ASAM Steps Up Efforts to Reduce Incidence of NAS

The incidence of Neonatal Abstinence Syndrome (NAS) increased 600 percent from 2003 to 2009, which has fueled increased efforts to address the problem. ASAM has joined that effort with educational events at Med-Sci along with other health care groups outside of the conference.

“NAS refers to a collection of syndromes that infants can display if their mother takes a drug that causes dependency. The baby gets that drug during the pregnancy, and once the cord is cut, the drug supply is cut off and the baby may have withdrawal symptoms,” said Jacquelyn J. Starer, MD, FASAM, ABAM Diplomate.

“The term ‘NAS’ implies that it is an opioid withdrawal syndrome, but many substances can cause NAS, including sedatives, barbiturates, nicotine, alcohol, and even SSRIs. The biggest epidemic now is opioid use,” said Dr. Starer, Associate Director, Physician Health Services, Waltham, Massachusetts.

NAS was discussed at two separate sessions at Med-Sci—Symposium 2A, “Update on Women’s Issues,” on Friday and Course 5, “Neonatal Abstinence Syndrome: Understanding the Variations in Expression of Symptoms and Mitigating Them,” on Saturday.

Beyond Med-Sci, ASAM is developing education modules related to NAS and addiction among pregnant women as part of the PCSS-MAT program, Dr. Starer said. PCSS-MAT is the acronym for Providers’ Clinical Support System for Medication-Assisted Treatment. One part of the PCSS-MAT program involves physicians trained in addiction medicine signing up at to serve as mentors to other physicians, such as primary care physicians, pediatricians, and obstetrician/gynecologists, who may deal with women’s issues in addiction.

“If they have questions or difficult cases, I am available, or someone else is available, to talk to them and give them advice,” Dr. Starer said. “This puts the specialist in everybody’s back pocket because many people do not have access to consultants specialized in these conditions. Obstetricians don’t generally have training in managing addiction, so this is a nice way to bring it together.

“The PCSS program is not fully rolled out, but ASAM is developing online educational modules related to primary care and women’s health, especially in the treatment of addiction among pregnant women, in the hopes of impacting NAS. We would like physicians in the community, whether they be obstetricians or pediatricians or family practitioners, to become more comfortable in managing pregnant women with addiction, recognizing NAS in babies and becoming well equipped to provide the best treatment for both.”

As another part of the PCSS-MAT program, ASAM’s efforts include presenting an eight-hour training and certification course on buprenorphine prescribing at the American College of Obstetricians and Gynecologists Annual Clinical Meeting. The course will enable obstetricians to obtain the Drug Enforcement Administration “X” waiver, allowing them to prescribe buprenorphine for opioid dependence.

“This is helpful because a lot of doctors are uncomfortable about treating women with buprenorphine when they are pregnant,” Dr. Starer said. “If we can get enough obstetricians on board, they can provide the prescription while the woman is pregnant and in the post-partum period. With the mentoring program, they will have the resources available to be comfortable in providing this care even if they don’t have a lot of experience.”

ASAM began working on these programs in January 2013, and also extends its efforts into other women’s issues through the ASAM Women and SUDS (Substance Use Disorders) Action Group.

“It is critically important to take integrated approaches to pregnant women with substance use disorders because both obstetrics and addiction tend to be segmented and somewhat separate from general medical care,” Dr. Starer said. “While respecting patients’ confidentiality is important, we need these women to understand that it is in their best interests to have their providers communicate, and consent to the sharing of information. The more information you have you can present a convincing case to the woman to do something that is beneficial to her.”