1. Delaware Dialogue: Addressing Substance Abuse DHMIC Summit 2017
David A. Paul, MD, FAAP
Chair, DHMIC
Clinical Service Line Leader, Christiana Care Health System
Professor of Pediatrics, Sydney Kimmel Medical College at Jefferson University, Philadelphia, PA
4/4/17

2. Panel Members Matt Denn, Delaware Attorney General
Karyl Rattay, MD, Director Division of Public Health
Mike Barbieri, Director, Division of Substance Abuse
Jennifer Donahue, Office of the Child Advocate
Trenee Parker, Department Family Services

3. Case Presentation 32 year old G4P1 mother History of heroin use
Started Methadone first trimester, 110 mg
Alprazolam (Xanax®), Sertraline (Zoloft®)
Tobacco use 1 pack/day
Maternal toxicology screen (+)opioids and methadone at delivery at 39 weeks
Baby treated with morphine, start DOL 2
Discharging home on DOL 28
What do we need to do to assure safe hospital discharge and transition to home?

4. NAS
Definition: signs and neuro-behaviors exhibited by newborn after birth following abrupt discontinuation to substances taken by mother
Among infants exposed to opioids in-utero, 55-94% develop withdrawal symptoms

5. Fetal Exposure to Opioids
Heroin
Methadone
Prescription drugs
Buprenorphine
Common comorbid usage
Tobacco
Marijuana
Benzodiazepines
SSRIs

6. 308 Overdoses in DE 2016
NY Times, June 1, 2016

7. NAS Patient Days Christiana Hospital 2010 -2016
number
Projected based on first 2 quarters
93% Medicaid
Mean hospital charge from Patrick article $66,000 then 2014 charges=$11.5 million

10. Delaware Birth Hospitals NAS 2013-2016 2016, projected through q3
Number of infants with NAS
20% increase in 2014
93% of patients Medicaid
27/1000 live births
Hospital

11. Comprehensive Addiction and Recovery Law (CARA) signed into place in July
CAPTA modified
State needs to ensure the safety and well being of infants upon transition of care
Sec of Health and Social services needs to monitor state compliance
Plan of safe care required