Epidemic Spreading Across the State

1. Epidemic Spreading Acrossthe State Erica Wilson M.P.H. Health Promotion Program Director East Region

2. Neonatal Abstinence Syndrome

3. What is it? Neonatal abstinence syndrome (NAS) is a term for a group of problems a baby experiences when withdrawing from exposure to narcotics.

4. What Causes It? Almost every drug passes from the mother's blood stream through the placenta to the fetus. Illicit substances that cause drug dependence and addiction in the mother also cause the fetus to become addicted.

5. What Happens to the Baby? At birth, the baby’s dependence on the substance continues. However, since the drug is no longer available, the baby’s central nervous system becomes overstimulated causing the symptoms of withdrawal.

6. What’s the Incidence of Neonatal Abstinence Syndrome?

8. NAS Surveillance Data • 626 cases in Tennessee as of 8/30/14 compared to 564 at same point in 2013 • Increase of 11%

10. NAS Surveillance Data East Tennessee continues to account for largest proportion of cases in the state (28.6%) 3rd highest rate in the state (35/1000 births)

11. NAS Surveillance Data Exposure source trends in East TN vary from those seen in all cases state-wide

12. NAS Surveillance Data

13. NAS Surveillance Data Highest rates based on provisional county birth estimates

14. Why is Neonatal Abstinence Syndrome a Concern?

15. The Baby • Tragedy and suffering of the babies and their caregivers. • With increased likelihood of foster care, families are torn apart. 

16. The Cost • According to current statistics in Tennessee, the TennCare costs for a healthy newborn were $4,237 compared to an average cost of $66,973 for an infant born dependent on drugs, diagnosed with NAS.

17. The Future • There may be other economic, psychological and physiological costs associated with their medical condition at birth since it is not yet known what challenges and needs these infants will have as they grow older.

18. What can we do in Public Health ? • NAS became a reportable condition in TN on January 1, 2013 • NAS Taskforce was formed July 11, 2013 – Collaborative effort with East Region and Knox • NAS/PPI Sub-committee was formed on September 5, 2013

19. Primary PreventionInitiative LARC Pilot Project East Region

20. The Process • Collaboration • Sheriff/Jail Administrator/Jail Nurse • Education • Partners (Pamphlet) • Participants (PowerPoint and Pamphlet) • Referrals (Referral/Follow-Up Form) • Clinical Services • Data Collection (Referral/Follow-Up Form)

21. LARC Project

22. Jail Settings • 1/14/14 – first education session at Cocke County • As of 8/8/14, six sessions have been held • 4 at Sevier County Jail • 2 at Cocke County Jail • 119 total persons educated • Anticipated referrals: 75 (63.0%)

23. Population Characteristics • Females ranging in age 20 – 45 (avg. age: 27) • Predominately non-Hispanic white • Mostly residents of Sevier and Cocke County, but a few from other areas:

24. Patient History

25. Method of Birth Control

26. Future Data Collection • Education levels • FP barriers • 28% of referrals were previous FP patients • Specific drug use history including during pregnancy • History of unplanned pregnancy

27. Cost Savings • Preventing the birth of one drug dependent infant saves an average cost of $66,973. • Preventing the birth of one drug dependent infant in each of the counties in the East Region would be a cost savings of $1,004,595. • Preventing the birth of one drug dependent infant in each of the counties in Tennessee would be a cost savings of $6,362,435.

28. LARC Pilot Update – September 10, 2014

29. Erica Wilson M.P.H. Health Promotion Program Director East TN Regional Health Office Erica.Wilson@TN.gov (865) 909-9404 Ext. 103 Questions