Dr. Douglas Springer
Tennessee has an alarming problem with narcotics, mothers and babies.
Last year, 855 infants spent their first few days, weeks and even months of life in agonizing withdrawal from prescription and non-prescription drugs because their mothers exposed them to narcotics during pregnancy. This dangerous and costly disease has been termed the Neonatal Abstinence Syndrome, or NAS. Tennessee has one of the highest rates of NAS by population of any state, more than tripling in the past eight years into a statewide epidemic.
The Tennessee Medical Association has pushed for solutions because narcotics addiction – in babies or adults – is a disease that cries for medical intervention. Babies born with NAS require prolonged treatment, usually in a hospital setting, with complicated medical issues and high-risk deliveries.
Science has not yet given us clear answers on the type and amount of medications to administer to mothers before delivery to mitigate NAS, but one thing is clear: We want the best care for the mother and infant.
This is why the TMA advocated for the Safe Harbor Act in 2013. The bill, which is now state law, was lauded nationally as a model for dealing with NAS. It states that if a mother seeks care by week 20 of her pregnancy and remains in prenatal care with a drug treatment program through the term of her pregnancy, then the Department of Children’s Services cannot take custody of her baby solely because she took narcotics while pregnant.
We can’t say yet whether the Safe Harbor Act is yielding results in the fight against NAS, but the intent was to give women an incentive to submit for prenatal care, and to eliminate fear, so they can feel free to discuss their narcotic addiction with their personal physician.
What we do know is that NAS affects more than mothers and babies. The average TennCare cost for an infant born dependent on drugs, diagnosed with NAS is nearly $67,000, approximately 16 times the $4,237 cost to taxpayers for a healthy delivery.
State officials take notice of a problem that adds more than $53 million annually to an already strained Medicaid budget, so the General Assembly attempted to address the problem by passing a new law this year (SB 1391/HB 1295). It takes the opposite approach of the Safe Harbor Act by giving district attorneys and law enforcement officials the authority to prosecute women who are caught using drugs while pregnant. It is the first law of its kind in the U.S.
Proponents maintain that the new law enables women to get affordable treatment they need through the courts that they could not or would not pursue on their own. TMA opposed the bill, and advocated for two important modifications.
First, a woman can only be charged with a misdemeanor and not a felony as the bill was originally drafted. This is important because the simple assault charge can be expunged by a judge if the mother undergoes treatment, so it should not affect her ability to earn employment. We hope women will not be deterred from seeking appropriate care because of this piece of the law.
Tennessee physicians like me remain concerned, however, that the new law will have unintended consequences. If misinformed mothers do not seek prenatal care for fear of prosecution or losing their babies, then an already dreadful situation will worsen.
The other important amendment to the new law was that it will sunset it two years. This gives us enough time to gather data we need to evaluate whether it is improving the situation, having no effect, or making it worse.
Right or wrong, at least we are doing something in Tennessee to try to deal with NAS. These laws passed during the past two years, along with the Controlled Substance Monitoring Database website, are the first of their kind. The State is producing a list of treatment doctors and facilities on its website, and officials are planning to disseminate more information soon to providers and prospective mothers.
We need to educate women about the danger of using narcotics while pregnant to prevent NAS cases. We need to closely monitor our new laws and develop better programs if we cannot demonstrate a measurable reduction in the NAS epidemic.
TMA strongly believes that the best option for women addicted to narcotics and the best protection for innocent babies is appropriate medical treatment, and a healthy, trusting relationship with their personal physician.
Douglas Springer, MD, FACP, FACG
Tennessee Medical Association