In recent years, thousands of Garden State women struggling with addictions gave birth to babies who shared their potentially deadly disease. The situation has created a growing need for highly specific medical care in a state already pressed to provide sufficient services to all those seeking drug treatment.
To help address the need, New Jersey officials announced Thursday they had awarded $5 million in contracts to a handful of nonprofit organizations to expand substance-abuse treatment and medical care for pregnant women and new moms.
The funding will provide residential treatment for nearly 900 women, they said, as well as help coordinating other medical and behavioral healthcare, plus other appointments. The programs, which will reach 13 counties and run from early December through June 2018, also help women plan the next steps in their recovery, including living arrangements and other services.
The dollars will come from the $200 million in unspent and otherwise “lapsed” funds that Gov. Chris Christie tapped in September to support several dozen addiction-related programs. These investments are the latest push from the outgoing Republican governor, who leaves office in January after two terms, to address the state’s ongoing epidemic of opioid abuse, which killed nearly 2,000 residents last year.
According to the federal Centers for Disease Control and Prevention, the number of babies born addicted, or with what is called Neonatal Abstinence Syndrome (NAS), grew from fewer than 3,000 in 2002 to nearly 22,000 in 2012, the last year for which data was available. By then, every 25 minutes a baby was born with drug dependency.
In New Jersey, the number of NAS cases has nearly doubled since 2008, when 340 babies were diagnosed, to 634 in 2014, according to data reported by hospitals. Since 2011, roughly 6 percent of Garden State births have involved addicted infants, state health officials said.
“It is imperative that we give these babies a fair start on life and ensure mothers get the treatment they need to restore their physical and psychological health,” Christie said. “This approach to treatment of pregnant women and new mothers in a specialized, integrated program will promote long-term recovery while offering ongoing medical care and support services.”
The cases involve mothers addicted to all kinds of opioid pills, street heroin and other drugs like benzodiazepines and some antidepressants; some may be active addicts, others already in treatment, but maintained on prescription opiates like buprenorphine to protect their health and that of the baby. The safest route, doctors have found, is to avoid detox until after the baby is born, then treat both mother and infant for what can be debilitating withdrawal symptoms.
“Getting help for substance abuse benefits both the mother and the baby,” acting state health commissioner Christopher Rinn said. “During pregnancy, addiction treatment can mean the difference between having a healthy child and losing a baby or giving birth to an infant with severe developmental challenges.”
For babies, the CDC reports withdrawal begins a day or so after birth and can involve tremors, seizures, irritability, sneezing, temperature spikes, problems sleeping, vomiting and difficulty feeding, which leads to poor weight gain and other concerns. Providers say the frequent, high-pitched cries of these infants — who are also more at risk for other deadly conditions — are also unique.
Calibrated morphine drip
Treating these young cases involves a carefully calibrated morphine drip to help calm infants as they withdraw, a process that can mean at least three extra weeks in a hospital, the CDC found. It cost $1.5 billion to treat these cases in 2012 — with $1.2 billion of it paid through Medicaid — often more than $100,000 per child.
The state funding announced Thursday will cover a different aspect of care, a mix of inpatient and outpatient treatment that, in an ideal world, wraps around the birth and any hospital care. Five organizations were awarded funding through a competitive bidding process to provide care that will reach large swaths of South and central Jersey and the Jersey Shore.
The contracts involve:
Each program includes a residential treatment component, with a focus on preventing relapses, and can link participants to a system of other doctors, nurses, therapists, social workers and support professionals. In addition, women can access help with housing, transportation, childcare, and job skills.
Cooper, which established its perinatal substance-use clinic in 2016, also offers medication-assisted treatment and a host of other wraparound care, including health education, breastfeeding support, and more. The program is connected to the emergency room and pediatricians in the Camden community who can refer patients. Nearly two-dozen healthy babies have been born so far, according to the hospital, with several more on the way this year.
“Treating addiction in a long-term chronic-care model has afforded the addiction medicine team the opportunity to engage women during pregnancy, through delivery and beyond,” explained Iris Jones, a behavioral therapist at Cooper Addiction Medicine, which runs the program. “This level of engagement allows us to support the bonding and unification so essential to successful recovery.”
Rinn, at the health department, agreed the goal is to help both the mother and baby over a longer term. “This is really a one-stop model of treatment that is designed to address many of the various issues that can deter a mother from sustained recovery.”