Epidemic Spreading
Across
the State
Erica Wilson M.P.H.
Health Promotion Program Director
East Region
Neonatal
Abstinence
Syndrome
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?
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 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
Incidence of
Neonatal
Abstinence
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
Types of Prescription Only Exposures, NAS Cases,
East TN Region, Jan. 1 - Aug 30., 2014
4%
Replacement Therapy
16%
Pain Therapy
Psychiatric/Neurologic
Therapy
80%
Reported Cases of NAS, by County, East TN Region,
Jan. 1 - Aug. 30, 2014
45
42
40
35
Number of Cases
30
25
24
20
20
16
15
12
10
5
6
14
14
7
5
5
5
3
4
2
0
County
Highest rates based on
provisional county birth
estimates
Why is
Neonatal
Abstinence
Syndrome a
Concern?
The Baby
• Tragedy and suffering
of the babies and their
caregivers.
• With increased
likelihood of foster
care, families are torn
apart.
The 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 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 Prevention
Initiative
LARC Pilot Project
East Region
The Process
• Collaboration
– Sheriff/Jail Administrator/Jail Nurse
• Education
– Partners (Pamphlet)
– Participants (PowerPoint and Pamphlet)
• Referrals (Referral/Follow-Up Form)
• Clinical Services
• Data Collection (Referral/Follow-Up Form)
High-Risk
Population
Outreach
NAS
Education
Session
Referral to
HD
Clinical Exam
at HD
Contraceptive
Placement
Pregnancy
Prevention in
Population at
High Risk for
NAS Child
• 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
Cocke
Davidson
Jefferson
Knox
Sevier
Out-of-State
Total
No.
14
1
1
1
24
2
43
Percent
32.6%
2.3%
2.3%
2.3%
55.8%
4.7%
100.0%
LARC Clinic Referrals, Patient History,
East Tennessee Region, 2014
History of drug use
79.1%
Drug charge
44.2%
Child born drug-dependent
20.9%
Child ever in state custody
14.0%
Taking pain/anxiety meds
2.3%
0.0%
10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%
Percent
(N = 43)
LARC Clinic Referrals, Patient Current Method of Birth Control,
East Tennessee, 2014 Depo
Unknown
9%
Condoms
7%
Provera
3% IUD
2%
(N = 43)
None
79%
FOR HEALTH DEPARTMENT STAFF USE ONLY
• Education levels
– 28% of referrals were
previous FP patients
2. Is the client currently incarcerated for drug-related issues?
Yes No
4. Highest level of education completed:
Some Middle School
HS Diploma/GED
Some HS
Some College
Associates
Bachelors
Professional Degree
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
• Specific drug use
history including
during pregnancy
7. Has the client ever had child(ren) born drug-dependent?
Yes No Refused to answer
If yes, how many?___________________
1. Has the client ever used prescription/non-prescription drugs?
If yes, which drugs? (check all that apply)
Marijuana
Meth/Methamphetamines
Cocaine/Crack/Coke
Ecstasy/E/Ex
Heroin
Oxy/Oxycontin
CLINICAL
• History of
unplanned
pregnancy
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:____________
CLERICAL
• FP barriers
1. Was the client referred as a condition of probation/parole?
Yes
No
Refused to answer
Other (specify) ____________
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 Savings
• Preventing the birth of one drug dependent
infant saves an average cost of $66,973.
• Preventing the birth of one drug dependent
infant in each of the counties in the East Region
would be a cost savings of $1,004,595.
• Preventing the birth of one drug dependent
infant in each of the counties in Tennessee
would be a cost savings of $6,362,435.
LARC Pilot Update –
September 10, 2014
Number of
Referrals
Received
Potential Total
Savings:
Cocke
Sevier
Comments
14
29
Total: 43
43 times
$67,000.00
=
$2.8 Mil
Questions
•
•
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•
•
Erica Wilson M.P.H.
Health Promotion Program Director
East TN Regional Health Office
Erica.Wilson@TN.gov
(865) 909-9404 Ext. 103