Online Program

Maternal substance use and newborn drug withdrawal: Public health epidemic?

Tuesday, November 5, 2013

Anne Lise Sullivan, RN, BSN, MA, Department of Maternal and Child Health, Marion County Public Health Department, Indianapolis, IN
Jo Ann Matory, MD, Indiana University School of Medicine, Wishard Health Services, Indianapolis, IN
Teri Conard, RN, MS, Department of Maternal Child Health, Marion County Public Health Department, Indianapolis, IN
Yvonne Beasley, MN, RN, Department of Maternal Child Health, Marion County Public Health Department, Indianapolis, IN
Background: In Marion County, Indiana a top contributing factor to fetal and infant mortality is maternal substance use. The escalating abuse of prescription opioids during pregnancy is particularly problematic. Although the relationship between adverse pregnancy outcomes, neonatal abstinence syndrome (NAS) and opioid use is well established, pregnant women are still experiencing institutional barriers to obtaining treatment. Objectives: Describe barriers to substance abuse identification and treatment based on our consumer voices. Discuss recommendations for practice and policy development related to substance abuse prevention and treatment. Methods: We conducted interviews with opioid addicted mothers who experienced a loss. We convened our multidisciplinary Indianapolis Healthy Babies- Fetal Infant Mortality Review (IHB-FIMR) team to review de-identified medical record data and maternal interview transcripts to prioritize key indicators for systems change. Results: Six main barriers to care emerged: moms avoid prenatal care when they feel labeled as: “drug seekers”; moms conceal drug use histories for fear of inadequate pain management during delivery; moms are not advised of the risks of using opioids during pregnancy even if medication is being used legally; moms are not being screened for drug use equally across all socio-economic levels; communication and collaboration between health providers is poor; and ER visits where opioids are dispensed are not adequately tracked. Discussion: IHB-FIMR findings suggest that service disparities and systemic barriers to addiction recognition and treatment utilization still exist. Our recommendations serve as a basis for developing community-based initiatives and policy changes aimed at improving pregnancy outcomes and reducing fetal and infant mortality.

Learning Areas:

Assessment of individual and community needs for health education
Conduct evaluation related to programs, research, and other areas of practice
Planning of health education strategies, interventions, and programs
Public health or related laws, regulations, standards, or guidelines

Learning Objectives:
Identify at least 3 institutional barriers to substance abuse treatment during pregnancy. Describe at least 1 potential community-based initiative or policy change that addresses the reduction of substance use in pregnancy based on IHB-FIMR recommendations.

Keyword(s): Drug Abuse Treatment, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the co-investigator on the majority of the FIMR substance use cases analyzed and presented here. I have worked with substance abusing clients clinically and in a community-based setting and work to evaluate and improve the level of service available to this population.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.