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13 Sep 2018

The Hidden Victims of the Opioid Crisis: Read Dr. Stang’s Article

posted under News , Our News

The hospital patient shows telltale signs of opioid withdrawal – feverish, shaking uncontrollably, crabby and irritated, crying out in anguish. But there is one distinguishing characteristic: the patient is a newborn baby, from a mother addicted to opioids. Mere hours from the womb – and withdrawing from opioids. The opioid crisis is well known. Its ripple effects – on jobs, on families, on communities – have had millions of words written about them. But opioid babies – they are the hidden victims, tucked away in NICUs (neonatal intensive care units) all over the country, far from the cameras and the journalists’ tablets. And the ripple effects of opioid babies? Overcrowded NICUs. Overworked NICU nurses. Overburdened Medicaid budgets.

I’m not saying this for effect. This is the reality: our collective failure to productively address the opioid crisis in today’s adults is, literally, breeding the next generation of opioid-addiction victims.

While I’m reluctant to focus too much on a dollars-and-cents angle, it’s certainly one of the lenses for looking at the problem, particularly if you’re a politician holding state office and grappling with whether to expand your state’s Medicaid coverage. So, consider:

  • There has been a significant uptick – over 500% from 2004 to 2014.1 in babies born with NAS: Neonatal Abstinence Syndrome, which is the medical term for babies born of mothers with substance use disorder from opioid dependency, sent into immediate withdrawal, and suffering from multiple maladies throughout their infant bodies.
  • In the US, it is estimated that one infant is born every 25 min with NAS representing $1.5 billion in additional hospital charges2
  • The majority of Medicaid coverage is for young mothers and their babies.
  • There has been a huge increase in Medicaid claims for NICU services – over 700% from 2004 to 2014.3

ProgenyHealth is in the vanguard in implementing an approach that starts to address this urgent challenge. Team NICU nurses and neonatologists/pediatricians, who have substantial expertise in appropriate infant medical care, with social workers, who are best equipped to work with families in their homes after babies are discharged. This creates continuity of care. It fosters a more nurturing and supportive home environment for the babies – who, remember, are being cared for by mothers with substance use disorder with an addiction to opioids. It’s a holistic approach to a complex and frightening medical situation.

And it’s effective. From 2010 to 2017, ProgenyHealth data showed little difference in hospital readmission rates for the first year of life between the NAS NICU babies (10.5%) and non-NAS NICU babies (10%) that we worked with. By comparison, other studies of NAS babies have shown readmission rates of 1.7 times4 and nearly 2 times5 the readmission rates of non-NAS babies. In other words, the ProgenyHealth approach supports and educates families, leading to measurable improvements in their health outcomes during the babies’ first year of life. What’s more, there are significant cost-efficiency benefits. ProgenyHealth data has consistently shown an average length of stay in the high-cost NICU of 15.2 days, compared with an average of 20.1 days, as reported by researchers using Vermont Oxford Network hospital data.6

But there are challenges to implementing this approach. The most significant challenge is that families resist case management because they fear their babies will be taken from them once they leave the hospital. The only way to mitigate that challenge is to introduce them to social workers shortly after birth, when NAS is identified in the newborn. The social workers can bond with the family early on, establishing the trusted relationship that is so crucial to the success of a baby’s recovery.

Simply put, this approach combines the most effective medical solution with the most cost-efficient use of Medicaid funds. Failing to support such a proven solution not only abandons these families and babies at their time of greatest vulnerability and need, but it prolongs the devastating medical condition – and the continued need for high-cost medical care, perhaps for years.

The opioid-addicted infant is a human tragedy. But in the universe of the opioid crisis, it’s the rare one with an evidence-based solution that can be implemented now to support these families and their infants at their time of greatest need. It just requires the courage and common sense of the politicians and medical authorities making the decisions on Medicaid budgets and medical protocols to make sure we don’t exclude the crisis’ smallest victims.

This article was also recently published in Becker’s Hospital Review.

Citations

1 Pediatrics, April, 2018

2 Journal of Perinatology, October, 2017

3 Pediatrics, April, 2018

4 Journal of Perinatology, October 2017

5 Hospital Pediatrics, October, 2015

6 Pediatrics, May, 2017