Science = Solutions For Substance Use Disorders and Infant Outcomes. Wilson M. Compton, M.D., M.P.E. Deputy Director National Institute on Drug Abuse

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1 Science = Solutions For Substance Use Disorders and Infant Outcomes Wilson M. Compton, M.D., M.P.E. Deputy Director National Institute on Drug Abuse Science = Solutions

2 Increased Opioid Mortality: Greater Rate of Increase in Women Sources: CDC Wonder, SAMHSA, 2014 National Survey on Drug Use and Health, released September % of current prescription opioid misusers are women 35% of current heroin users are women 20,000 15,000 10,000 Prescription Opioid Overdose Deaths Total Female Male Male rate increased by 350% Female rate increased by 540% 12,000 10,000 8,000 6,000 Heroin Overdose Deaths Total Female Male Male rate increased by 430% Female rate increased by 750% 5,000 4,000 2,

3 Increasing Neonatal Abstinence Syndrome NICU Admissions for NAS (Number per 1000 Admissions) Source: Tolia VN, Patrick SW, et al. NEJM 2015;372:

4 Increasing Neonatal Abstinence Syndrome: Incidence & Geography, U.S Patrick SW, Davis MM, Lehman CU, Cooper WO. Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to J Perinatol Aug;35(8):667. doi: /jp PubMed PMID:

5 Increasing Neonatal Abstinence Syndrome: Opioid prescriptions during pregnancy In a Tennessee Medicaid sample of 112,029 pregnant women: Of the babies born with NAS: 28% 72% 65% 35% used at least one prescription opioid during the pregnancy were born to mothers with a legal opioid prescription SW Patrick et al. Prescription opioid epidemic and infant outcomes. Pediatrics. (2015)

6 Improved Treatment of Neonatal Abstinence Syndrome Protocol Defined Treatment in Southwest Ohio for Infants with NAS Protocol Adopting (n=75 pre, 93 post) * P < * * Existing Protocol (n=454 pre, 359 post) Days of Opioid Treatment Protocol Adopting (n=75 pre, 93 post) Before After Existing Protocol (n=454 pre, 359 post) Inpatient Hospitalization Days Source: Hall ES, et al. Pediatrics 2015;136:e803-e810

7 Improved Treatment of Neonatal Abstinence Syndrome 25 Protocol Defined Treatment in Southwest Ohio for Infants Exposed in utero to Short-Acting Opioids or Buprenorphine * * 9.4 Buprenorphine (n=38) 5 Methadone (n=163) 0 * P <.001 Days of Opioid Tx Length of Stay Source: Hall ES, et al. Journal of Pediatrics 2016;170:39-44

8 Shifting Treatment of Neonatal Abstinence Syndrome Medication Use in NAS (Per Cent of Infants) Source: Tolia VN, Patrick SW, et al. NEJM 2015;372:

9 Recent Scientific Workshop: Opioid Use in Pregnancy, Neonatal Abstinence Syndrome, and Childhood Outcomes April 4 5, 2016 Co-sponsored by NICHD/ACOG/AAP/SMFM/CDC/MOD Screening for opioid use, abuse, and addiction in pregnancy Pregnancy management of women with opioid use disorders Intrapartum and postpartum management of women with opioid use disorders Neonatal abstinence syndrome (NAS) and child outcomes Social services and ethical issues around NAS

10 It s Not Just Opioids: Tobacco addiction and infant outcomes Smoking during pregnancy and reproductive years is harmful for women and infants Women: placenta abruptio, placenta previa, ectopic pregnancy, early labor Infant: prematurity, low birth weight, SIDS, cleft lip/palate Current prevalence of smoking during pregnancy: General population: ~10% Medicaid: ~20% (higher in many places) The Affordable Care Act expanded coverage of cessation services for pregnant women. Activities are underway across the Department to help women quit before or during pregnancy

11 Increased Price of Tobacco Associated with Decreased Infant Mortality Strong association between higher cigarette tax and infant mortality showed, on average: For every $1 tax increase per pack 2 fewer infants died per day Effect sizes are larger for African American infants than white infants Indicates an intervention point to address infant mortality, and racial disparities in infant mortality Source: Patrick SW, et al. Pediatrics 2016;137:1

12 HHS Resources on Smoking Cessation for Pregnant Women 2020 Healthy People Goal: Increase abstinence from cigarette smoking among pregnant women to 98.6% For women women.smokefree.gov Pregnancy & Motherhood (National Cancer Institute) SmokefreeMOMtext messaging (National Cancer Institute) Show Your Love campaign for preconception care (CDC) For health care providers Smoking Cessation in Pregnancy and Beyond: A Virtual Clinic (CDC) Treating Tobacco Use and Dependence PHS Guidelines (Agency for Health Care Research and Quality) New Medicaid Tobacco Cessation Services State Medicaid Director Letter (CMS) List of HHS Resources available at:

13 Interventions After Acute Neonatal Care are Important: Nurse Home Visiting impacts long-term outcomes 6 5 Percent of Children Who Used Tobacco, Alcohol, or Marijuana (Last 30 Days) Child Age 12 Percent of Children with Internalizing Problems (Borderline or Clinical) 6 Child Age Nurse Comparison PIAT Scores - Reading & Math Age 12 (Born to Low-Resource Mothers) Nurse Comparison Percent of Mothers with Role Impairment due to Alcohol or Drug Use Child Age Nurse Comparison Arch PediatrAdoles Med, 164(5) , Nurse Comparison Science = Solutions

14 Protecting Our Infants Act of 2015 Report to Congress due November 2016: Review of Programs Strategy to address gaps in Research Treatment availability Federal coordination Report to Congress due May 2017: Comprehensive research assessment Evaluation of best practices in prevention and treatment of both OUD and NAS

15 Science = Solutions