Alison Mitchell, University of Maine
originally published in the Bangor Daily News on March 18, 2014
Maine’s increase in substance-exposed births has received a lot of coverage lately. Gov. Paul LePage unveiled his plan to address the issue last week. Much of the focus of recent coverage is related to Maine’s troubling opioid abuse rate, the highest in the nation. Opioids include prescription narcotic painkillers as well as heroin and its relatives.
We can solve this public health problem if we come together as a community and gain a greater understanding of the issue. First, let’s separate fact from fiction.
There were 927 drug-affected baby notifications last year. Sadly, that is a fact. But the situation is more complex than a number.
What might have been reported as a drug-affected baby by one hospital might not have been reported as such by another.
The number 927 may include infants affected by alcohol, legally prescribed medications, marijuana and other illegal drugs. It may include infants of mothers who tell their physician they used marijuana or consumed alcohol before they knew they were pregnant. It may include infants of mothers taking legally prescribed medication under a doctor’s supervision to manage medical conditions.
Policy makers and providers are working together to clarify guidelines and make reporting consistent.
The 927 drug-affected births represent about 7 percent of Maine births in 2013. At Eastern Maine Medical Center in Bangor, there were 308 substance-exposed infant reports in 2011, approximately 19 percent of births at EMMC that year. Of those, 173 included an opioid as at least one of the substances.
Fiction: drug-addicted babies
An infant cannot be born addicted. Addiction is a long-term, chronic, treatable disease, marked by an uncontrolled need to take a substance regardless of consequences. Infants are simply not capable of that kind of uncontrolled need or independent action.
Infants may receive treatment for physical dependence on a substance resulting from exposure before birth, but that dependence does not equate to addiction.
Fact and fiction: “We must save our babies from lifelong suffering,” LePage said in his State of State address.
Of course we must save babies from lifelong suffering. Alcohol is the most common cause of preventable birth defects. Research indicates avoiding alcohol while pregnant is best.
But where opioids are concerned, the long-term impacts might be surprising. While most infants exposed to opioids during pregnancy are at risk for withdrawal, some can leave the hospital after just five days of monitoring.
Moreover, early data suggests these infants are less involved in the child welfare system than might be expected.
In a first-ever attempt in Maine to track involvement in the child welfare system, University of Maine graduate students found the majority (80 percent) of opioid-exposed infants recorded at EMMC in 2011 appear to have had no formal involvement with the child welfare system in their first year of life. Most infants lived in two-adult households with other children in the home.
The findings from this student project support a family-oriented approach to follow-up medical care and support services, and emphasize the need for a strong community-based system-of-care.
The Penquis region benefits from just that through the efforts an existing network of more than 32 social service agencies. Their collaboration resulted in the Penquis Regional Linking Project, a five-year federal grant project focused on working with service providers and families to support children under age 6 affected by substance abuse.
Fact: Treatment saves money.
The federal Substance Abuse and Mental Health Services Administration reports that for every $1 spent on substance abuse treatment, communities experience $7 in benefits. The same report shows that for every $100,000 spent on treatment, more than $450,000 in health care costs and $700,000 in costs related to crime can be avoided.
Outpatient treatment is approximately 10 times cheaper than putting the same adult in jail.
This is not to minimize the severity of the problem. Rather, the point is that the problem is far more complex than a soundbite or a number reported without explanation. Communities are strongest when they work together toward a common goal.
The well-being of children and families is fundamental to the development and sustainability of a healthy society. Investing in Maine’s children and families establishes a strong foundation for our communities and our state. It starts with understanding.
In May, Alison Mitchell will complete her master’s in social work from the School of Social Work at the University of Maine. She is a graduate fellow for the Maine Chapter of the Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications. Members’ columns appear every other week.