Kentucky has very high rate of addicted mothers; rose by double-digit percentages early in decade, seemed to level off in 2015-16

By Melissa Patrick and Al Cross
Kentucky Health News

Kentucky has had a very high rate of opioid-use disorder among women delivering babies in hospitals, according to a study published by the Centers for Disease Control and Prevention.

In Kentucky, 19.3 mothers out of every 1,000 who gave birth in a hospital in 2014 had an opioid-use disorder. Among the 30 states studied, only two were ahead of Kentucky: Vermont, at 48.6 per 1,000, and West Virginia at 32.1. The national rate is 6.5 per 1,000. West Virginia was the only state adjoining Kentucky to be included in the study.

Opioid use during pregnancy, whether it be heroin, prescription painkillers or some other narcotic, is associated with pre-term labor, stillbirth, neonatal abstinence syndrome and maternal death.

The study, published Aug. 10 in CDC's Morbidity and Mortality Weekly Report, analyzed hospital discharge data from 1999 through 2014. Over that time, the national rate of mothers with opioid-use disorders at delivery more than quadrupled, going from 1.5 to 6.5 cases per 1,000.

Kentucky's rate showed big jumps from 2010 through 2014, going from 7.2 to 9.5 to 14 to 15.7 to 19.3. Over the same five years, the national rate rose from 3.9 to 6.5 per 1,000. The Kentucky numbers represented annual increases of 32, 43, 5 and 23 percent.

Kentucky neonatal abstinence syndrome cases. Ky. Dept. for Public Health graphic.

The researchers say that while their study is the first multi-state look at the prevalence of opioid-use disorder diagnosis among women giving birth, this data is "mostly consistent" with  neonatal abstinence syndrome studies between 1999 and 2013 and correlates with state opioid prescribing rates in the general population. They add that the increasing trends could also be a result of improved screening and diagnosis.

Hospital-discharge data for babies born with neonatal abstinence syndrome for 2015 and 2016 show increases of only 2.9 and 2.2 percent in Kentucky, indicating that the problem did not worsen during these years, compared to the five years before that, but remains very bad. 

Additional surveillance by the state Department for Public Health showed more babies were born with neonatal abstinence syndrome at birth than the hospital-discharge data showed, but also showed a decrease in that number from 2015 to 2016.

Precise reporting of the problem can be a challenge, due to the stigma it carries and different state laws on reporting.

As of July, eight states required health-care professionals to test for prenatal drug exposure when it is suspected, and 24 states and the District of Columbia require professionals to report suspected use among pregnant women. Twenty-three states and D.C. consider substance use during pregnancy to be child abuse, and three states consider it to be grounds for admitting a woman involuntarily into a psychiatric hospital. The researchers note that these strict policies could cause women to try to conceal substance use from their providers.

Kentucky began defining neonatal abstinence syndrome, or withdrawal symptoms, as child abuse this year. The legislature added that to a foster care measure (House Bill 1). Under the new law, such a finding could result in the termination of parental rights unless the mother enrolls in a drug-addiction treatment program within 90 days of the birth.

State caseworkers who learn of babies having neonatal abstinence syndrome make recommendations to family court judges on a case-by-case basis, and removing the baby is not an automatic outcome, John Cheves of the Lexington Herald-Leader reports.

The researchers recommend improved access to prescription-drug monitoring programs, increased substance-abuse screening, use of medication-assisted therapy and substance-abuse treatment referrals.

“State-level actions are critical to curbing the opioid epidemic through programs and policies to reduce use of prescription opioids and illegal opioids including heroin and illicitly manufactured fentanyl, both of which contribute to the epidemic,” the report says.