH the rising drug epidemic, and especially the increased use and abuse of opiate and opioid drugs, has a severe impact. The national incidence of NAS babies more than quadrupled between 2000 and 2012, rising from approximately 1.2 to 5.8 episodes of NAS per 1000 births. By contrast, CHH has seen the incidence of NAS increase from 10 babies per 1000 births in 2003 up to 110 out of every 1000 in 2013.4 The Neonatal Intensive Care Unit

of CHH is overburdened and overflowing. Time and care that doctors can provide to each suffering infant is reduced with each newly occupied crib in the unit. Lily’s Place was born out of that need.

Lily’s place is modeled after the Neonatal Therapeutic Unit (NTU) at CHH, which has a very successful track record of caring for NAS infants. “Providing quality care which utilizes the same treatment protocol, most of the same physicians, and well trained nursing care is the backbone to our success,” says Dr. Loudin, “Utilizing a neonatal abstinence center like Lily’s Place and considering them as a unique type of healthcare facility will allow a continuation of care from the inpatient hospital setting to this outpatient setting without altering care.”

KiabethMorning has come, March 17th has dawned, and the

day is finally here. After patient waiting and copious planning we are ready for this experience. We are excited! When we get to Lily’s place, we meet up with Rhonda Edmunds and Sara Murray, a neonatal intensive care nurse of 25 years, NTU Clinical Coordinator at CHH, and a member of the Board of Directors for Lily’s Place. Our tour begins, and excitement gives way to speechless heartbreak when we see the babies. These cribs are full, and each child is here because they are hurting, their systems desperate for a place of quiet and comfort to see

them through the pain. This is their start in life.

The human brain produces naturally occurring opiate substances - for example endorphins and enkephalins - which have a complex interplay with the neural pathways of the brain. Naturally occurring opiates play critical roles in brain development early

Rhonda Edmunds, Kiabeth, Kendyll, Sara Murray (l-to-r)

in life. Adding external opiates and opioids - such as heroin, buprenorphine, or oxycodone - to the developing fetal brain causes changes in the natural opiate processes. Tolerance and dependence can occur, resulting in the drug withdrawal that occurs when the baby is born and the supply of external drug is removed. This occurs for other substances as well, including nicotine and alcohol.

KendyllWe’ve started out our visit with a tour of the

facility graciously given by Rhonda, along with a little information about what Lily’s place does. The rooms are beautiful. They’ve done a great job giving the exterior of the building as inviting of a look as one can get with a concrete and brick building, but it still hides a very warm, delicate interior designed to bring comfort. The rooms are calming, with soft colors and soft pillows and stuffed monkeys in comfy rocking chairs. These are the babys’ rooms moms dream of bringing their children home to. That’s what it is all about here: comforting babies in pain.

Lily’s place isn’t just about the babies, however, and we see rooms for mom and baby to share near the end of an infant’s treatment, once the withdrawal subsides. Mommy and baby share these rooms for up to 48 hours before leaving the facility, while mom receives supervised, hands-on training on how to care for her high needs

infant. An unfortunate reality is that neonatal abstinence syndrome is an ongoing issue that these kids and their families are going to be dealing with for the rest of their lives. The care and comfort from Lily’s Place is definitely a better start than many other NAS babies get, though.

Babies suffering from withdrawal are typically jittery and

hypertonic, a fancy way of saying they cry long, loudly, and with a very high pitch. They are also hypersensitive to external stimuli, such as bright lights and loud noises. Drugs in a baby’s system may act to depress the neural transmitters they bind to, resulting in overcompensation by other systems in the brain. Once the supply of drug is ended, the suppressive effect of the substance is gone, and an infant’s brain is flooded with norepinephrine as a response. This is what causes the jitteriness and other signs of NAS. Hypersensitivity results from the overcompensation of the various neural systems that now have no drug to bind up neural transmitters. It takes time for these systems to come back down to a normal level where an infant can once again tolerate typical external stimuli.

KendyllIt’s time to meet the babies. I’m all nerves. We have

to wash up first, so I head into the bathroom and get cleaned up. After I throw my paper towels away, a young lady tells me I’ve accidentally thrown them in the bin for dirty smocks. She’s dressed casually in jeans and a long-sleeved shirt, and clutching a bottle of Mountain Dew as if it’s holy water (Sara Murray refers to Mountain Dew as the state drink of West Virginia). I realize this is not a Lily’s Place staff member, but one of the young moms whose baby is being cared for, and now there is a sudden tension in me. She’s been nothing but pleasant and helpful to me, but all I can think in my head is, “How could you? How could you do that to your baby?” I pick my paper towels out of the bin, put them in the garbage can, and leave quickly.

Soon after, I’m in one of the care rooms holding baby Lucy. She’s beautiful. She looks like many other babies you would see, but she doesn’t act like one. She is inconsolable, her cry sounding more like a wail of pain than a typical baby’s cry, and I can tell her stomach hurts. I’m nervous and tentative while rocking her. I don’t have children, or nieces and nephews, and the last time I briefly held a normal newborn was more than two years ago. Lucy’s crying was so persistent, and I think, ‘Well this just reaffirms that I am no good with kids.’ But, really, no one could have done any better in this situation. I hold Lucy in the rocking chair, a regular chair, standing

Spring/Summer 2015 NeoToxRooms are kept dim and quiet for

the benefit of the newborns.

11USDTL

up, sitting down with her head on my knees while moving her legs back and forth towards her stomach, scrunching her up into a little ball with her legs and feet towards her stomach, but nothing seems to ease her pain for longer than a few minutes. I’m told Lucy has been crying the whole night with occasional moments of peacefulness.

Later, I’m sitting with Lucy, Rhonda Edmunds, and Sara Murray in the room. Lucy has stopped crying, and there are several minutes of peacefulness. We talk about patience. I say to Rhonda, “I’m a normal person, not having to deal with any sort of addiction, and I’m not always necessarily patient with kids that constantly cry. I cannot imagine these babies going home to a family addicted to drugs, in an altered state of mind, and having to be patient with a newborn who is always crying.” Rhonda looks at me and nods in agreement. “That is very likely the outcome that many of these newborns will face,” she says.

KiabethHer name is Ellie, and she is precious. She is eight

weeks old, beautiful, and with cheeks that beg to be squeezed. But, right now her defining trait is pain. Ellie is crying, and this is not a normal cry. I’m a parent, and I know my cries: the I’m hungry cry, the change my diaper cry, the I’m just generally feeling under the weather cry. This is none of those. It’s a cry of pain and a cry for help. She suddenly spits out a white liquid that the nurse tells me is due to the acidic feeling in her stomach. NAS babies experience gastrointestinal problems, causing stomach cramping. As I hold her and try to console her, the nurse coaches me to hold Ellie in a ‘C’ shape.

Holding her feet up puts pressure toward her stomach and helps soothe the cramping. She’s been living with these horrible symptoms for eight weeks, the very first of her

new life. I just want to heal her.

Ellie is bundled tightly in a blanket, like a burrito, with hands covered. She’s pretty strong though, and her hands come right out and up to her mouth, where she begins to suck really hard on them. This is a common behavior for NAS babies. Pacifiers help, but only for short moments. Miraculously, she falls asleep in my arms after several minutes, and I see her smile. My feelings and thoughts are difficult to work through. I say a prayer for Ellie and

the rest of the babies here and future babies that will unfortunately sleep in these cribs.I hope there is a bright path ahead for Ellie. I am truly humbled by this experience.

Lily’s Place is not only about treating infant withdrawal. Their commitment to the treatment of NAS addresses the larger issues of parental addiction and economic disparity. Mothers are offered help to find the resources they need including substance abuse treatment, counseling, smoking cessation services, education and employment training, food and nutrition counseling, and many other outlets to help improve the fortunes of both mother and baby. The mission statement of Lily’s Place encompasses their holistic approach to addressing the burdens of NAS:

“Lily’s Place provides behavioral health to infants suffering from prenatal drug exposure and offers education and support services to families and

Kiabeth and baby Ellie

12 Spring/Summer 2015 NeoTox

communities to help recognize and manage the needs of substance abused babies. In its efforts to provide immediate, short-term care for these infants, Lily’s Place provides non-judgmental support for mothers, offers counseling and support for families, all at a savings to the taxpayers of West Virginia.”

“With so many people focused on the cost burden of NAS to the

healthcare community,” says Dr. Loudin, “we hope that Lily’s Place can show how the system of care can be both of good quality and economically beneficial.”

KiabethThe stories we hear about the mothers of these children

are truly heartbreaking. One of them, a 20 year old first time mother, was taught to shoot up heroin at age 13 by her mother, who in turn learned it from her own mother. We see her briefly and she smiles at us, only 2 teeth remaining in what might once have been a bright smile of innocence. She only made it through 8th grade. Now she is being offered help to remain in a recovery center in TN and have her baby transferred with her after treatment at Lily’s Place. Will she sign the waiver to go to the recovery center? We do not know. It’s an unknown at the beginning of her baby’s life, which has become despairingly more common in West Virginia.

I can’t help but ask the question over and over in my head: how can a mom expose their baby to drugs in the womb? The reality is that many women are not in full control of their life. Addiction is a disease, and addicts need help. This young girl has not known a drug free life since she was 13. She was young, trusting her mother, and thought mom knew best. That innocent trust led to addiction. Now it hits me: what I do for living, what I am part of, is about advocating for the future, for babies and mothers. It’s not about being the mommy police. It’s about partnering with good organizations like Cabell

Huntington Hospital and Lily’s Place to address the whole problem. We can’t know what has occurred in a person’s life to lead them to addiction. They just simply need help. That’s what our work is about - the beginning of help.

KendyllWhat is the biggest lesson I’ll take home from visiting

Lily’s Place? Don’t judge. I instantly judged that young mother I had met in the bathroom. Now, I take a step back and realize that this young girl, 20 years old, needs a support system. She needs a group of people to show her the right path, because she was not steered in the right direction during her formative years. We spend a lot of time talking about the babies who are addicted and dealing with withdrawal during their first few weeks of life, but we need to remember that these newborns are a result of young women out there who need help and didn’t get it in time. To fix a problem, you need to start at the source. For these newborns to have the best possible chance at starting a healthy life, we need to make sure that we make efforts to help from the very beginning. For mothers who struggle with addiction during their pregnancy, and their newborns who need extra care right from the start, I am glad there is Lily’s Place to provide support and get these families on a healthy path to a long and happy life.

References1. Prescription Drug Abuse: Strategies to Stop the

Epidemic. Retrieved from: http://healthyamericans.org/

reports/drugabuse2013/

2. West Virginia Fighting a War Against Heroin

Addiction, Overdose Deaths. Retrieved from: http://

wvpublic.org/post/west-virginia-fighting-war-against-

heroin-addiction-overdose-deaths

3. Stitely, M.L., Calhoun, B., Maxwell, S., Nerhood,

R., and Chaffinn D. (2009). Prevalence of drug use in

pregnant West Virginia patients. West Virginia Medical

Journal. 106(4 Spec No), 48-52.

4. Sean Loudin, MD. (2015). The Impact of Neonatal

Abstinence Syndrome on One West Virginia

Community. Retrived from: http://www.slideshare.net/

USDTL/the-impact-of-neonatal-abstinence-syndrome-on-

one-west-virginia-community

A Lily’s Place room awaiting

the newest arrival.

HEROIN USE ON THE RISE

CESAR FAX: Percentage of National Treatment Admissions for Heroin at Highest Level; Admissions for Other Opiates May Be Leveling Off.

The percentage of admissions to state-funded substance abuse treatment facilities citing heroin as a primary substance of abuse has reached the highest level since data collection began in 1992, according to data from the national Treatment Episode Data Set (TEDS). After six years of stability, heroin admissions increased from 14%

in 2010 to 16% in 2012 (the most recent year for which data are available). In contrast, admissions for the primary abuse of other opiates*, which had increased steadily since the late 1990s, remained at around 10% in 2011 (10.1%) and 2012 (9.7%). Cocaine admissions continued to decline, reaching a new low of 7% in 2012 (data not shown).

NOTES: TEDS data are of admissions to treatment ages 12 and older for abuse of alcohol and/or drugs in facilities that report to State administrative data systems. Data include records for admissions that were received and processed through 10/17/13.TEDS admissions do not represent individuals; an individual admitted to treatment twice within a calendar year would be counted as two admissions. Admissions can report up to three substances of abuse that led to the treatment episode.

*The category Other Opiates includes non-prescription methadone, buprenorphine, codeine, hydrocodone, hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene, tramadol, and any other drug with morphine-like effects.

†While the focus of this analysis is on treatment admissions for drugs other than alcohol, it should be noted that alcohol remains the most frequently mentioned primary substance of abuse—despite the fact that the percentage of admissions for alcohol decreased from 59% in 1992 to 39% in 2012.

SOURCE: Adapted by CESAR from the Center for Behavioral Health Statistics and Quality, SAMHSA, Treatment Episode Data Set (TEDS): 2002-2012. National Admissions to Substance Abuse Treatment Services, 2014. Available online at http://www.samhsa.gov/data/client-level-data-teds/reports?tab=18.

Percentage of All

Admissions

Primary Substance of Abuse (Other Than Alcohol†) at Admission to U.S. State Licensed or Certified Substance Abuse Treatment Facilities, Ages 12 and

Older, 1992 to 2012

0%

1992 1996 2000 2004 2008 2012

4%

8%

12%

16%

20%

Heroin

Other Opiates

13USDTL

Umbilical Cord Specimens Amphetamines | 3.2%

Cocaine | 1.7%

Opiates | 10.3%

Cannabinoids | 16.7%

Benzodiazepine | 2.3%

Oxycodone | 4.7%

Meperidine | 1.6%

Tramadol | 1.1%

Buprenorphine | 11.1%

Ethyl Glucuronide | 2.1%

Cotinine | 50.5%

Barbiturates | 1.8%

Methadone | 3.2%

105

0201545

50

Not shown: Phencyclidine 0.0%, Propoxyphene 0.0%

USDTL NATIONAL POSITIVITY RATES*

14 Spring/Summer 2015 NeoTox

Meconium SpecimensAmphetamines | 4.3%

Cocaine | 2.9%

Opiates | 8.9%

Cannabinoids | 19.0%

Oxycodone | 1.1%

Meperidine | 0.6%

Tramadol | 1.3%

Buprenorphine | 6.6%

Fatty Acid Ethyl Esters | 12.6%

Barbiturates | 0.9%

Methadone | 4.4%

2045

5010155

0

Not shown: Phencyclidine 0.1%, Benzodiazepine 0.2%, Propoxyphene 0.0%

Quarterly report date range: January 1, 2015 – March 31, 2015* These data report national positivity rates for newborn toxicology tests conducted by USDTLon behalf of external clients and are not reflective of systematic research results.

15USDTL

EVENTS & EXHIBITS

• September 11 – Indiana Section AWHONN Conference – Plainfield, IN

• September 16-19 – 18th National Mother Baby Nurses Conference – Orlando, FL

• October 1 – Substance Exposed Pregnancy Conference – Louisville, KY

• October 14-17 – The Florida Association of Neonatal Nurse Practitioners 26th Annual National Neonatal Nurse Practitioner Symposium – Clearwater Beach, FL

• October 14-17 – The Fetus & Newborn Conference – San Diego, CA

• October 22-23 – 10th Annual Professional Outreach Education Conference – Spokane, WA

• October 22-25 – National Association of Neonatal Nurses 31st Annual Educational Conference – Dallas, TX

1700 S. Mount Prospect Rd. | Des Plaines, IL 60018 | 800.235.2367 | www.USDTL.com

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16 Spring/Summer 2015 NeoTox

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