Butler County is not unlike many other places around Ohio. Opioid addiction has devastated communities, and in 2017 there were 232 overdose drug deaths. More than 80 percent of those were opioid-based deaths. Those numbers have steadily climbed annually for the past several years. Everyone from the governor's office to local politicians and anti-drug advocates is trying to figure out how to reverse the increased use of opioids and the number of deaths.
As the county coroner is dealing with the issue at the end of life, doctors around Ohio are addressing the issue at birth.
The region has seen an 8 1/2-fold increase in the rate of newborns exposed to opioids during pregnancy over the past eight years, according to Cincinnati Children's.
A collaborative of nearly all of Ohio's neonatal intensive care units, or NICUs, showed significant improvements with best practices of non-drug treatments and drug-based treatments, according to a new neonatal narcotic abstinence syndrome article in the medical journal "Pediatrics."
Wexelblatt and Lannon were co-authors of the article.
They worked with the Ohio Perinatal Quality Collaborative NAS project, supported by the Ohio Department of Medicaid.
“Other states are looking at this OPQC model to spread to their states,” Wexelblatt said. “I think Ohio is leading the way in how to collaborate on a large scale. In the medical literature, there’s nothing on this scale for care of infants with NAS.”
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The report, which was released on Wednesday, highlighted the best practices that were developed from a 2012 commitment from Ohio Gov. John Kasich's pledge of $1 million to NAS research.
The length of stay for infants born with drug withdrawal is decreasing among the NICUs in the state, said Wexelblatt and Lannon.
“We’re continuing to show that we’re having an impact on that, even over the last several years,” Lennon said. “Since 2014, the length of stay has decreased for babies.”
The average was upwards of 18 days and it’s down to 16 days, they said.
Lannon said people are pleased by the work of 52 of the 54 NICUs that participated in the collaborative, but “we still have work to do.”
As hospitals are working to treat babies born with drug withdrawal, the next step is to work with expecting mothers similar to what the collaborative did, which started with Ohio’s six Children’s Hospitals, for both pre-birth and post-birth.
“We’re going to develop and provide better assistance so when the baby is born, we can be supportive of both the mother and the infant,” Lannon said. “Moms often get a lot of support and services during pregnancy, but this support often decreases when the baby is born, when it may be especially needed.”
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“We’ve been focusing on the baby but the earlier we can get mom in a better care program the better outcomes for both mom and baby,” he said.
The impact this increase in babies born with drug withdrawal has on the Medicaid system is inconclusive, according to Lannon and Wexelblatt, as well as Eric Seiber, associate professor at The Ohio State University’s Center for Public Health.
Lannon and Wexelblatt said the definition of NAS could vary among doctors and hospitals — and medical billing coders based on the severity of NAS — and Seiber said it’s an issue “we need to dig deeper” in because “we don’t know how big the discount is.”
The Ohio Legislative Service Commission at the Ohio Statehouse estimates the 2006 Medicaid charges for inpatient hospitalization for NAS in Ohio was $10 million. The Ohio LCS estimated the costs jumped to $59.7 million in 2011 and $119.5 million by 2014.
In 2015, there were 2,174 babies — or six babies a day — were admitted to Ohio hospitals for neonatal abstinence syndrome, or NAS, which is a consequence of the opioid crisis. A decade earlier in 2006, just more than 300 cases were reported statewide.
“There are two reasons those (Medicaid) numbers could be growing up,” Seiber said. “More kids being born with that condition, or charges per kid could be going up.”