NAS mothers obtain Safe Harbor
By Jessica Brown
For thousands of drug dependent mothers, the Safe Harbor Act offers a new opportunity.
“While there is limited data, it is believed that the Safe Harbor Act has allowed women to obtain services without the threat of incarceration,” said Rod Bragg, assistant commissioner for the Tennessee Division of Substance Abuse Services.
“A pregnant woman who is abusing opioid pain killers may be arrested with a simple assault misdemeanor if the woman is using opioids during the pregnancy.”
During a pregnancy, drugs and alcohol pass through the placenta, where the baby can develop a dependency on the substance in the womb.
At birth the baby may experience withdrawal symptoms, often referred to as Neonatal Abstinence Syndrome, which can lead to sweating, hyperactive reflexes, irritability, trembling and discoloration of the skin.
According to the Northeast Regional Department of Health, the number of NAS cases increased by 15-fold, in comparison with the national increase of 3-fold between April 2013 to present.
“A pregnant woman who is abusing opioid pain killers may be arrested with a simple assault misdemeanor if the woman is using opioids during the pregnancy.” — Rod Bragg
A law such as the Safe Harbor Act was enacted in 2013 and provides NAS mothers with an opportunity for change.
Bragg said if a mother participates in substance abuse treatment and actively stays in the program throughout her pregnancy, she may be dropped of the charges.
If she does not comply with the requirements, she can be convicted of a simple assault misdemeanor.
However, Bragg said the Safe Harbor Act does not specifically address what will happen with the child.
At the Northeast Regional Health Department, mothers or guardians of the infants have reached out for services.
If a mother receives WIC or other government benefits, the health department is directly involved with these procedures.
“Sometimes you know if the mother’s parental rights have been terminated or if she’s not in charge of the baby at the time, it would be a grandmother [bringing the baby in], that’s typically what we see,” said Christen Minnick, health promotion and community services coordinator.
Minnick said several doctors in the East Tennessee region focus on providing NAS education for the community.
“The Knoxville area [Health Department] teamed up with UT medical and they’ve been going out into jails and talking about NAS with the female inmates,” Minnick said.
Dr. Cynthia Thomas, a physician at Northeast Regional Health Department, gained interest in this idea and began it in the Northeast Tennessee region.
She has visited Washington County, Greene County and plans to outreach to Carter County providing women with educational opportunities.
“There’s a physician in Carter County that was really interested in NAS,” said Minnick. “He’s seen a lot of issues in their practice with moms bringing their babies in and they were still using [opioids] and they could see signs on NAS with the babies too, it’s pretty sad.”
The act states that providers of obstetrical care, who have identified that a pregnant woman has used prescription drugs, results can be harmful and patients should seek counseling and substance abuse treatment.
If a woman continues in her treatment, the Department of Children’s Services will not terminate parental rights based solely on the mother’s history of drug usage during pregnancy.
“Although there is other legislation that deals with the use of prescription drugs during pregnancy,” Thomas said.
The Safe Harbor Act is intended to increase the referral rate among women seeking treatment and other available resources.
Thomas said the Safe Harbor Act encourages pregnant women seeking this treatment, in which they are the first priority.
One doctor who specializes in supervised replacement therapy, Dr. Stephen Loyd, an associate professor of medicine and Vice Chair for Veteran Affairs.
He has worked with women for years by providing supervised replacement therapy to help with their drug dependencies.
“If you have a pregnant woman who is addicted to opioids then you place her on either Buprenorphine or Methadone,” said Loyd. “Then you decrease her risk of acquiring HIV or Hepatitis C because most people who use opioids make the needle.”
Loyd said it’s crucial to take the mother out of the illegal drug market, while preventing her from going into withdrawal.
“The withdrawals won’t kill her but it will kill the baby,” he said.
Over 55 percent of his patients give birth while on supervised replacement therapy, Loyd said.
“And I get very excited because I think that’s a great sign,” said Loyd. “They’re receiving treatment.”
On April 11, according to the weekly statistics by the Tennessee Department of Health, 208 NAS cases were reported this year.
“The Safe Harbor Act said that we want to try to identify pregnant women, who are addicted, and we want to try to get them help,” said Loyd. “That’s the right thing to do.”
Loyd said if you look at the babies born with NAS, not on replacement therapy, they will spend an average of 33 days in the NICU, at an estimated $5,000 a day.
“I propose that the money would be much better used for treatment and prevention,” Loyd said.
It is also strongly advocated that women receive prenatal care.
“We get women, who are seven-and-a-half, eight months pregnant, who haven’t seen an OBGYN doctor yet,” Loyd said. “The shame creates this gulf between that person and where they need to get help.”
The stigma needs to be erased in order for women to seek treatment, Loyd said.
Dr. Robert Pack, associate dean for academic affairs in the College of Public Health at East Tennessee State University, said he agreed stigma is a significant part of the NAS complexity.
“The shame creates this gulf between that person and where they need to get help.” — Robert Pack
Loyd said it isn’t a complete barrier but it makes the treatment process more challenging.
“It drives women underground,” he said.
Loyd said he has witnessed many diverse situations throughout his career but encourages women to seek prenatal care.
Many times it is this negative stigma that prevents women from seeking treatment before they give birth.
Loyd said one of his patients was pregnant and she didn’t want to go to the doctor because she thought her baby would be taken away.
Ultimately, more problems can occur because people are not seeking treatment.
“It’s really easy to knee jerk your reaction to these things, I used to do it all the time but you need to look at the stories,” said Dr. Loyd. “They are captivating.”
