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Pregnant women addicted to opioids quadruples

More than 72,000 Americans died from drug overdoses last year. That's a 7% increase from the year before, according to a new CDC report. Most of those deaths were opioid-related -- and there's a new part of the population in crisis: pregnant women. CNN's Chief Medical Correspondent, Dr. Sanjay Gupta, is OutFront.

Posted: Aug 19, 2018 8:49 PM
Updated: Aug 19, 2018 8:49 PM

Nationwide, the rate of opioid use disorder among women delivering babies more than quadrupled over the 15-year period ending in 2014, according to a Morbidity and Mortality Weekly Report published Thursday by the US Centers for Disease Control and Prevention.

Use of opioid drugs, whether heroin or prescription painkillers, during pregnancy harms the health of both mother and child and can lead to stillbirth, preterm labor, neonatal abstinence syndrome and, in some cases, death of the mother.

"More and more women are presenting with opioid use disorder at labor and delivery," Dr. Wanda Barfield, director of the CDC's Division of Reproductive Health, said in a statement. She added that the data included in the new report can provide a "solid foundation for developing and tailoring prevention and treatment efforts."

Lowest state rates and highest

The CDC researchers, who did not include Barfield, analyzed hospital discharge data from the US Department of Health and Human Service's Healthcare Cost and Utilization Project to characterize trends from 1999 through 2014.

During that time, the national prevalence of opioid use disorder diagnoses among women giving birth in hospitals increased 333%, from 1.5 cases per 1,000 deliveries to 6.5. This amounts to an average annual increase of 0.4 per 1,000 hospital deliveries per year.

The CDC's analysis is based on data available for only 30 states.

In 1999, the prevalence of opioid use disorder ranged from 0.1 per 1,000 hospital deliveries in Iowa to 8.2 in Maryland. In 2014, prevalence ranged from 0.7 in the District of Columbia to 48.6 in Vermont. Prevalence also exceeded 30 per 1,000 hospital deliveries in West Virginia in 2014, while at the opposite end of the spectrum, Nebraska had the second lowest rate at 1.2 per 1,000.

Over the study period, average rate increases in opioid use disorder were lowest in California and Hawaii, where growth amounted to fewer than 0.1 cases per 1,000 deliveries each year, and highest in Maine, New Mexico, Vermont and West Virginia -- all with an annual growth of more than 2.5 cases of opioid use disorder diagnosed per 1,000 deliveries.

Different state policies might contribute to this variability, the CDC authors believe. As of July, eight states required health care professionals to test for prenatal drug exposure when it is suspected, while 24 states and the District of Columbia require professionals to report suspected use among pregnant women. Twenty-three states and D.C. consider substance use during pregnancy to be child abuse, and three states consider it to be grounds for admitting a woman involuntarily into a psychiatric hospital.

Still, the CDC researchers noted that strict policies could cause women to try to conceal substance use from their providers. "Data on the impact of these policies are scarce," the authors concluded.

The report offers a glimpse of one special group within the many faces caught in America's opioid epidemic.

Dr. Elizabeth E. Krans, an assistant professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at the University of Pittsburgh, wrote in a paper published in July that "an expanded, socioeconomically and demographically diverse population" has become addicted to opioids over time.

Epidemic 'touched everyone'

In the 1960s, more than 80% of patients entering treatment programs for opioid abuse were urban men who used heroin, Krans and her co-author wrote. But by 2010, the majority were women, often middle-class, living in less-urban or rural areas, and over 90% were white.

The opioid epidemic has "touched everyone," Krans, who was not involved in the new CDC report, told CNN. "When something is so broad and affects all populations, we also see it reflected in the pregnant population.

"Pregnancy is a really important time. Women are often worried that invested in their own health and the health of their baby, but they're also fearful of judgment," Krans said. Pregnant women are fearful that people will treat them negatively or, in the worst cases, remove their babies, she said.

"We have effective treatments that are available during pregnancy, and we want to encourage women to seek early care and engage in treatment as soon as possible," Krans said, adding that pharmacological treatments include bupenorphrine and methadone.

At Magee-Womens Hospital of University of Pittsburgh Medical Center, where she works, services for pregnant women with opioid use disorder include social services, psychiatric and behavioral health support, and pediatric and neonatal support after delivery. "We're trying to take a comprehensive approach," she said.

The American College of Obstetricians and Gynecologists recommends universal substance use screening at the first prenatal visit to manage opioid use disorder, according to the CDC.

"Arranging for pregnant patients with opioid use disorder to deliver at facilities prepared to monitor and care for infants with neonatal abstinence syndrome can facilitate access to appropriate care," the CDC researchers wrote. "After delivery, women might need referrals to postpartum psychosocial support services, substance-use treatment, and relapse-prevention programs."

Indiana Coronavirus Cases

Data is updated nightly.

Cases: 775686

Reported Deaths: 14025
CountyCasesDeaths
Marion1066871814
Lake572681031
Allen43500701
Hamilton37653427
St. Joseph37508568
Elkhart29882471
Tippecanoe23732232
Vanderburgh23634405
Porter19690327
Johnson19020394
Hendricks18271323
Clark13730199
Madison13719348
Vigo12949256
Monroe12691180
LaPorte12645225
Delaware11218198
Howard10832237
Kosciusko9851124
Hancock8855150
Bartholomew8343157
Warrick8216157
Floyd8128183
Grant7457181
Boone7289105
Wayne7273201
Morgan6988143
Marshall6376117
Dubois6327118
Cass6130112
Noble607391
Dearborn605878
Henry6001111
Jackson520977
Shelby514898
Lawrence5020128
Gibson471697
Montgomery464792
Clinton462755
DeKalb461485
Harrison459277
Huntington429082
Whitley421045
Steuben414561
Miami411573
Jasper403957
Knox397291
Putnam388762
Wabash373884
Adams358956
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White341854
Daviess3110100
Wells305981
Greene298485
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Posey288235
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Scott285458
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Clay277649
Washington257638
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Spencer240531
Fountain239050
Starke231559
Owen226759
Sullivan224143
Fulton210446
Jay204132
Carroll200623
Orange194456
Perry193139
Vermillion183444
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Tipton174348
Franklin173935
Parke157816
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Blackford138732
Pulaski124748
Newton124137
Benton111615
Brown106743
Crawford106716
Martin92715
Warren88715
Switzerland8568
Union73910
Ohio58711
Unassigned0429

Ohio Coronavirus Cases

Data is updated nightly.

Cases: 1132798

Reported Deaths: 20530
CountyCasesDeaths
Franklin1312911496
Cuyahoga1180592268
Hamilton830231263
Montgomery541901064
Summit491891018
Lucas43982835
Butler40324615
Stark34056941
Lorain26232511
Warren25125312
Mahoning22881614
Lake21602397
Clermont20592261
Delaware19295138
Licking16977227
Fairfield16959207
Trumbull16940493
Medina16019278
Greene15721254
Clark14439309
Portage13548219
Wood13411201
Allen12124245
Richland11870214
Miami11140229
Wayne9344228
Columbiana9282236
Muskingum9207137
Pickaway8796123
Marion8774140
Tuscarawas8756257
Erie8220166
Ashtabula7318180
Hancock7080135
Ross7070165
Geauga7032153
Scioto6887108
Belmont6261179
Lawrence6033106
Union595149
Jefferson5787162
Huron5678122
Sandusky5536130
Darke5476131
Seneca5391128
Washington5391111
Athens528660
Auglaize510587
Mercer492885
Shelby487798
Knox4678112
Ashland450198
Madison450066
Defiance444599
Fulton443275
Putnam4366104
Crawford4152112
Brown414163
Preble3988107
Logan396379
Clinton395667
Ottawa378281
Highland370768
Williams361878
Champaign351760
Guernsey334054
Jackson324954
Perry300550
Morrow298544
Fayette291350
Hardin280465
Henry279067
Coshocton275161
Holmes2735102
Van Wert254465
Gallia254150
Adams253658
Pike247137
Wyandot236557
Hocking224163
Carroll203349
Paulding181542
Meigs153940
Monroe139446
Noble138739
Harrison115738
Morgan112024
Vinton88217
Unassigned04
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