More Ohio newborns suffer from mother’s addiction

The number of Ohio babies who come into the world sick and craving drugs continues to soar.

New state reports show that the rate of neonatal abstinence syndrome — the medical term for withdrawal symptoms suffered by newborns — jumped to 159 per 10,000 live births in 2015.

That’s more than eight times the rate a decade earlier, in 2005, when there were just 19 such hospitalizations for every 10,000 live births.

“Given the way that the other numbers in the state are going, unfortunately, they were what I expected. I expected the NAS rate to go up,” said Rick Massatti of the Ohio Department of Mental Health and Addiction Services.

Ohio is awash in drug abuse and addiction, at times leading the nation in deaths from heroin and synthetic-opioid overdoses. And women who become pregnant while using drugs can double the harm if they don’t get help quickly.

But awareness and availability of treatment continue to lag.

“As a community, we are failing these moms by not having adequate treatment slots,” said Dr. Barry Halpern, an OhioHealth neonatologist who has helped lead local efforts to care for pregnant drug users and their infants.

– Rita Price
The Columbus Dispatch

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Use of a state PDMP may help identify patients who are at high risk for diversion or doctor shopping… To quantify the effects of PDMPs, studies were conducted of ED providers who cared for adult patients with pain. Of the patients with complete data in one study, information from the state’s PDMP System altered prescribing practice in 41%.

ACEP - Annals of Emergency Medicine - 525

Attention to patterns of prescription requests and the prescribing of opioids as part of an ongoing relationship between a patient and a healthcare provider can decrease the risk of diversion. Periodic review of state PDMP, where available, is also a useful tool to monitor compliance. Evaluation should initially include…a drug history… Documentation is essential.

February 2013 American Academy of Pain Medicine

You’re not only reducing the supply [of pain medications] for those who use them inappropriately, but also for those in need.

Bob Tillman – Director of Policy and AdvocacyAmerican Academy of Pain Management

The AAOS recommends the following tools, which have been shown to significantly reduce medication errors:

computerized physician order entry

computerized decision support systems

computerized monitoring of adverse drug events

pharmacist-assisted rounds

high-risk drug protocols

Overdose deaths are “just the tip of the iceberg”: that for every death there are many more hospital treatment admissions, emergency room visits, people who abuse or are dependent on prescription drugs and nonmedical users.

American Psychological Association

In 2012, both New York and Tennessee required prescribers to check their state’s PDMP before prescribing painkillers.

The results one year later:
New York realized a 75% drop and Tennessee a 36% drop in patients who were seeing multiple prescribers to obtain the same drugs.

PDMP [National] Center of Excellence at Brandeis U, 2014

PDMPs have many limitations in their current format, including complex access issues, timeliness, and whether the data are presented to the physician automatically or require physician effort to retrieve.

ACEP - Annals of Emergency Medicine – 525

A study was conducted to estimate the societal costs of prescription opioid abuse, dependence, and misuse in the United States. Costs were grouped into three categories: health care, workplace, and criminal justice.

The results: Total US societal costs of prescription opioid abuse were estimated at $55.7 billion in 2007 (USD in 2009). Workplace costs accounted for $25.6 billion, health care costs accounted for $25.0 billion, and criminal justice costs accounted for $5.1 billion. Workplace costs were driven by lost earnings from premature death ($11.2 billion) and reduced compensation/lost employment ($7.9 billion).

Conclusions: The costs of prescription opioid abuse represent a substantial and growing economic burden for the society. The increasing prevalence of abuse suggests an even greater societal burden in the future.

Pain Medicine, Volume 12, Issue 4, April 2011

Recommendations for full use of PDMP include:

PDMPs can be effective clinical tools in medication management involving controlled substances.

PDMPs should be available for clinicians across state boundaries.

Every prescribing clinician should be familiar with the process of accessing and utilizing information from PDMP’s so that they can incorporate this information in their practices.

American Society of Addiction Medicine

What prescribers can do to safely and effectively use opioids for CNCP (includes the following)

Screen for prior or current substance abuse/misuse

Do not use concomitant sedative–hypnotics or benzodiazepines

Track daily MED using an online dosing calculator

Use the state Prescription Drug Monitoring Program to monitor all sources of controlled substances

Neurology, 2014; 83; 1277-1284, September 2014

Effective monitoring systems [PDMPs] will augment clinical judgment, provide evidence of misuse, and facilitate prescription of the most appropriate analgesic for the situation…The Emergency Department is regarded as the nation’s safety net…the last bastion of around-the-clock access to care … Unfortunately, some of the solutions to opioid misuse [limiting ED physicians to 3-day opioid prescriptions] preempts judgments from trained emergency medical providers.

American College of Physicians, Annals of Internal Medicine, 9 April 2013

Use of a state PDMP may help identify patients who are at high risk for diversion or doctor shopping… To quantify the effects of PDMPs, studies were conducted of ED providers who cared for adult patients with pain. Of the patients with complete data in one study, information from the state’s PDMP System altered prescribing practice in 41%.

ACEP - Annals of Emergency Medicine - 525

In 2012, both New York and Tennessee required prescribers to check their state’s PDMP before prescribing painkillers.

The results one year later:
New York realized a 75% drop and Tennessee a 36% drop in patients who were seeing multiple prescribers to obtain the same drugs.

PDMP [National] Center of Excellence at Brandeis U, 2014

A study was conducted to estimate the societal costs of prescription opioid abuse, dependence, and misuse in the United States. Costs were grouped into three categories: health care, workplace, and criminal justice.

The results: Total US societal costs of prescription opioid abuse were estimated at $55.7 billion in 2007 (USD in 2009). Workplace costs accounted for $25.6 billion, health care costs accounted for $25.0 billion, and criminal justice costs accounted for $5.1 billion. Workplace costs were driven by lost earnings from premature death ($11.2 billion) and reduced compensation/lost employment ($7.9 billion).

Conclusions: The costs of prescription opioid abuse represent a substantial and growing economic burden for the society. The increasing prevalence of abuse suggests an even greater societal burden in the future.

Pain Medicine, Volume 12, Issue 4, April 2011

The use of PDMPs…is helping to reduce misuse of prescription drugs.

PDMP Center of Excellence at Brandeis University, February 2014 Briefing

An improved PDMP … with accurate and timely data analysis should be regarded as the cornerstone of our collective efforts to address prescription drug abuse.

Department of Public Health

The abuse of opioid pain medication has a devastating impact on public health and safety in this country, killing 46 people every day… Prescription Drug poisoning deaths – now over 30,000/yr – outnumber deaths from motor vehicle crashes.

National Center for Health Statistics/CDC

You’re not only reducing the supply [of pain medications] for those who use them inappropriately, but also for those in need.

Bob Tillman – Director of Policy and AdvocacyAmerican Academy of Pain Management

The AAOS recommends the following tools, which have been shown to significantly reduce medication errors:

computerized physician order entry

computerized decision support systems

computerized monitoring of adverse drug events

pharmacist-assisted rounds

high-risk drug protocols

Overdose deaths are “just the tip of the iceberg”: that for every death there are many more hospital treatment admissions, emergency room visits, people who abuse or are dependent on prescription drugs and nonmedical users.

American Psychological Association

Prescribing or dispensing to an abuser, diverter, misuser or ‘doctor shopper’ puts the provider, their practice and or institution, as well as the patients at high risk.

Although relieving pain and reducing suffering are primary emergency physician responsibilities, there is a concurrent duty to limit the personal and societal harm that can result from prescription drug misuse and abuse.

ACEP Annals of Emergency Medicine 525

What prescribers can do to safely and effectively use opioids for CNCP (includes the following)

Screen for prior or current substance abuse/misuse

Do not use concomitant sedative–hypnotics or benzodiazepines

Track daily MED using an online dosing calculator

Use the state Prescription Drug Monitoring Program to monitor all sources of controlled substances

Neurology, 2014; 83; 1277-1284, September 2014

David Stengle

David is Prescription Advisory’s Chief Marketing Officer. Software startups are his passion.

He also serves as the Director of Startup Grind Princeton and a mentor for the Princeton University eLab.

More Ohio newborns suffer from mother’s addiction

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