NOW: Nurturing Options for Women

Overview

Neonatal abstinence syndrome (NAS) is a withdrawal syndrome that occurs in infants exposed to opioids in utero. Prenatal misuse and abuse of addictive opiate drugs has resulted in 3.39 per 1,000 hospital births diagnosed with neonatal abstinence syndrome [NAS]. Hospitalization time to treat NAS infant drug withdrawal symptoms necessitates substantial public dollars, as most mothers are uninsured or Medicaid recipients. Total NAS costs in 2000-2009 were an estimated $190 million to 720 million.1 More than half (52.1%) of Tennessee babies diagnosed with NAS in 2014 were from the East Tennessee. Over a quarter of the women who gave birth to babies diagnosed with NAS (27.7%) had prenatally used only prescribed opioids (TDOH, 2015); this figure includes women enrolled in a medication assisted treatment (MAT) for opioid addiction. Challenged economic conditions, compromised health status, and a greater use of health services contribute to women being more vulnerable to opioid use disorder (OUD) compared to men. Women are more likely to prescribed opioids, experience depression, and receive pain-related diagnoses. In turn, women have reported greater past year problematic use of opioids than men. Despite this vulnerability, women are vastly underrepresented in substance use treatment centers. Women have reported fear of loss of custody, not wanting to be away from children/partner, concern about stigma or privacy, and lack of childcare and transportation as barriers to treatment. Among women currently abusing opioids or in treatment for this condition, the rate of unintended pregnancy has been reported to exceed 80%, in contrast to the national U.S. rate of 45% in 2011.7 This disparity in unintended pregnancies strongly suggests that women who repetitively use opioids face multiple and potentially unique barriers to effective contraceptive use. Despite the high rate of unintended pregnancies in this population, in Tennessee in 2015 just 15% of the 38,000 Medicaid (a.k.a., TennCare)-eligible women aged 15-44 who were prescribed long-term pain killers also received a prescription for or were currently using an effective contraception method in that same year.3 The Appalachia region has ravished by OUD and its effects on its communities and its children. Rural East Tennessee including Claiborne and Scott Counties have been particularly devastated, with some of the highest NAS, prescribing, and overdose rates in the nation. In order to prevent NAS, Nurturing Options for Women (NOW) will enhance the quality and number of support services available to adolescent girls (ages 10-15) and women of reproductive age (ages 18-44). This collaborative venture, directed by the University of Tennessee, Knoxville (UTK), will also involve the Hill and Servolution Health Services (SHS) of Claiborne County and STAND of Scott County. Together, this team will serve to improve the provider workforce, both in number and quality, with and focus on adolescent girls, women of reproductive age, and their families. First a 6-month assessment phase that will culminate in a strategic plan and logic model will be completed. If supported by the results, the proposed services will include: (1) youth behavioral health support; (2) the addition of LCSW case management and behavioral health support on an interprofessional care team, (3) stigma reduction training for social service and healthcare providers; (4) CEU-certified training for healthcare providers including integrating family planning services, Medicaid reimbursement, risk reduction, and MAT recruitment and certification, and (5) transportation to increase access to recovery meetings. Process and outcome evaluation of these activities will ensure continuous quality improvement and ultimate success in preventing NAS in rural East Tennessee. These data will also support sustainability by incremental transition of LCSW salary recovery through billing, partnership with the UTK College.