U.S. GAO Recommends Further Action in NAS Treatment

WASHINGTON — The U.S. Government Accountability Office is recommending to the secretary of the Department of Health and Human Services the development of a strategy for treating babies who suffer withdrawal symptoms from opioid addiction.

An Oct. 4 report looked at health care facilities in four states, including West Virginia, to better understand hospital settings for treating infants with neonatal abstinence syndrome. The GAO ultimately recommends the Health and Human Services Secretary should create a plan and how it is subject to government funding.

The study comes as the byproduct of the Comprehensive Addiction and Recovery Act of 2016, which was introduced by Sen. Sheldon Whitehouse, D-R.I., and signed in July 2016.

One of the legislation’s source bills was the Nurturing and Supporting Healthy Babies Act, a bill introduced in the House of Representatives by Rep. Evan Jenkins, R-W.Va., and in the Senate in part by Sen. Shelley Moore Capito.

Jenkins said as opioid addiction has increased, the most victimized of the epidemic has been infants.

“This report is a powerful and important tool in trying to make sure we are doing the very best we can to provide every baby — even those exposed during pregnancy — to have the best chance possible to have a healthy start in life,” he said.

Capito shared similar concerns in a statement.

“It’s important that we do more to draw attention to this issue and take action to address it,” she said. “That’s why I pushed to make sure CARA included a provision requiring this study and have continued working to advance legislation that will help these infants.”

According to the report, NAS increased by 500 percent between 2000 and 2012, going from a rate of 1.2 hospital births per 1,000 to 5.8 hospital births per 1,000. The symptoms seen in babies are similar to those of opioid withdrawal, including irritability, sweating and respiratory distress.

According to a 2013 report from the U.S. Centers for Disease Control and Prevention, West Virginia has a rate of more than 33 births per 1,000.

A 2015 report in the Journal of Perinatology noted one infant was born with NAS every 25 minutes. The same study found more than 80 percent of cases identified were paid for under Medicaid.

Jenkins said NAS has not received the attention it deserved until recently.

“This report shows the exponential increase in recent years and, tragically, right here in our home state of West Virginia, we are near the top of the charts of infants suffering from NAS,” he said. “This provides a roadmap of action and sets forth a number of steps federal officials need to take.”

As there is no present national standard for treating infants with NAS, the GAO looked at the options available at facilities in Kentucky, Vermont, West Virginia and Wisconsin for best practices. The report includes pictures of Lily’s Place, a Huntington facility and the first center in the United States for related treatment. The facility offers non-medication options — such as swaddling and skin-to-skin contact — in specialized nursing rooms, as well as providing babies with morphine.

“In West Virginia, health care providers said infants are typically placed in individual nursery rooms where nurses provide them with nonpharmacologic treatment,” the report stated. “The rooms in the West Virginia facility are also equipped with a rocking chair to encourage mothers to visit and provide this care as well.”

The GAO also mentioned prioritizing the mother-infant bond in the list of practices at facilities.

Jenkins was involved in opening Lily’s Place in 2014.

“It showed me how unprepared we are for models of care, methods of care reimbursement of care,” he noted. “All the aspects of taking care of these newborn infants.

According to GAO, two-thirds of infants are treated in special care nurseries or a neonatal intensive care unit. Health care providers receive funding through grants and private donations, and the West Virginia Medicaid program pays for doctor visits.

The report said the Health and Human Services Secretary should implement practices, including increased education for mothers and health care providers, reducing the stigma women who use opioids may face and the development of a protocol for screening infants.

Capito said this report is a roadmap for extending services to families who do not have access.

“By raising awareness of treatment options like those available at Lily’s Place and exploring strategies to help infants in need, we can really begin to address this tragic aspect of the opioid crisis,” she said.

“This study is another step in a much larger fight, but it’s a welcome and useful tool that I know will inform our efforts moving forward.”

Jenkins said the next step is finding other ways to combat the opioid epidemic.

“This is the most challenging public health and safety issue of our time,” he said. “I have been passionate and diligent and unrelenting in securing much needed federal resources to support everything from police efforts to go after the drug dealers, but also funding to support treatment and recovery.”

He added increasing job opportunities is also part of the plan.

“My mantra is ‘a good job solves a lot of problems,’” he added.

Sen. Joe Manchin, D-W.Va., said in a statement Wednesday he supported the recommendations, calling NAS “one of the most tragic consequences of the opioid epidemic.”