I appreciate the recent candid discussion of efforts launched under the administration of Gov. Larry Hogan to address the opioid epidemic, as well as suggestions on how to further improve these efforts moving forward (“After Larry Hogan vowed to take on Maryland’s opioid epidemic, deaths soared. What happened?” Oct. 10). However, the article failed to mention a particularly disturbing consequence of the opioid epidemic — the increasing number of infants born with neonatal abstinence syndrome or NAS.
NAS is a collection of withdrawal symptoms that can result from in utero exposure to licit and illicit opioids, as well as other drugs (such as alcohol, cocaine, methamphetamine and others). Between 2007 and 2015, Maryland experienced a 56.6 percent increase in the number of infants born with opiates, alcohol, narcotics or other drugs in their system. As the opioid epidemic rages on, hospitals across the state are seeing an overwhelming number of infants born to mothers who have abused prescription painkillers or heroin.The withdrawal symptoms associated with NAS often necessitate lengthy and expensive hospital stays.
The extended hospitalization and intensive care required for infants with NAS has left NICUs across the state at capacity and health care personnel feeling overwhelmed. Although there is no national standard of care in relation to the treatment of NAS, guidelines created by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend the placement of infants in a quiet, dimly-lit environment and continued maternal involvement throughout the course of treatment – qualities not afforded by the typical NICU. Moreover, the treatment of NAS in a hospital setting is focused on the short-term medical needs of the infant. Maryland’s hospital system does not have the time or resources necessary to address the long-term care needs of the infant-mother dyad. The limitations associated with contemporary inpatient treatment necessitates the development of more comprehensive and cost-effective models of care.
Maryland policymakers can obtain valuable insight by examining successful, cost-effective NAS care models that have been implemented by other states. For example, the Boston Medical Center NAS Therapeutic Unit utilizes variety of evidence-based treatment modalities to address the short- and long-term care needs of infants and their mothers. The placement of the therapeutic unit within the collective of clinics and programs comprising the BMC facilitates the provision of highly-integrated and coordinated care. This allows for a comprehensive approach that addresses the interrelated issues of maternal substance use, maternal health and infant health. Prior to the establishment of the therapeutic care unit, infants with NAS were admitted to the BMC NICU for an average of 19 days to the tune of $67,000, and more than 80 percent received opioid-replacement therapy. The establishment of the therapeutic care unit combined with the emphasis of non-pharmacological care techniques has drastically reduced the duration of stay, the cost of care, and the need for opioid replacement therapy. Infants admitted to the therapeutic unit stay an average of nine days, the average cost of care hovers just under $20,000 and only 30 percent of infants receive opioid replacement therapy.
As policymakers continue to propose and implement strategies designed to address the growing opioid crisis, pregnant women and infants should be a priority for targeted, well-funded public health interventions. By standing on the shoulders of other states battling this epidemic, Maryland policymakers can promulgate policies and interventions that allow for the comprehensive and cost-effective provision of care to infants born with NAS and their mothers.
Kathryn Varga, Highland