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Epidemic Spreading Across the Nation Erica Wilson M.P.H. Community Services Director Tennessee Department of Health East Region (No Financial Disclosures)

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Presentation on theme: "Epidemic Spreading Across the Nation Erica Wilson M.P.H. Community Services Director Tennessee Department of Health East Region (No Financial Disclosures)"— Presentation transcript:

1 Epidemic Spreading Across the Nation Erica Wilson M.P.H. Community Services Director Tennessee Department of Health East Region (No Financial Disclosures)

2 Neonatal Abstinence Syndrome

3 What is it? Neonatal abstinence syndrome (NAS) is a term for a group of problems a baby experiences when withdrawing from exposure to narcotics.

4 What Causes It? Almost every drug passes from the mother's blood stream through the placenta to the fetus. Illicit substances that cause drug dependence and addiction in the mother also cause the fetus to become addicted.

5 What Happens to the Baby? Baby At birth, the baby’s dependence on the substance continues. However, since the drug is no longer available, the baby’s central nervous system becomes overstimulated causing the symptoms of withdrawal.

6 What’s the Incidence of Neonatal Abstinence Syndrome?

7

8 626 cases in Tennessee as of 8/30/14 compared to 564 at same point in 2013 Increase of 11%

9 Maternal County of Residence by Region October 25, 2014 # Cases% Cases Davidson405.1 East Hamilton121.5 Jackson/Madison20.3 Knox Mid-Cumberland698.8 North East Shelby324.1 South Central263.3 South East192.4 Sullivan638.1 Upper Cumberland West222.8 Total %

10 Exposure source trends in East TN vary from those seen in all cases state-wide

11

12 Highest rates based on provisional county birth estimates

13 Why is Neonatal Abstinence Syndrome a Concern?

14 The Baby Tragedy and suffering of the babies and their caregivers. With increased likelihood of foster care, families are torn apart.

15 The Cost According to current statistics in Tennessee, the TennCare costs for a healthy newborn were $4,237 compared to an average cost of $66,973 for an infant born dependent on drugs, diagnosed with NAS.

16 The Future There may be other economic, psychological and physiological costs associated with their medical condition at birth since it is not yet known what challenges and needs these infants will have as they grow older.

17 What can we do in Public Health ? NAS became a reportable condition in TN on January 1, 2013 NAS Taskforce was formed July 11, 2013 – Collaborative effort with East Region and Knox NAS/PPI Sub-committee was formed on September 5, 2013

18 Primary Prevention Initiative LARC Pilot Project East Region

19 The Process CollaborationCollaboration –Sheriff/Jail Administrator/Jail Nurse EducationEducation –Partners (Pamphlet) –Participants (PowerPoint and Pamphlet) Referrals (Referral/Follow-Up Form)Referrals (Referral/Follow-Up Form) Clinical ServicesClinical Services Data Collection (Referral/Follow-Up Form)Data Collection (Referral/Follow-Up Form)

20 High-Risk Population Outreach NAS Education Session Referral to HD Clinical Exam at HD Contraceptive Placement Pregnancy Prevention in Population at High Risk for NAS Child

21 1/14/14 – first education session at Cocke County As of 10/29/14, 10 sessions have been held for a total of 197 persons educated –Cocke County Jail: 3 sessions, 49 participants –Jefferson County Jail: 1 session, 40 participants –Sevier County Jail: 6 sessions, 108 participants Anticipated referrals of the 197 = 99 (50.0%) Jail Settings

22 Of the 197 educated, 63 (32%) completed referral to Cocke, Sevier, or Jefferson County HD Difference from number of anticipated referrals (99) likely due to lag time between session and first exam Referral Outcomes

23 Females ranging in age 20 – 45 (avg. age: 27) Predominately non-Hispanic white Mostly residents of Sevier and Cocke County, but a few from other areas: County No.Percent Cocke % Davidson 12.3% Jefferson 12.3% Knox 12.3% Sevier % Out-of-State 24.7% Total %

24 Patient History

25 Method of Birth Control

26 54/63 patients (85.7%) received some form of contraceptive Of the 9 that did not, 7 had been released or transferred before placement could occur One patient was provided a 3 mos. supply of COCs One patient refused all methods offered Contraceptive Placement (N = 54)

27 Education levels FP barriers –28% of referrals were previous FP patients Specific drug use history including during pregnancy History of unplanned pregnancy

28 Tennessee House Bill 1295 As enacted, provides that a woman may be prosecuted for assault for the illegal use of a narcotic drug while pregnant, if her child is born addicted to or harmed by the narcotic drug.

29 Long Acting Reversible Contraceptives The “YOU CAN’T FORGET ME” Methods

30 IUD Effectiveness Over 99 per cent effective. Less than two women in 100 will get pregnant over five years. Older IUDs have less copper and are less effective.

31 IUD How it works A small plastic and copper device is put into the uterus. It stops sperm reaching an egg, and may also stop a fertilized egg implanting in the uterus. How long it lasts Can stay in 5–10 years depending on type but can be taken out sooner.

32 IUD IUD How it affects periods Your periods may be heavier or longer or more painful. How it affects fertility When the IUD is removed your fertility will return to normal.

33 IUD How it is inserted/removed A doctor or nurse practitioner will insert the IUD. This takes 15–20 minutes. It can be uncomfortable or painful and you may want to use a local anesthetic. A doctor or nurse can remove the IUD in a simple office visit.

34 IUD Effectiveness Over 99 per cent effective. Less than one woman in 100 will get pregnant over five years.

35 Mirena IUD How it works A small, T-shaped plastic device, which releases the hormone progestin, is put into the uterus. This thins the lining of the uterus to prevent a fertilized egg implanting, thickens cervical mucus to prevent sperm reaching an egg, and may stop ovulation. How long it lasts Works for five years but can be taken out sooner.

36 Mirena IUD How it affects periods Your periods usually become lighter, shorter and sometimes less painful. They may stop altogether. How it affects fertility When the IUD is removed your fertility will return to normal.

37 Mirena IUD How it is inserted/removed A doctor or nurse practitioner will insert the IUD. This takes 15–20 minutes. It can be uncomfortable or painful and you may want to use a local anesthetic. A doctor or nurse can remove the IUD in a simple office visit.

38 Implants Effectiveness Over 99 per cent effective. Less than one woman in 1,000 will get pregnant over three years.

39 Implants How it works A small flexible rod is put under the skin of the upper arm. It releases the hormone progestin. It stops ovulation, thickens cervical mucus to stop sperm reaching an egg, and thins the lining of the uterus (womb) to prevent a fertilized egg implanting. How long it lasts Works for three years but can be taken out sooner.

40 Implants How it affects periods Your periods may stop, be irregular or longer. How it affects fertility When the implant is removed your fertility will return to normal.

41 Implants How it is inserted/removed A doctor or nurse practitioner numbs your skin in the inner area of your upper arm with a local anesthetic and inserts the implant. It takes a few minutes and feels similar to having an injection. To remove it, the doctor or nurse uses a local anesthetic, makes a tiny cut and gently pulls the implant out.

42 What if the LARC can’t be placed before my release?

43 Injection Effectiveness Over 99 per cent effective. Less than four women in 1,000 will get pregnant over two years.

44 Injection How it works It releases the hormone progestin which stops ovulation, thickens cervical mucus to prevent sperm reaching an egg and thins the lining of the uterus to prevent a fertilized egg implanting. How long it lasts Lasts for 12 weeks.

45 Injection How it affects periods Your periods may stop, be irregular or longer. How it affects fertility Your periods and fertility may take time to return after you stop using the injection.

46 Injection How it is inserted/removed The hormone is injected into a muscle, usually in your buttocks. It can also be injected into the arm. The injection cannot be removed from the body so any side effects may continue for as long as it works and for some time afterwards.

47 Cost Savings Preventing the birth of one drug dependent infant saves an average cost of $66,973.Preventing the birth of one drug dependent infant saves an average cost of $66,973. Preventing the birth of one drug dependent infant in each of the counties in the East Region would be a cost savings of $1,004,595.Preventing the birth of one drug dependent infant in each of the counties in the East Region would be a cost savings of $1,004,595. Preventing the birth of one drug dependent infant in each of the counties in Tennessee would be a cost savings of $6,362,435.Preventing the birth of one drug dependent infant in each of the counties in Tennessee would be a cost savings of $6,362,435.

48 Questions Erica Wilson M.P.H. Community Services Director East TN Regional Health Office (865) Ext. 103 Cell – (865)


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