The Use Of Drugs

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 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).

Methadone maintenance therapy is the primary go to source for addicts looking to quit the street drug, heroin. Methadone on it's own has its own number of controversies within society. However add on the fact that a number of patients that attend the meth clinic that is pregnant, well this can add additional controversy and raise ethical implications as well. Ultimately the child is better off when not being subjected to harmful substances such as drugs an alcohol. However when given the choice of heroin or methadone, we will examine what the benefits of methadone maintenance therapy can provide the mother, and the fetus. Methadone clinics provide a safe form of the drug with clean needles which helps cut the spread of HIV/AIDS among the population. While the client is at the clinic it is a good time to reach out and provide the future mother with resources that may help her once her child is born. Clinicians can also take advantage of this meeting time to reach out to the mother and inform her on the benefits of attending a treatment facility to help achieve sobriety.

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).

“Every 25 minutes, 1 baby is born suffering from opiate withdrawal. Newborns with neonatal abstinence syndrome (NAS) are more likely than other babies to also have low birth weight and respiratory complications” (Dramatic Increases in Maternal Opioid Use and Neonatal Abstinence Syndrome, 2015, Paragraph 2). To insure a better life for these babies, people are trying to create an Act called the Plan of Safe Care Improvement or otherwise known as the Infant Plan of Safe Care Improvement. This Act is meant to protect future babies from not only being born drug dependent because of their mothers, but also ensuring them a drug-free environment after birth. It will also “get help for the mothers and any other guardians involved in drug addiction”

The problem was discovered by Ashley Kilpatrick, NNP, Project Manager of this process improvement initiative. Ashley saw the opportunity to improve patient care by standardizing the care of the infants by decreasing the variation in care. I was made aware of the problem in weekly discharge rounds that occur every Tuesday in RNICU/CCN with the nurse managers, assistant nurse managers, social services, utilization management, UAB Police and the discharge coordinator to talk about any financial or social barriers to discharge. During discharge rounds, we discussed infants whose mother was addicted to drugs, whether prescription, illegal, or opioid substitutions. We also discuss whether the infants are having withdrawals and receiving Methadone. There would always be questions about weaning the Methadone, what day of weaning were the infants on so they could be discharged. There would be questions whether we were monitoring 3 -5-7 days off Methadone to send the infant home. This could ultimately be a safety and quality issue for the organization.

This process consists of 6 components: assessment, diagnosis, planning outcomes, planning interventions, implementation, and evaluation. Assessment was conducted in the study by the researchers finding eligible mothers who were misusing prescribed substitute methadone during pregnancy (McGlone et al., 2013) and those who did not abuse any drugs. Once they finished with the assessment, diagnosis was applied to find out the other drugs the mothers were abusing with blood test and analyzing the infant meconium, and to make sure that their control group had healthy, drug free infants. They also implemented an exclusion criteria for the diagnosis which includes birth before 36 completed weeks’ gestation, congenital ocular abnormality, significant neonatal illness, and infants <36 weeks’ gestation. Planning outcomes includes the researcher’s hypothesis that there would be an adverse effect on the neonatal flash VEPs and there would be some sort of relationship between visual electrophysiology and subsequent neonatal abstinence syndrome (McGlone et al., 2013). Next step is planning intervention and this was done by assessing the drugs that each mother abused during their pregnancy in order to see if these drugs had an effect on the flash VEP instead of solely methadone. Implementation was not used in this research due to the fact that researchers were trying to see the relationship between prescribe methadone and flash VEP. Last step in the nursing process is evaluation which is the results that the researcher acquired from the study. Now this research was not conducted by nurses but the nursing process can be applied to it to show how this process is indirectly applied across the

According to Lowe (2017), “…across the United States, a woman presents every 3 minutes to an emergency department for opioid misuse or abuse” (p.657). With the significant increase in the misuse of opioids over the last thirty years in the US, it has become a serious public health concern. With the most dramatic rise in opioid use being of childbearing age women, it is a very important issue in maternal health care (Keough & Fantasia, 2017). It is imperative that nurses are informed and have efficient knowledge of the potential risks, effects, treatment, and prevention of opioid dependence during pregnancy.

The title slide and variables could have been explained in a way to let the reader know that neonatal outcome was being measured after exposure to treatment medication methadone and buprenorphine and not just "opioids."Mariah's presentation followed the grading rubric she did not over-crowd her slides, which made it an easy read. Overall, Mariah's presentation was informative.

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

I have worked in a maternity center for over 3.5 years now as a Certified Nursing Assistant (CNA). Through my experience I have witnessed first-hand the impact of maternal drugs, alcohol, and tobacco use during pregnancy has on newborns. It makes me wonder if certain interventions took place during a woman’s pregnancy, then maybe her likelihood of engaging in substance use would cease or decrease. I frequently concern myself with how these often new mothers will manage both their baby’s care as well as their own when they leave the hospital. Some women I care for come from homes where they have been abused, the father of the baby is not involved in their lives, or they lack any other form of social support.

Most people feel that drug addiction is a choice, and a mother using during pregnancy has a total disregard for her baby’s well-being, lack of love for the baby, moreover, she is a poor parent. Additionally, the mother realizes her situation is dire, however, she continues using having full knowledge, and there are serious medical risk factors for herself and the baby.

The dependent variable is the amount of morphine newborns require in their treatment of NAS. The independent variable is the opioid drug, buprenorphine or methadone. Extraneous variables in this study could include illicit drug use, nicotine ingestion, depression, exposure to sexual victimization, physical violence, inadequate nutrition on mother, or any other stressors the mother has that could potentially stress the fetus in turn causing different effects on the newborn and NAS. Another extraneous variable could be whether the newborns are fed breast milk or formula. Since buprenorphine and methadone are still given after delivery and the opioid can be transferred via breast milk, the newborn can either still be getting the drug during breastfeeding, or be weaned from it by slowly going from breast milk to formula; both can affect withdrawal symptoms thus affecting the NAS.