This year may prove to be a turning point for Tennessee’s crisis of drug-dependent babies. Preliminary figures on the number of cases show they’re down roughly 10 percent — the first meaningful drop since the state started keeping track, partially as a result of a budding philosophical change in treatment.
Looking across the state, East Tennessee has had a much bigger problem with neonatal abstinence syndrome, called NAS, and with opioids more broadly. The region has also seen this year’s greatest drop in newborns who end up going through painful withdrawals. She says some obstetricians have resorted to unconventional methods.
“I will say, there are more changes in treatment around NAS in the east and northeast part of the state,” says Dr. Morgan McDonald, who oversees family health for the Tennessee Department of Health. “There is more of an emphasis on allowing — in some practices — in allowing women to even detox off of opioids during pregnancy.”
Currently, the recommended treatment puts mothers on special opioids that help keep them stable, though that medication still can result in withdrawals for the baby.
But
Dr. Craig Towers of UT Medical Center’s high risk pregnancy team is leading a rethinking of the standard treatment, presenting research to make his case. This month in the journal
Pediatrics, he
published a study showing smaller head circumference in newborns with NAS.
“There is some harm to the baby for being chronically exposed, but there is a real risk for a mom that tapers or detoxes, that she will relapse, could overdose, and if that happens, could die, killing her and the baby,” Towers says. “I don’t take it lightly. I think there’s a lot of people in the country that think I just kinda willynilly detox everybody or twist their arm and force them into it.”
Towers says he warns mothers that detoxing is more of a risk to them than to the baby, but he says many are willing to accept it. Just this year, he’s delivered roughly 180 babies to mothers who got off drugs entirely. He says he did not recommend detox, just offered “informed consent.”
Towers wants the American College of Obstetrics and Gynecologists to acknowledge detox in its treatment guideliness.
“I’m hoping that eventually what I’m doing will be listed…as an option, that’s all I’m asking for,” he says.
His caseload alone could be making all the difference in the
statewide decrease of more than 100 cases through this time in 2017, though state health officials also credit new
emphasis on providing long-acting birth control to women on opioids and doctors avoiding overdiagnosis of the condition.
Tennessee Seems To Be An Outlier
Tennessee was one of the first states to start aggressively tracking NAS with weekly surveillance reports. While other states have followed suit
and even improved upon the process, state-to-state figures are still difficult to compare. New Mexico is still
reporting rising numbers as is
Arkansas, but those numbers aren’t from 2018.
Tennessee health officials say other states don’t seem to be experiencing the same decline. McDonald says that’s pushed the TDOH to double check all of its data to make sure there’s nothing wrong with the numbers.
“It has certainly made us redouble our efforts to make sure we’re getting good reporting,” McDonald says. “And it’s made us really dig into where are we seeing those declines.”
Figures for 2018 are expected to be finalized in March.
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