Ivy Click
By Jeff Keeling
Third in a series. Our latest story on Neonatal Abstinence Syndrome (NAS) examines the positive role providers and pharmacists can play in helping prevent births of drug-dependent infants. Researchers at East Tennessee State University found a lack of adequate communication on the part of many health care providers and pharmacists when addressing the risks of pregnancy and childbirth by women taking opiates.
There is one surefire way to prevent neonatal abstinence syndrome (NAS). It’s recognized by Tennessee’s Department of Health (TDH), and TDH considers the methods for achieving it to be best practices that should be followed by physicians, pharmacists and others who interact with women of childbearing age.
It’s pregnancy prevention, and judging from a study and survey conducted by two East Tennessee State University professors, it wasn’t being promoted as well as it could by physicians, prescribers or pharmacists – at least a couple of years ago.
That was when Drs. Ivy Click of Quillen College of Medicine and Nick Hagameier of Gatton College of Pharmacy conducted their study. They surveyed community pharmacists, pain clinic directors, rural family medicine physicians and health care providers who prescribe buprenorphine, a medication assisted therapy (MAT) drug used to help treat opiate addiction. The study was partially funded by the TDH.
“We surveyed their knowledge, attitudes and behaviors around NAS primary prevention,” Click said. “It was really focused on primary prevention, which is stopping women from being pregnant to begin with when they’re using opioids.”
So what should providers be doing when they know a woman of childbearing age is being prescribed opioids, including MAT drugs? They should discuss the risk of physical dependence and addiction on newborns, Click said.
They should also routinely conduct pregnancy tests. And they should recommend “long-acting reversible contraception,” such as IUDs.
Those are the best practices, fairly new at the time of the survey, around which Click and Hagameier built their survey.
Nick Hagameier
The results weren’t terribly encouraging. Click said the pair tracked 15 behaviors, asking, ‘if you saw 10 women, how many of those women would you do this (behavior with)?’
“They’re saying, ‘yes, NAS is a concern in my practice,’” Click said. “They are saying, ‘yes, I do talk to women about the risk of addiction and dependence.’ But they’re not doing it as often regarding the risk of addiction or dependence for a newborn. They’re not as often recommending these long-acting reversible contraceptives.”
If respondents talked about contraception at all, they weren’t elevating long-acting reversible contraception above others, even though it has a much higher adherence rate because patients don’t have to remember to take it every day.
Of pharmacists surveyed, Hagameier said, eight of 10 counseled patients regarding the indications for the prescribed medication. Only three in 10 asked about their pregnancy status. One in 10 directed the patients to a place they could get long-acting reversible contraception. Click said the numbers were similar among providers.
Hagameier said he hopes more practitioners are following the best practices now than were doing so during their study. Publicity about NAS has continued to increase, and close to two-thirds to mothers of babies born with NAS are using opioids, including buprenorphine, with a legal prescription.
“It’s not a magic bullet,” he said. “There’s still going to be people taking (opioids) without a prescription, but it sure has the potential to make a big impact.”
He said from the pharmacist standpoint, “I think there’s little things that can be integrated into work flow that can have the potential to make a big difference.”
From the provider side, Click said protocol can extend to nurses and others who interface with patients, and not just doctors.
“There’s a need for more education at the formative level, as well as continuing education around this issue,” she said.
