2016 Webinar Series
Over the last several decades, the incidence of NAS has varied, usually associated with the waxing and waning of heroin use in the general population. However, the current rise in the numbers of infants with NAS represents a wide spectrum of pregnant women’s use of opiates. These uses include heroin addiction, polydrug use, sanctioned and non-sanctioned prescription opioid use, and medication (methadone or buprenorphine) assisted treatment (MAT). From the most recent data sets, it can be surmised that a significant number of cases of NAS are occurring in infants whose mothers have been prescribed opiates during the pregnancy. In order to address the prevention of and intervention for NAS, states are in a position to develop broad systems perspectives that stretch from the preconceptional period through childhood and that address clinical and systems issues across multiple domains.
With the increasing number of states passing or considering medical marijuana laws and the legalization of marijuana in some states, an important question arises: What responsibility does the public health system have in educating the public about the impact of marijuana on pregnancy and establishing guidelines for the prescription of marijuana to women of child bearing age and pregnant women? The purpose of this webinar is not to discuss the pros and cons of the legalization of marijuana use, the pros and cons of medical marijuana prescriptions, punitive measures regarding substance use during pregnancy, or a woman’s right to make choices for her own pregnancy. The purpose of this presentation is to frame and discuss the narrow question of medical marijuana laws and the public health response for pregnant women and women of child bearing age.
A high rate of co-occurring mental health disorders have been documented in children with prenatal alcohol exposure. Investigators have demonstrated that alcohol’s impact on the developing fetal brain, combined with environmental factors, is the source of this problem. However, more recent research has begun to focus on factors embedded in the child welfare system, preventable factors that can be an important determinant for risk of mental health problems in children. State Child Protective Services departments can develop policies that reduce mental health morbidity for children in the system’s care who have been prenatally exposed to alcohol or illicit drugs.
Clear evidence demonstrates that the earliest possible intervention significantly improves outcomes of children prenatally exposed to alcohol and illicit drugs. A four-tiered behavioral health system of care serves to screen all children in the community; provides families of any children with a positive screen instruction in basic home-based early intervention strategies or refers, as appropriate, children to 0-3 or school-based programs; and ensures that all children have access to an appropriate level of comprehensive assessment and highest quality treatment.
The health and welfare of children is a politically attractive issue; however, our systems of care are set up to be reactive rather than proactive. We spend money addressing difficulties that never need to occur. How do we establish prevention as a priority for health care systems and policy-makers? What key actions can be taken to reduce the rate of substance use in pregnancy and improve long-term outcomes for children prenatally exposed to alcohol and illicit drugs? How do we move from multidisciplinary to transdisciplinary systems of care?