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Tennessee launches additional efforts in 2013 to reduce the number of Drug-Dependent Newborns

Tennessee Department of Health - TDOHNashville, TN – In 2013, 921 newborns in Tennessee experienced withdrawal from drugs their mothers used while pregnant.

Many people across Tennessee, including a group of state leaders, are working to reduce that number and in the past year launched several efforts to help prevent the suffering and expenses associated with the condition known as neonatal abstinence syndrome, or NAS.

Commissioners and staff members from the departments of Children’s Services, Health, Human Services, Safety and Homeland Security and Mental Health and Substance Abuse Services, along with the TennCare program administered by Finance and Administration, came together under Tennessee Governor Bill Haslam’s leadership to form the NAS Subcabinet.

This group, along with the state legislature and supporters in the private sector, recorded some significant progress during the past year in addressing the problem.

“We’re far from where we want to be, but thanks to the contributions of many across our state, Tennessee is on the leading edge in our understanding of this epidemic and efforts to address it,” said Tennessee Health Commissioner John Dreyzehner, MD, MPH. “When you look at work done here in 2013, it’s obvious there is a commitment to prevent drug dependence in newborns and to reduce other burdens associated with this preventable epidemic.”

Efforts to reduce the number of NAS newborns in Tennessee this past year included:

NAS Added to List of Reportable Disease and Events

Effective January 1st, 2013, TDH added NAS to the department’s list of Reportable Diseases and Events. Hospitals have been very cooperative with the requirements to report NAS cases within 30 days and TDH publishes a weekly surveillance summary report. This real-time data is crucial to further understanding the scope and impact of responses to NAS in Tennessee.

Reports are available at http://health.tn.gov/mch/nas/NAS_Summary_Archive.shtml.

Controlled Substance Monitoring Database

Prescribers and dispensers across Tennessee have been instrumental in efforts to reduce drug-dependent newborns by using the Controlled Substance Monitoring Database, or CSMD.

This database, a key part of the Prescription Safety Act of 2012 passed by the Tennessee General Assembly, required clinicians to register by January 1st, 2013, and to begin using it by April 1st, 2013, for most new prescriptions of opioids or benzodiazepines. As the number of searches of the CSMD increased three-fold in 2013, the number of “doctor shoppers” decreased by 50 percent.

For the first time since the database became operational, opioid prescriptions have not increased and doctor shopping has been reduced. Next month, the CSMD will be enhanced to generate notifications about the need for conversations among clinicians and women of childbearing age about the risk of medications that can cause or contribute to NAS if used during pregnancy.

Regional Educational Training & Guidelines

Tennessee Department of Health staff conducted ten training sessions across the state to educate providers on the prescription drug epidemic, implications regarding the CSMD and consequences of misuse or abuse and convened a statewide meeting to develop pain prescribing guidelines. Numerous other training sessions with coalitions and medical experts have also occurred.

Funding for Prescription Drop-off Boxes

The Tennessee Department of Mental Health and Substance Abuse Services provided funding for 86 permanent prescription drug take-back boxes in 48 counties for anyone to safely drop off unused prescription drugs. To see the full list of locations, go to http://1.usa.gov/1jUDoxu.

Additionally, TDH provided funding to the Tennessee Department of Environment and Conservation for 50 prescription drop-off boxes across the state. This was made possible through a Centers for Disease Control and Prevention Core Violence and Injury Grant.

Pilot Project – Screening, Brief Intervention and Referral to Treatment (SBIRT)

The Tennessee Department of Mental Health and Substance Abuse Services, along with TDH, is training local health department staff on Screening, Brief Intervention and Referral to Treatment, or SBIRT. TDH staff members in Putnam County are being trained to implement SBIRT in primary care and family planning clinics.

This evidence-based intervention is already in use in other clinical settings around the state, including mental health clinics. Early reports in the health department context are positive and TDH plans to expand this to other local health departments.

Boxed Warning

In September 2013, the Food and Drug Administration responded to requests from Tennessee officials and others that followed to announce it was implementing its most prominent warning in labeling:  a boxed warning. It is intended to increase awareness about the relationship between some powerful opioids and NAS. The new labeling will elevate awareness about the need for caution when prescribing to women of childbearing age.

TennCare Working with Prescribers via Preauthorization

TennCare modified the prior authorization process already in place for certain controlled medications to remind all prescribers of the danger of NAS. If the prescriber is seeking prior authorization for those medications for a woman of childbearing age, the prescriber must confirm the woman has been counseled regarding the risk of NAS and that access to contraceptive services has been offered.

Management of NAS cases

The Tennessee Department of Children’s Services and the Tennessee Initiative for Quality Prenatal Care are working to optimize management of infants with NAS and have established a dedicated liaison with East Tennessee Children’s Hospital to coordinate response to NAS cases.

NAS Research

The Tennessee Department of Health held a research meeting to facilitate collaboration among practitioners and researchers who are working to better understand how to prevent NAS. Modest grants will support partnerships between community providers and academic researchers to answer key NAS-related research questions.

Five grants have been awarded to help address the following questions:  Can we develop a model to identify infants at risk for developing NAS? What is the optimal management of pregnant women to reduce the likelihood of NAS? What is the optimal management of infants with NAS? What do providers know about NAS and how can we change prescribing behavior? What are barriers to contraceptive use among women who use opioids?

“While this is a problem affecting all social and financial strata, we know the TennCare cost for a healthy newborn in 2012 was $4,736 while the average cost for a NAS newborn was $62,324,” said TennCare Deputy Director Wendy Long, MD. “That’s not a sustainable cost. Though the majority of NAS newborns are the result of legally prescribed drugs, many are caused by illicit use. In 2014, we will use the most significant approaches as we continue work to reduce NAS in Tennessee.”

“Addiction is a very complex issue, and we need to make sure we are doing all that we can to care for our fellow Tennesseans,” said TDMHSAS Commissioner E. Douglas Varney. “Treatment for these mothers with addiction issues is very important, as it helps them lead lives of recovery and helps keep their babies safe, healthy and happy.”


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