PowerPoint Presentation

Preventing Neonatal Abstinence Syndrome (NAS)Presenters:Sheri Lawal, MPH, CHES, Senior Associate, The Pew Charitable TrustsMichael D. Warren, MD, MPH, Assistant Commissioner, Tennessee Department of HealthDeborah Huddleston, Media Relations and Project Director, Metro (Knoxville) Drug CoalitionKaren Pershing, MPH, CPS II, Executive Director, Metro (Knoxville) Drug Coalition Prevention TrackModerator: Carla S. Saunders, NNP-BC, Advance Practice Coordinator, Pediatrix Medical Group, Neonatal Nurse Practitioner, East Tennessee Childrens Hospital, and Member, Rx and Heroin Summit National Advisory Board

DisclosuresDeborah Huddleston; Sheri Lawal, MPH, CHES; Karen Pershing, MPH, CPS II; Michael D. Warren, MD, MPH; and Carla S. Saunders, NNP-BC, have disclosed no relevant, real, or apparent personal or professional financial relationships with proprietary entities that produce healthcare goods and services.

DisclosuresAll planners/managers hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.The following planners/managers have the following to disclose:John J. Dreyzehner, MD, MPH, FACOEM Ownership interest: Starfish Health (spouse)Robert DuPont Employment: Bensinger, DuPont & Associates-Prescription Drug Research Center

Learning ObjectivesDescribe how Tennessee is collecting NAS data and using it to inform primary prevention projects.Identify NAS primary prevention opportunities for state and local health departments.Explain the Born Drug-Free Tennessee program for raising awareness of NAS and educating expectant mothers.Provide accurate and appropriate counsel as part of the treatment team.

Neonatal Abstinence SyndromePhysical withdrawal in newborns with in-utero drug exposure*Does not matter if drug it is prescribed, diverted, misused, or illicit*

Multiple symptoms including: irritability and high-pitched cry, poor sleep, poor feeds, increase tone/tremors, hypersensitivity, autonomic instability/tachypnea, sneezing, yawning, fever, sweating, vomiting, cramping, diarrhea, excessive sucking, skin breakdown

Incidence has increased to 5.8 cases per 1000 inpatient births ~ 1 baby every 25minutes

The total US hospital charges for infants with NAS is > $1.25 billion

100% Preventable

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Partnering with Health Departments to Prevent Neonatal Abstinence SyndromeSheri Lawal, MPH, CHESResearch Analyst

DisclaimerThe Pew Charitable Trusts did not review or endorse the findings or conclusions in this presentation.

OutlineTrends in Opioid Use Among WomenHealth Departments Role in Preventing NASPrevention Strategies

Trends in Opioid Use Among Women

Between 2000 and 2009, the incidence of NAS grew by nearly 300%, from 1.20 per 1,000 hospital births per year in 2000 to 3.39 in 20091Compared to men, women are more likely to:2Have chronic painBe prescribed prescription opioidsBe given higher dosesUse them for longer time periodsMay become dependent on prescription opioids more quicklyMay be more likely to engage in doctor shopping1 Patrick SW, Schumacher RE, Bennyworth BD, Krans EE, McAllister JM & Davis MM. (2012). Neonatal Abstinence Syndrome and Associated Health Care Expenditures: United States, 2000-2009. Journal of the American Medical Association, 307(18): 1934-40.2 Centers for Disease Control and Prevention (2013). Vital Signs: Prescription Painkiller Overdoses: A Growing Epidemic, Especially Among Women. Accessed at: http://www.cdc.gov/vitalsigns/pdf/2013-07-vitalsigns.pdf

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Trends in Opioid Use Among WomenSince 1999, the percent increase in prescription opioid overdose deaths was more than 400% among women3In 1999, 1,287 women died from prescription opioid overdose In 2010, 6,631 women died from prescription opioid overdoseBetween 1999 and 2010, 47,935 women died from prescription opioid overdose

3 Centers for Disease Control and Prevention (2013). Vital Signs: Overdoses of Prescription Opioid Pain Relievers and Other Drugs Among Women United States, 1999 2010. Accessed at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6226a3.htm?s_cid=mm6226a3_w

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Health Departments are Vital to the Prevention of NASPublic health departments protect the community, respond in times of crisis, and are instrumental in leading or participating in:4SurveillanceBuilding PartnershipsTreatment and RecoveryEducationLegislationFunding and Research

4 National Association of County and City Health Officials. (2015). Statement of Policy: Responding to Americas Prescription Drug Abuse and Overdose Epidemic. Accessed at: http://www.naccho.org/uploads/downloadable-resources/Policy-and-Advocacy/14-04-Rx-Drug-Epidemic.pdf.

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Surveillance at the Local and State LevelsEpidemiology and Surveillance ServicesSize of Population ServedAll LHDs30 days supplied)Narcotic Users Rate per 1,000Women Prescribed Contraceptives and Narcotics% of Women on Narcotics and ContraceptivesWomen Prescribed Narcotics without Contraceptives% of Women on Narcotics Not on ContraceptivesAll Women320,32738,2101195,62515%32,58585%15-2085,1741,3331654141%79259%21-2448,1692,7875881429%1,97371%25-2959,1656,9981181,56122%5,43778%30-3453,6149,4831771,45915%8,02485%35-3942,9639,2812168049%8,47791%40-4431,2418,3282674465%7,88295%

Data source: Division of Health Care Finance and Administration, Bureau of TennCare. CY2014 data. Available at: http://www.tn.gov/assets/entities/tenncare/attachments/TennCareNASData2014.pdf

Opportunities for Preventing NAS:Primary Prevention InitiativePrimary Prevention Initiative (PPI): Department-wide initiativeVision by State Health OfficerFocus upstreamEngage community partners to address local issues

Opportunities for Preventing NAS:Primary Prevention InitiativeEast TN PPI Project:Started in Cocke and Sevier countiesPartnership with local jailsHealth education sessionsFocus on NAS preventionInformation on effective contraceptionPartnerships with jails to refer inmates to local health department for family planning

Opportunities for Preventing NAS:Primary Prevention InitiativeEast TN PPI Project:All services are voluntaryAny patient referred to health department for family planning services is offered a variety of acceptable and effective contraceptive methods

Opportunities for Preventing NAS:Primary Prevention InitiativeSelected results from East TN PPI project:442 referrals in 2014-1588% with history of drug use30% reported drug use during pregnancy19% had delivered infant with NAS73% reported no contraceptive methodAmong referred patients:94% received a contraceptive method (N=406)84% chose a voluntary reversible long-acting contraceptive (N=361)

Opportunities for Preventing NAS:Primary Prevention InitiativeProject has been replicated in 24 countiesKey Lessons Learned:Community partners are interested in reducing burden of NASInmates are receptive to health education and to referrals to public health servicesNeed to emphasize that services are voluntary and offer a variety of acceptable and effective contraceptive methods

SummaryPublic health surveillance for NAS allows real-time tracking of incidence and description of exposure sourcesLocal partnerships can move prevention efforts upstream

For More InformationWeekly NAS Surveillance Archivehttp://www.tn.gov/health/article/nas-summary-archive Monthly and Annual NAS Reportshttp://www.tn.gov/health/article/nas-update-archive

AcknowledgementsTDH CommissionerJohn J. Dreyzehner, MD, MPH, FACOEMTDH NAS SurveillanceAngela M. Miller, PhD, MSPHEast TN Regional Health Office StaffDanni Lambert, RNJanet Ridley, RN, BSN, MSNBrittany S. Isabell, MPH

Born Drug-Free Tennessee: NAS in Your StateDeborah Huddleston, BS Karen Pershing, MPH, CPS II March 29, 2016

DisclosureI, Karen Pershing, MPH, CPS II have no real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services.

I, Deborah Huddleston, BS, have no real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services.

ObjectivesDescribe how Tennessee is collecting NAS data and using it to inform primary prevention projects.Identify NAS primary prevention opportunities for state and local health departments.Explain the Born Drug-Free Tennessee program for raising awareness of NAS and educating expectant mothers.Provide accurate and appropriate counsel as part of the treatment team.

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Coalition ResponseWhat is a community coalition?

Whos involved?

Purpose

Status of Coalitions in Tennessee-52

SAMHSAS Strategic Prevention Framework

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Moving to ActionProvide InformationBorn Drug-Free Tennessee campaignPrint and television media outreachHealth education curriculum includes NAS

Enhance Skills/Training and EducationPain clinic provider educationTreatment provider educationSBIRT training for OBs/PCsEducate medical providers on discussing pregnancy prevention when prescribing

Action ContinuedProvide Support/Build CapacityConnect with local HD FP programWork with judges and jails on educating incarcerated women

Change Incentives/DisincentivesIncrease access to gender-specific trauma informed treatmentDecreased access to opiate narcoticsEstablish Family Recovery Courts

Action ContinuedReduce Barriers or Enhance AccessExpand Access to LARC

Change Physical Design of EnvironmentReduce number of pill mills

Modify Policies and Systems ChangeCollect local information on criminalization lawStrengthen pain management clinic regulationsExpansion of treatment coverage

Born Drug-Free Tennessee Launch

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Knoxville Media ReachKnoxville population: 444,622TV households in the Knoxville DMA*: 503,410 Media Reach: 17 counties

*Direct Marketing Association

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Media Outreach

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Media Outreach ContinuedCampaign Launch YTDOver 65,000 visits to borndrugfreetn.com78% of women visitors were of child-bearing age24% visitors viewed Find Out More section

Facebook: 863 page likes*23,972 organic post reachTwitter: 168 followers

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Questions?

Preventing Neonatal Abstinence Syndrome (NAS)Presenters:Sheri Lawal, MPH, CHES, Senior Associate, The Pew Charitable TrustsMichael D. Warren, MD, MPH, Assistant Commissioner, Tennessee Department of HealthDeborah Huddleston, Media Relations and Project Director, Metro (Knoxville) Drug CoalitionKaren Pershing, MPH, CPS II, Executive Director, Metro (Knoxville) Drug Coalition Prevention TrackModerator: Carla S. Saunders, NNP-BC, Advance Practice Coordinator, Pediatrix Medical Group, Neonatal Nurse Practitioner, East Tennessee Childrens Hospital, and Member, Rx and Heroin Summit National Advisory Board

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