[S]tate officials and health advocates are questioning the findings of a recent federal report that says Vermont has the nation’s highest rate of new mothers who are opioid-dependent.
The report, from the Centers for Disease Control and Prevention, says nearly 5 percent of women who were hospitalized in Vermont to give birth in 2014 had opioid use disorder. That’s far above the national average of 0.65 percent.
But the study’s authors acknowledge limitations, both in the amount of data collected and in the possible reasons for state-by-state variations.
The Vermont Health Department countered the CDC report with data showing a recent drop in the number of babies exposed to opioids. And when infants are exposed, officials say it’s often because a mother is receiving medically supervised addiction treatment.
“Vermont’s been successful at screening and has been successful in treatment capacity for these women,” state Health Commissioner Mark Levine. “And we have great hospital protocols in caring for these women and their babies.”
The CDC says pregnant women using opioids is a “significant public health concern.” And at the national level, the report shows that the problem worsened significantly between 1999 and 2014.
The prevalence of opioid-use disorder among women who went to the hospital to deliver babies jumped 333 percent during that time, from 1.5 cases per 1,000 to 6.5 per 1,000.
In announcing the findings, CDC Director Robert Redfield said the numbers “illustrate the devastating impact of the opioid epidemic on families across the U.S., including on the very youngest.”
“Untreated opioid use disorder during pregnancy can lead to heartbreaking results,” Redfield said. “Each case represents a mother, a child and a family in need of continued treatment and support.”
The CDC found “significant increases” in the number of opioid-dependent new mothers in each of the 28 states where sufficient data was available.
The states with the biggest average annual increases were Maine, New Mexico, Vermont and West Virginia. The number of Vermont deliveries in which mothers had opioid use disorder climbed from 0.5 per 1,000 hospital births in 2001 to 48.6 per 1,000 births in 2014.
That latter number put Vermont at the top of the list. The state ranking second, West Virginia, had a rate of 32.1 opioid-dependent mothers per 1,000 hospital births. Kentucky came in third with a rate of 19.3 per 1,000 births.
There are questions, however, about what those numbers mean.
The use of four-year-old statistics is one issue, because much has changed in the opioid-abuse landscape in recent years. Vermont’s “hub and spoke” system of medication-assisted treatment for opioid addiction, which now serves thousands of residents, was just getting started in 2014.
Also, the CDC study’s geographic reach was limited due to a lack of available data. The 2014 rankings were based on just 25 states, plus the District of Columbia.
Even among those states with sufficient data, the CDC says “differing state policies” could affect rankings. Some states do more than others to seek out and treat opioid dependence among expectant mothers.
“Increasing trends might represent actual increases in prevalence or improved screening and diagnosis,” the report’s authors wrote.
Some say that’s the case in Vermont.
Levine said the state is “very successful in getting women to verify that they have the disorder, and successful in getting women into treatment.”
That effort predates the hub and spoke system, and officials said it is showing results: The Health Department said the rate of infants exposed to opioids was 28.3 per 1,000 births in 2016, which was a 17 percent decrease from the year prior and equal to 2011’s rate.
“I still say that’s a rate that’s too high,” Levine said. “But it’s a decrease, which is promising.”
A Health Department spokesperson said those statistics do not include infants who have been exposed to opioids via a mother who is undergoing medication-assisted addiction treatment.
Given the health risks of opioid use disorder, experts say it’s important to get pregnant women into treatment as soon as possible. That’s true not only to reduce the immediate risk to a mother and her baby, but also to reduce the chance of a mother’s relapse, said Dr. Marjorie Meyer, an obstetrician at University of Vermont Medical Center.
“Most of the babies in this state that are exposed (to opioids) are exposed because their moms are in treatment … and we think that’s a good thing,” said Meyer, who is also director of the Maternal Fetal Medicine Division at UVM’s Larner College of Medicine.
Meyer said the state’s treatment offerings allow expectant mothers to seek assistance if they need it. Rather than taking a punitive approach to addiction, “we encourage women to come to us for help,” Meyer said.
Sally Borden, executive director of the Burlington-based KidSafe Collaborative, puts it another way: “Pregnancy is an opportunity to really make sure that we’re doing everything we can.”
KidSafe leads Vermont’s CHARM team; the acronym stands for “children and recovering mothers.” The partnership of health care and social service providers started in the early 2000s, and it’s designed to connect expectant or new mothers who have opiate dependence to prenatal care and addiction treatment.
“It’s been, I would say, very effective,” Borden said. “We were able to get out ahead a bit of many other areas in the country in how to best address this.”
At an opioid-funding event earlier this year in Richmond, Dr. Anne Johnston – a UVM Medical Center neonatologist and a founder of what became the CHARM team – said the state had “made a lot of headway … in terms of assuring that women are in treatment earlier in their pregnancy and have healthier pregnancies and healthier babies.”
“One of the most important things that affects these women is shame – shame that they’re an addict, and shame that they’re pregnant and they can’t stop,” Johnston said. “And recognizing that allows us to really (address), what are the roots of the shame, and try and combat that shame and fear by providing a straight-faced approach and a trauma-informed approach.”
Levine said he believes the state’s current policy approach to the problem is sound. But he also sees a need to look beyond prenatal care and ensure that mothers can access post-pregnancy, longer-term assistance like recovery coaches, housing and employment.
“That’s where, if there’s going to be a relapse, it’s going to occur,” Levine said.