Opioid Epidemic: Innocent Victims (NAS)

[jeastridge, BSN, RN]

We have all seen the stories on television and online: infants struggling with a complex picture of symptoms including twitching, pain, seizures, diarrhea, abdominal cramps. These are babies born addicted to opioids (and sometimes other substances). Once a relatively rare occurrence, NICUs around the country are finding themselves overwhelmed with the numbers of babies born addicted and requiring long-term care to safely wean them off of opioids. When a mother uses drugs, whether for treatment of addiction or not, babies have a 55-95% chance of being born with NAS.

What is NAS?

If you read the title to this article and thought, "What's that?" you are not alone. NAS, or Neonatal Abstinence Syndrome, was first described by Finnegan in 1975 (Finnegan LP, Connaughton JF Jr, Kron RE, Emich JP). Neonatal abstinence syndrome: assessment and management. Addict Dis 1975;2:141-158). Since that time, the term has come into much more common use as the incidence of NAS, also known as Neonatal Drug Withdrawal Syndrome, has continued to rise dramatically. From 2000 to 2012, the rate increased by a factor of 5.

A complex picture, victims of Neonatal Drug Withdrawal are observed to suffer all the symptoms that adults suffer when in drug withdrawal including: fever, sweating, sneezing, tachypnea, projectile vomiting, weight loss, watery stools, excessive sucking, tremors, high-pitched crying, twitching, high muscle tone, etc. Additionally, the average length of stay in hospital for NAS babies is 17 days (Patrick SW, Davis MM, Lehmann CU, Lehman CU, Cooper WO). Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. (J Perinatol 2015;35:650-655). Often, the sequelae continue after discharge, although it is unknown as yet what all the long term effects of being born with NAS are. It remains to be seen what their long term needs will be, but it is safe to say that they are starting off life with some additional challenges-as are their families.

So what are we to do as nurses observing a growing problem?

Ashlie Harrod, RN, works at the Sullivan County Health Department in East Tennessee. Her county has among the highest rates of NAS reported (although only 5 states currently report statistics on NAS). "The incidence in our area is so high because of a combination of lack of education regarding pregnancy prevention, and a high rate of drug abuse, among other socioeconomic problems." She goes on to say, "Contraception is not common sense." She spends her workdays leading classes in jails, health departments, halfway houses and at outpatient drug maintenance clinics-basically any place she can find men and women who will listen to her sage advice on all matters of pregnancy prevention.

While 45% of pregnancies are unintended in the general population, that number climbs steeply to 86% among addicts. Harrod attests to the general lack of knowledge about body functions, biology and specifically about the various methods of birth control. When she visits the various settings, she offers birth control pills, Depo Provera shots (3 months of contraception) as well as more long-term prevention, including long-acting IUDs, rings, patches and implants. Besides paving the way for implants and IUDs, she can also help get men set up for vasectomies-after careful screening. All services of the health department are offered free of charge.

"Our goal is a healthy community"

Harrod goes on to say that at the Health Department, "Our goal is a healthy community. We want to provide information, education, counseling, testing, whatever people need to do effective family planning." In addition to pregnancy prevention, the health department works hard to take care of women who are already pregnant, making sure they get what they need while pregnant and that they are connected with a variety of services that can help them when the baby is born.

If the baby has NAS, families often need early intervention and long-term assistance, using a care team approach. NAS babies are irritable, in pain, difficult to console. During this perinatal time of bonding and attachment to their parents, these infants and their families need a lot of extra help and attention.

Nurses always have a role to play. As professional health care providers, we are examples in the community. We can lead the way to finding out what is available in our area, helping to get that information out there and lending a hand through community networks. Maybe we will be the ones in the newborn nursery or the NICU, but we also might be the ones to learn first of an unintended pregnancy, or of a need for foster care. Whatever our situation, we will all be called on to answer and to serve in some way.

Harrod says, "This crisis is an opportunity for all of us to put our differences aside and to stand up for this next generation of children." The time is now. As professionals, let us band together to advocate for and help these tiny, innocent victims. What is your response?

Joy Eastridge

[klone, MSN, RN]

We've seen pretty ugly NAS from babies whose mothers took Kratom during pregnancy. I can't believe that **** is available OTC.

[karenvalk]

Very timely and important topic! NAS is a very troubling aspect of the opioid crisis which has affected so many communities across the U.S. Its effects will be felt for generations, as NAS babies are often pushed into the foster care system or cared for by extended family members. As these babies grow older, developmental and learning problems also become apparent. Thank you for calling attention to this devastating problem Joy!

[Elvish, BSN, DNP, RN, NP]

I hope most (if not all) inpatient facilities have appropriate orders or guidelines in place to screen/care for these kids when they're born. Could be too much optimism on my part, but I've been working at a facility that's taken care of NAS babies for well over a decade.

My bigger worry is what these kids are up against when they are discharged.

[jeastridge, BSN, RN]

Very timely and important topic! NAS is a very troubling aspect of the opioid crisis which has affected so many communities across the U.S. Its effects will be felt for generations, as NAS babies are often pushed into the foster care system or cared for by extended family members. As these babies grow older, developmental and learning problems also become apparent. Thank you for calling attention to this devastating problem Joy!

Thank you, Karen, for your comment. Working on this article brought home how critical the situation is. We all--every one of us--needs to help in some way. And for a long time. Joy

[jeastridge, BSN, RN]

I hope most (if not all) inpatient facilities have appropriate orders or guidelines in place to screen/care for these kids when they're born. Could be too much optimism on my part, but I've been working at a facility that's taken care of NAS babies for well over a decade.

My bigger worry is what these kids are up against when they are discharged.

Thank you for your comment. It will be interesting to hear from nurses that work with outpatient follow-up, with health departments, early intervention, pediatricians, etc. to hear what their experiences have been. Joy

[NurseNeLz]

Saw a baby with NAS in nursing school and I will never ever forget the distinctive shrill cry and the poor baby with nonstop diarrhea. My heart breaks for these babies.

[Kratoswife]

Very timely and important topic! NAS is a very troubling aspect of the opioid crisis which has affected so many communities across the U.S. Its effects will be felt for generations, as NAS babies are often pushed into the foster care system or cared for by extended family members. As these babies grow older, developmental and learning problems also become apparent. Thank you for calling attention to this devastating problem Joy!

Is this only a crisis because this primarily affects people of a lighter complexion? I don't recall the era of Crack being considered a crisis?

Why aren't the people doing these drugs being arrested like the ones who were doing crack?

[Munch]

Is this only a crisis because this primarily affects people of a lighter complexion? I don't recall the era of Crack being considered a crisis?

Why aren't the people doing these drugs being arrested like the ones who were doing crack?

Some of these mothers weren't doing anything illegal. Methadone is safe during pregnancy. Many doctors don't educate patients on the effects their opioid pain medications have on an infant. While I personally don't work mother/baby my sister is a hospital social worker and has seen so many babies born to mothers that were on methadone maintenance. Methadone is considered safe during pregnancy. While no reason on earth is crack consumption considered legal. If the opiate consumption is illegal I know at my sisters hospital DCFS gets involved.