Paper On Neonatal Abstinence Syndrome

Tennessee is one of the states hit hardest by the nation’s opioid epidemic which began about 20 years ago and had a stark increase since 2009, now reaching unprecedented levels across the county with a 200% increase in the rate of deaths involving opioids (Rudd, Aleshire, Zibbell, & Gladden, 2016; Fletcher, 2016). In Tennessee specifically, it is estimated that about 1 in 6 abuse opioids; the CDC estimates that for every one person who dies from an opioid overdose in Tennessee there are 851 others in the state who are in various stages of their abuse, misuse, and treatment; and the most recent statistics show that opioid overdoses alone make up about 7.7% of deaths in Tennessee, making them responsible for more deaths than car accidents in the state (Botticelli, 2016; Rudd, Aleshire, Zibbell, & Gladden, 2016; Fletcher, 2016; ONDCP, 2016; Thompson, 2016).

The use of heroin, cocaine, and other illicit drugs has become a public health concern especially during pregnancy. Maternal substance abuse has become an issue during the crack epidemic in the 1980’s; however, there is an alarm rate of infants born addicted to heroin. More than 3.7% women have indicated the uses some form of illicit drugs during their pregnancy, as well as 1.9 % reports binge drinking (Bhuvaneswar el at., 2008; Grant el at., 2009). With this in mind, more than 375,000 infants are born to maternal substance abusers each year costing over $100,000 in medical expenses covered by the state (Reitman, 2002).

Substance abuse during pregnancy can have a negative force on the health and wellness of not only the fetus, but that of the mother. The harmful effects of medications, alcohol and illegal drugs on an unborn child can be devastating and can have significant consequences to its use. Sometimes the effects can be faced and treated, and other times the outcome is a lifelong challenge. During the prenatal period, it is important that new mothers are informed of the different types of abuse, how they may affect the fetus, and the adverse conditions their child may be faced with before and after birth.

In 1913, sex education became a topic that was found to be an important education tool. Since then, this form of education has been a hot and debatable topic among many Americans. The original reason for sex education classes was to reduce problems such as sexually transmitted illnesses and prostitution. In recent years, abstinence has become the focus of sex education curriculum. Abstinence means refraining from sex completely. Although, it is the only one-hundred percent way to prevent sexually transmitted diseases and unwanted pregnancies, abstinence-only instruction should not be the only form of sex education taught. Our youth need to know about all aspects of sex. This intails how to protect them if they choose to become sexually

The babies, born to mothers who continue to use cocaine during pregnancy, show withdrawal symptoms two to three days after birth. These symptoms include tremors, restlessness, irritability, muscle rigidity, sleep disturbance and feeding difficulties. The babies can be hyperactive or very sleepy. Other less common symptoms are diarrhea, vomiting and sometimes seizures can also happen. If you have been taking cocaine during pregnancy inform your obstetrician so they are prepared to deal with any complications.

In 2014, after seeing a significant increase in babies born with neonatal abstinence syndrome (NAS), Tennessee began criminally charging pregnant women who use drugs (Sakuma, 2014). Supporters of the new legislation refer to it as a “velvet hammer” used to convince the pregnant drug users into going into treatment, or doing jail time. However, critics are concerned that this legislation will be just another barrier for a group of women who are already at risk, (Sakuma, 2014).

The use of controlled substances throughout pregnancy is a very prevalent issue among society today. Controlled substances have devastating effects on not only the mothers using the substances, but also infants while they are in utero and after they are born. Many infants born to mothers, who are abusing drugs, suffer from life threatening illnesses and are forever affected through adulthood. Specifically, heroin is a common drug form that is often used during pregnancy and results in the life threatening effects mentioned above.

The National Health Institute (NIH) explains that addictive drugs such as amphetamines, cocaine, barbiturates, diazepam, and opiates consumed during pregnancy pass from mother to the fetus by crossing the placenta. This causes the baby to become addicted to these drugs along with the mother. Once born, the newborn no longer receives these drugs which then results in NAS (“Neonatal abstinence syndrome”, 2012a).

Within seventy-two hours after birth, many infants who were exposed prenatally to drugs experience withdrawal symptoms, including tremors and irritability. Their skin may be red and dry; they may have a fever, sweating, diarrhea, excessive vomiting, and even seizures. Such

It can cause substantial teratogenic effects early in gestation, during the embryonic stage. During the fetal period, abnormal growth and maturation, alterations in neurotransmitters and their receptors, and brain organization are direct effects caused by opioid abuse (Behnke & Smith, 2017). Continuous use of opioids throughout pregnancy increases the risk of prematurity and growth retardation, deficits in attention, cognition, and behavior, neonatal morbidity and mortality, and neonatal abstinence syndrome (NAS) (McQueen, Murphy-Oikonen, & Desaulniers, 2015).

Opioid abuse in Tennessee is a statewide epidemic affecting both rural and urban cities. One thousand two hundred sixty-three deaths related to opioid overdose occurred in the state of Tennessee in 2014. More people died from opioid overdose than the number of gunshot and motor vehicle accident deaths combined. Known as “Hillbilly Heroin,” the opioid of choice are Hydrocodone, Percocet, Oxycodone IR, and Oxycontin with street values ranging from $5 to $80 dollars per pill. Currently, Tennessee remains the leader in the number of pain pill prescriptions per person (Fletcher, 2015). The misuse and abuse of opioids in Tennessee has resulted in legislative bills proposed and supported by Governor Bill Haslam, as well as local district representatives Senator James R. “Randy” McNally (R-Tenn- Dist. #5) and Representative John Ragan (R-Tenn Dist. #33).

The rest of the United States have no specific laws. These laws were made by taking in account the risk of fetuses dying minutes after birth, being born with neonatal abstinence syndrome (NAS), heart defects, weak immune system etc. Additionally, there can also be long-term effects as stated in “March of Dimes”such as learning and behavior problems, sudden infant death syndrome (SIDS), and slower-than-normal growth problems (Street). The first weeks of a drug dependent baby are like an old wooden roller coaster full of trembles and thrills but in this case the thrills are not the pleasant ones. In article published by “Daily Mail,” it shows a disturbing video of a baby’s feet shaking vigorously. This is the kind of heart moving evidence that needs to be shown to society to grasp the depth of this

Tennessee passed a new law that any pregnant women who has been found using narcotics during pregnancy or if the baby is born being addicted to the drug will be arrested. Tennessee is the first state to allow this type of criminal law to go into place. Tennessee law allowed police to arrest women who used drugs when they were pregnant, but this approach never worked (Perez, 2014). Tennesee has a staggering infant mortality rate which ranks among 3rd in the nation (Sakuma, 2013). In 2013, Tennesee lawmakers actually sought to encourage mothers to get treatment under the Safe Harbor Act. The act let mothers get the help they need for the addiction, but they were promised they would not lose custody of their baby so long as they were seeking treatment (Sakuma, 2014). The new law permits moms to avoid prosecution if they can successfully complete their drug rehabilitation program (Sakuma,

The independent variables in this study were buprenorphine and methadone and the dependent variables were the number of neonates requiring treatment for NAS, the peak NAS score, the total amount of morphine needed to treat NAS, the length of the hospital stay for the neonates, and neonatal head circumference.

(n.d.) also conducted a study focused on infants that were exposed to buprenorphine or methadone while in utero. Unlike MacMullen et al. (2014) their focus was on predicting how the symptoms of NAS might manifest in the exposed newborns. Since the 1970s (MacMullen et al., 2014) methadone has been the treatment of choice for mothers with opioid dependence during pregnancy, the use of this drug allows for a decrease in withdrawal symptoms for the child after birth. The main categories of symptoms include central nervous system hyperirritability, gastrointestinal dysfunction, respiratory distress and vague autonomic symptoms (MacMullen et al., 2014). Although methadone has been being used for many years buprenorphine has only been used since 2002 in the United States (MacMullen et al., 2014). Their research was consistent with Kaltenbach et al. (n.d.) in that infants born to buprenorphine-exposed mothers had lower scores for NAS than those born to methadone-exposed mothers, but still had varying severities of symptoms and scores across all infants. For at least 10 days after birth, an expert scored the newborns on a modified Finnegan scale every 4 hours. The results showed that high birth weight was often a predictor for high NAS scores, along with lower NAS scores for infants delivered by cesarean section. MacMullen et al. (2014) were unable to find any connection between the use of methadone and buprenorphine to indicators of symptoms of NAS. The main