Maine ranked second among 28 states in 2012 for the number of babies born with a drug withdrawal syndrome primarily caused by exposure to opioids while in the womb, according to a U.S. Centers for Disease Control and Prevention report released Friday.
According to CDC statistics compiled from the 28 states that have publicly available data, the incidence rate of neonatal abstinence syndrome, or NAS, in Maine was 30.4 per 1,000 hospital births in 2012, almost double the rate from 2008. Vermont was the only state with a higher incidence rate in 2012, at 30.5 births per 1,000.
Substance abuse providers and a state official said Friday that the report underscored the toll that Maine’s opioid crisis is taking, particularly on its most vulnerable citizens.
“It’s shocking. It’s not surprising, but it’s shocking,” said Dr. Dora Anne Mills, a former director of the Maine Centers for Disease Control and Prevention, and the current vice president for clinical affairs at the University of New England.
“This is an indication of the tragic power of these drugs,” Mills said. “I think we need to keep in mind that these opioids are extremely addictive and these are mothers who do not want to harm their babies.”
NAS is a postnatal drug withdrawal syndrome primarily caused by in-utero exposure to opioids like heroin and prescription painkillers. An unborn child also can be exposed to medication used in opioid-abuse treatment like methadone or suboxone.
Newborns exposed to opioids in the mother’s blood stream suffer withdrawal symptoms that include pain, nausea and anxiety. They often cannot sleep or eat, and may be treated with drugs to ease cravings. Substance abuse during pregnancy also can result in preterm birth, low birth weight and intrauterine death. The CDC report said there is limited data on the longterm developmental outcomes related to opioid exposure during pregnancy.
The CDC reports that between 1999 and 2013, the incidence of NAS increased almost 300 percent in states with publicly available hospital data.
According to the report, West Virginia had the third-highest NAS incidence rate in 2012, at 21.7 per 1,000 births, followed by 12.5 in Massachusetts, 12.3 in Kentucky and 11.4 in Maryland.
Data for Maine was unavailable for 2013, when the rates jumped again in Vermont, West Virginia and Kentucky.
“The findings underscore the importance of state-based public health programs to prevent unnecessary opioid use and to treat substance use disorders during pregnancy, as well as decrease the incidence of NAS,” the CDC said.
DRUGS-AFFECTED BABIES A GROWING PROBLEM
The percentage of Maine babies born affected by drugs – whose mothers used illicit drugs, abused alcohol, or were using medication-assisted treatment while pregnant – was 8 percent last year, or about 1 in every 12 births, according to the Maine Department of Health and Human Services. The number of drug-affected babies born in Maine has increased at a rapid pace, from 178 in 2006 to 995 in 2015, according to the Maine CDC figures.
In an interview Friday, Maine Department of Health and Human Services Commissioner Mary Mayhew said the CDC’s recommendations are “consistent” with state’s focus on tackling the opioid crisis.
“I think this helps reinforce the recommendations we have been identifying and advancing,” including a new state law that put limits on prescription pain killer dosage and duration, and created a prescription monitoring program, Mayhew said.
The state also has rolled out a number of programs aimed specifically at pregnant women dealing with opioid abuse.
In a March letter to Maine obstetricians and gynecologists, Mayhew advertised Snuggle ME, guidelines for universal screening of pregnant women for substance abuse.
“The earlier that screening and referral for treatment occur, the greater the opportunity to reduce harm to both mother and baby,” Mayhew wrote.
The state has re-issued a request for proposals for a residential treatment center specifically for pregnant women and new mothers. Last September the state declined to award a contract for the same request.
CALLS FOR STATE TO DO MORE
Mayhew said the 211 resource information service offers a “warm hand-off” service to connect pregnant women directly with treatment providers, and has a sustained publicity campaign about the issue.
The state also has located substance abuse treatment with parenting education in a pilot program serving 250 people and is pairing public health nurses with child services home visits to identify at-risk families and provide support, Mayhew said.
Some treatment providers think more can be done.
Pat Kimball, the outgoing executive director of Wellspring Substance Abuse and Mental Health Services that operates a treatment center for women in Bangor, said part of the problem is the statistics for drug-affected babies don’t differentiate between mothers who are using illegal drugs and those who are seeking medically assisted treatment.
“We are really good at touting numbers and saying what numbers are, but what are our long-term plans?” Kimball said.
“The bottom line is all the statistics are saying we are not taking very good care of women and children and they need to get access to treatment and they need to get it quickly.”
Eric Haram, director of the Addiction Resource Center at Mid Coast Hospital in Brunswick, said the center’s Healthy Generations program has shown success getting women rapid treatment for opioid addiction and decreasing the time drug-affected babies are hospitalized after birth. For the 17 patients who came through the program last year, babies stayed in the hospital about 18 days, lower than the national average of 31 days, he said.
“I think there is a correlation between the increasing prevalence of NAS and the poor access to medically assisted treatment we have here in Maine,” Haram said, adding that increased state attention on the issue is welcome.
“We have had a very well-publicized and growing problem for at least a decade and it is great to see support coming now.”