As social service advocates, treatment professionals and politicians scramble to address a major public health problem with the proliferation of opiates in the community, there is another problem related to the rapid increase in the use and abuse of opiates in Massachusetts.
The number of babies born with drugs in their system is increasing rapidly. The drugs causing most of the baby’s problems are opiates. In one local hospital, the number has increased four times since 2008.
Percentage of Babies Born with Drugs in Their System-South Shore Hospital
These babies experience what is called “neonatal abstinence syndrome,” suffering withdrawal pains as a result of exposure to illegal opiates such as heroin or prescription drugs such as Oxycontin or methadone, according to a first of its kind survey of local hospitals.” In addition to the difficult physiological reaction due to withdrawal, long term effects may include: poor intrauterine growth, premature birth, seizures, and birth defects.
Many people are looking to the beleaguered Department of Children and Families to address this dilemma but a successful solution already exists that utilizes a different approach. This model, developed by the Kaiser Permanente Health Plan over 20 years ago, drastically reduces the effects and costs of drug use in pregnant women.
The program, Kaiser Early Start (ES), is based on the premise that substance abuse is a treatable disease and addresses it in a nonjudgmental, accepting manner. A substance-abuse counselor is located in each obstetrics clinic providing accessible one-to-one counseling to pregnant women screened at risk for alcohol, tobacco, or drug use as part of the routine prenatal care package offered to all patients.
The original model was developed by experts from Born Free, a program in Contra Costa County, California and adapted by Kaiser professionals into the health plan.
The innovative aspect of ES is stationing a licensed substance abuse expert, or ES specialist (ESS), within the Obstetrics Department to work as part of the prenatal care team. The role of the ESS is to assess, educate, and provide ongoing counseling to at-risk women.
Evaluation of the pilot project found that 92% of the patients who were referred to the ESS by their clinician accepted the referral. For 81% of these women, the ESS diagnosed moderate to severe substance abuse problems. These women were regularly tested for alcohol and other drugs during their prenatal care. Subsequently, 69% had negative findings on toxicology screens by the 32-week point in their pregnancies, and their babies had significantly better birth outcomes and shorter hospitalizations compared with women who continued to use alcohol and street drugs.
1300 babies were born in Massachusetts in 2012 with drugs in their system, usually resulting in treatment in the neonatal intensive care unit (NICU) of the hospital. . Personal conversations with representatives from Kaiser back in the 1990’s provided estimates of $250,000 per baby served in a NICU. This would translate to a savings of close to $3 million if a Healthy Start program was implemented state wide in Massachusetts. And this is just the medical savings at the beginning of their life.
If the child survives infancy, there are usually multiple medical, psychiatric and learning needs that must be addressed, putting additional financial stress on the social service, medical and educational systems and ongoing emotional stress on the families.
It looks like it is time for the Commonwealth to support an Early Start program in Massachusetts.