Running head: PROTECTING OUR INFANTS ACT OF 2015
Review of United States Senate Bill 799: Protecting Our Infants Act of 2015
Rachel Krogstie
Methodist University
1
PROTECTING OUR INFANTS ACT OF 2015
2
Review of United States Senate Bill 799: Protecting Our Infants Act of 2015
The Protecting Our Infants Act of 2015 has a goal of addressing problems relating to
prenatal opioid use and neonatal abstinence syndrome (NAS) (S. 799, 2015). The bill requires
the Secretary of Health and Human Services to submit a report outlining current treatment and
management of women and children affected by these disorders and a strategy to address “gaps
in research… and duplication [of treatment programs] among Federal programs” (S. 799, 2015).
Senate Bill 799 (2015) also requires a study and recommendations for preventing and treating
prenatal opioid disorders, to include long-term effects of these disorders. These strategies and
recommendations are vital to the creating and implementation of new and improved guidelines
on the prevention, diagnosis, and treatment of opioid dependence disorders in expectant mothers
and newborns.
Senator Mitch McConnell, the senior senator from Kentucky, is the primary sponsor of
this bill and it is co-sponsored by 22 senators from 16 different states (US SB799, 2015). A
previous version of this bill was introduced by Senator McConnell on July 31, 2014, where it
was referred to the Committee on Health, Education, Labor, and Pensions (US SB799, 2015).
There was no further action taken on this version of the bill.
A national study published by the Substance Abuse and Mental Health Services
Administration (SAMHSA) in 2010 states that 16.2% of pregnant teens and 7.4% of pregnant
women 18-25 use illicit drugs (Patrick, et al., 2012). A follow-up study by SAMHSA, published
in 2013, shows increases to 18.3% and 9%, respectively (McKeever, Spaeth-Brayton, & Sheerin,
2014). This shows significant increases in reported illicit drug use in pregnant women, especially
in younger women. In the United States, 6-26% of women use prescription opioids during their
pregnancy (Smith, Costello, & Yonkers, 2015). Opiate use in pregnancy significantly increases
PROTECTING OUR INFANTS ACT OF 2015
3
the risk of intrauterine growth restriction, preterm birth, and NAS (McKeever, Spaeth-Brayton,
& Sheerin, 2014; Patrick, et al., 2012). However, complete withdrawal of opiates can lead to
placental abruption, newborn mortality, preterm birth, maternal hypertension, and maternal
tachycardia (McKeever, Spaeth-Brayton, & Sheerin, 2014).
Current treatment of opiate addiction in pregnancy includes the use of methadone or
buprenorphine, along with traditional prenatal care and substance abuse counseling (McKeever,
Spaeth-Brayton, & Sheerin, 2014). Methadone is a synthetic opioid that has been used since the
1970s (Stover & Davis, 2015), however, it is strictly distributed only in specifically licensed
clinics (McKeever, Spaeth-Brayton, & Sheerin, 2014) and methadone can still cause withdrawal
symptoms in newborns (Patrick, et al., 2012). Buprenorphine has not been approved for use in
pregnancy; however, it is used in current practice because the benefits have been shown to
outweigh the risks (McKeever, Spaeth-Brayton, & Sheerin, 2014). These treatment regimens
have been shown to increase compliance with prenatal care and improve birth outcomes
(McKeever, Spaeth-Brayton, & Sheerin, 2014).
Current Status
Senate Bill 799 was introduced to the Senate and referred to the Committee on Health,
Education, Labor, and Pensions on March 19, 2015 (US SB799, 2015). The committee amended
the title of the bill and removed all of Section 2, which was the findings stating the reasoning for
the study (S. 799, 2015). It was passed by the Senate, as amended, by unanimous vote on
October 22, 2015, and was sent to the House of Representatives (US SB799, 2015). The House
passed the bill by voice vote on November 16, 2015 (US SB799, 2015). Senate Bill 799 is
currently awaiting approval by the President.
PROTECTING OUR INFANTS ACT OF 2015
4
House Bill 1462
House Bill 1462 was introduced as an identical bill to Senate Bill 799 on March 19, 2015
(H. R. 1462, 2015). Representative Katherine Clark from Massachusetts is the primary sponsor
of this bill, and she is joined by 99 co-sponsors from 30 different states and Puerto Rico (US HB
1462, 2015). It was immediately referred to the House Committee on Energy and Commerce’s
Subcommittee on Health (US HB 1462, 2015). The committee reported on the bill on September
8, 2015, and passed the House on September 9, 2015 (US HB 1462, 2015). It is currently
pending review by the Senate.
Stakeholders
Key stakeholders involved are pregnant women with opioid dependence disorders,
physicians, advanced practice nurses, substance abuse counselors, and social workers.
Comprehensive prenatal care is essential for all pregnant women; however, according to
McKeever, Spaeth-Brayton, & Sheerin, pregnant women with dependence disorders are hesitant
to seek care due to shame or fear of stigmatization (2014). Often times, dependence disorders are
accompanied with other mental illnesses or histories of abuse (Smith, Costello, & Yonkers,
2015; McKeever, Spaeth-Brayton, & Sheerin, 2014). Taking all this into account,
interdisciplinary care is required for expectant mother with substance abuse disorders.
This bill will support educating these stakeholders on prenatal opioid use and NAS (S.
799, 2015). An educated multi-disciplinary team that addresses concurrent social, medical, and
mental health disorders is in the best interest of the patient (McKeever, Spaeth-Brayton, &
Sheerin, 2014). The goals and expectations of care must be developed using all members of the
team, including the patient (Marquis & Huston, 2012). Using the information published in the
report required by this bill, healthcare providers at every level can use the most up-to-date and
PROTECTING OUR INFANTS ACT OF 2015
5
effective treatment protocols for the holistic care of women during and after pregnancy. They
can also use the information to educate women on the effects of opioid dependence on the baby
during pregnancy and after birth (McKeever, Spaeth-Brayton, & Sheerin, 2014).
Support of Organizations
The Protecting Our Infants Act of 2015 has received overwhelming support from various
entities including the March of Dimes, American Congress of Obstetricians and Gynecologists
(ACOG), and American Academy of Pediatrics (AAP). All of these organizations state that this
bill will put into place much needed research into ways to prevent and treat maternal opioid use,
as well as newborns suffering from withdrawal of these drugs (ACOG, 2015; AAP, 2015; March
of Dimes, 2015). ACOG President Dr. Mark S. DeFrancesco also said, “The Protecting Our
Infants Act will take action to ensure a healthy outcome for both mother and baby while offering
non-punitive, family-centered medical treatment.” (AAP, 2015). There has been no opposition to
this bill noted.
Conclusion
It is clear that legislation regarding federal programs combating maternal opioid
dependence and neonatal abstinence syndrome is desperately needed. Senate Bill 799 passed
through both the Senate and the House of Representatives with no opposition and very little
debate, showing the overwhelming need and support of this legislation (US SB799, 2015). The
numbers of expectant mothers using opioids and babies being born with NAS are increasing
dramatically, and there are currently no standard guidelines for the diagnosis or treatment of
NAS (AAP, 2015). This bill will pave the way for implementing newer research and clinical
guidelines to combat these disorders. This author fully backs the Protecting Our Infants Act of
2015 and looks forward to seeing it signed in law by the President.
PROTECTING OUR INFANTS ACT OF 2015
6
References
American Academy of Pediatrics (AAP). (2015, November 16). Leading medical, children's and
women's health groups applaud passage of protecting our infants act of 2015. Retrieved
November 20, 2015, from American Academy of Pediatrics (AAP):
https://www.aap.org/en-us/about-the-aap/aap-pressroom/pages/POIAJointReleaseFinalPassage.aspx
March of Dimes. (2015, November 16). Protecting our infants act. Retrieved November 20,
2015, from March of Dimes: http://www.marchofdimes.org/advocacy/protecting-ourinfants-act-of-2015.aspx
Marquis, B. L., & Huston, C. J. (2012). Leadership and management tools for the new nurse: A
case study approach. Philadelphia: Lippincott Williams & Wilkins.
McKeever, A. E., Spaeth-Brayton, S., & Sheerin, S. (2014, August/September). The role of
nurses in comprehensive care management of pregnant women with drug addiction.
Nursing for Women's Health, 18(4), 284-293.
Patrick, S. W., Schumacher, R. E., Benneyworth, B. D., Krans, E. E., McAllister, J. M., & Davis,
M. M. (2012, May 9). Neonatal abstinence syndrome and associated health care
expenditures. Journal of the American Medical Association, 307(18), 1934-1940.
Protecting Our Infants Act of 2015, H.R. 1462, 114th Congress (2015).
Protecting Our Infants Act of 2015, S. 799, 114th Congress (2015).
Smith, M. V., Costello, D., & Yonkers, K. A. (2015, March). Clinical correlates of prescription
opioid analgesic use in pregnancy. Maternal and Child Health Journal, 19(3), 548-556.
Stover, M. W., & Davis, J. M. (2015, November). Opioids in pregnancy and neonatal abstinence
syndrome. Seminars in Perinatology, 39(7), 561-565.
PROTECTING OUR INFANTS ACT OF 2015
7
The American Congress of Obstetricians and Gynecologists (ACOG). (2015, August). Support
the protecting our infants act of 2015. Retrieved November 20, 2015, from ACOG: The
American Congress of Obstetricians and Gynecologists:
http://www.acog.org/About_ACOG/ACOG_Departments/~/media/Departments/Govern
ment%20Relations%20and%20Outreach/2015ProtectingOurInfantsOnePager.pdf
US HB1462 | 2015-2016 | 114th Congress. (2015, September 09). Retrieved November 20,
2015, from LegiScan: https://legiscan.com/US/bill/HB1462/2015
US SB799 | 2015-2016 | 114th Congress. (2015, Novemeber 19). Retrieved November 20, 2015,
from LegiScan: https://legiscan.com/US/bill/SB799/2015