The Bootheel of Missouri is in the epicenter of a region with the highest opioid prescription rates in America (see 2016 CDC figure below). While rates have improved recently, over 210 million prescriptions for opioids are filled in the USA annually, with 2% of Americans using opioids “regularly”.
Most women in our region receive excellent prenatal care. While there are no published statistics available for opioid use by pregnant women in southeast Missouri, large studies using insurance claims data suggest about a third of women fill a prescription for opioids during pregnancy.
Increases in neonatal abstinence syndrome have been temporally correlated with increases in opioid pain reliever use by pregnant women. With at least one infant with neonatal abstinence syndrome born every hour in the United States, the hospital charges alone are more than $1.4 billion a year. Opioid use in pregnancy also contributes massive additional costs through prematurity, birth defects, and abnormal neurocognitive and behavioral development.
Maternal risks associated with prescription and illicit opioid overuse include overdose, hepatitis, blood stream infections, incarceration, and job loss. Mental health disorders both contribute to and exacerbate substance use.
Unfortunately, public resistance to invest in care and prevention for depression and substance abuse remains, even though far more expensive care for potentially preventable heart attacks, strokes and cancers face minimal public resistance. Depression and addiction are both treatable chronic diseases. The costs of treating these diseases are minimal relative to the health and economic benefits for individuals and society.
Recent passage of HB 2280 allows substance abuse treatment for the entire postpartum year. Portions of SB 951 designate 2018-2028 “Show Me Freedom from Opioid Addiction Decade” and instruct the Department of Health to establish “Improved access to Treatment for Opioid Addiction”. While the exact implications of this bill are unclear, it is encouraging that opioid addiction and suboptimal delivery of mental health care are being acknowledged and addressed.
Gibson Recovery Center (www.gibsonrecoverycenter.org) and Family Counseling Center (www.fccinc.org) are two local treatment and counseling centers focused on caring for pregnant women with substance misuse.
My college roommate, Matt Miofsky, is an articulate pastor who describes compassion as “Not mere niceness. Compassion means to suffer with, understanding another not through preconceptions but through the other’s experiences. It means setting aside our judgments long enough to see life through their eyes. When we can begin to get a glimpse of another’s experiences, it is much harder to judge them, and much easier to begin to understand them.” It can be difficult for health care providers to display this compassion for parents whose actions may have contributed negatively to pregnancy outcomes. Pragmatically and ethically, the infant, mother, family, healthcare providers and society need compassion to be displayed toward the mother. Each mother loves her newborn. Her involvement is key to optimizing care and reducing hospitalization time and need for medications. The time in the NICU provides an excellent opportunity for health care providers and counselors to connect with mothers. While some of these mothers need medications and/or inpatient rehabilitation, all individuals (myself included) can benefit from improving coping mechanisms vital in caring for an irritable infant.
How can you can help? First, display compassion. Second, support efforts to improve prescription drug monitoring. Missouri remains the only state in America without a prescription drug monitoring program; HB 90 failed to be approved again this year. Third, thank legislators for addressing the opioid epidemic and supporting infant and mental health care services.
Missouri House Representatives Holly Rehder, Don Rone, Kathy Swan, Herman Morse, and Donna Lichtenegger and Senators Wayne Wallingsford and Doug Libla are our southeast Missouri state legislators. Please make sure they are aware of the needs and benefits of providing compassion toward mothers and families challenged by opioid use during pregnancy. Their contact information is available at www.house.mo.gov and www.senate.mo.gov.