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Addressing role of providers, pharmacists in NAS
Ivy Click and Nick Hagemeier

JOHNSON CITY (May 12, 2016) – When Drs. Ivy Click and Nick Hagemeier were awarded a $50,000 grant in late 2014 to survey providers about neonatal abstinence syndrome (NAS), the East Tennessee State University faculty members were well aware of the issue’s continuing growth and wanted to address ways to reduce it.

“It has become an epidemic across the state,” said Click, an assistant professor of family medicine at ETSU’s Quillen College of Medicine. “We’re talking about a tenfold increase in Tennessee over the past decade, and here in the eastern region, the numbers are higher than anywhere else in the state.”

NAS is defined as a condition in which a baby has withdrawal symptoms after being exposed to addictive illegal or prescription drugs while in the mother’s womb. When the baby is born, it goes through withdrawal because it is no longer receiving the substances.

Through the grant from the Tennessee Department of Health, Click and Hagemeier, an assistant professor at ETSU’s Bill Gatton College of Pharmacy, set out to better understand the knowledge, beliefs and practices of licensed prescribers and pharmacists regarding NAS.

“A majority of women who deliver a baby diagnosed with NAS have legal prescriptions for opioids, either for the treatment of addiction, pain, or another condition,” Hagemeier said. “This means they are likely seeing a prescriber and a pharmacist before taking the opioids.  We wanted to see if there was something at those stages that could be done to reduce instances of NAS.”

Two years ago, the state came out with chronic pain prescribing guidelines that spell out what providers should be doing in cases where women of child-bearing age are being prescribed opioids.

Among the recommendations is the administering of a pregnancy test before prescribing opioids to ensure the patient is not pregnant before she starts taking the drugs. A provider should also be recommending women of child-bearing age who are going to be on opioids for a certain amount of time use a long-acting reversible contraceptive (LARC) to prevent unintended pregnancy while taking the drugs, the guidelines state.

“The idea there is, if we’re going to be on a long-term opioid, then let’s just not get pregnant,” Click said, pointing out that a majority of NAS births are from unintended pregnancies. “Stopping women from getting pregnant to begin with while they are on opioids will dramatically reduce NAS cases.”

After conducting the survey, Click and Hagemeier now have a better picture of whether the guidelines are being followed.

“Providers who responded to the survey said NAS is a concern in their practice and they do talk about risks of addiction and dependence. But they weren’t talking with patients as often specifically about addiction and dependence of a newborn,” Click said. “We also found many of them never administered pregnancy tests before they initiated opioids and many were not routinely recommending long-acting reversible contraceptives.”

Pharmacists’ responses indicate opportunities for additional engagement in NAS prevention.

“Pharmacists were good at asking patients if they have questions about the medication, but they inquired about pregnancy status in only 3 out of 10 women of childbearing age who were prescribed a long-term prescription opioid, and directed only 1 out of 10 such patients to where they can access LARC,” Hagemeier said. “There’s a lot of room for improvement and it has a potential to make a big impact.”

Click and Hagemeier concluded the research with the determination that more education at the formative level as well as at the continuing education level for prescribers and pharmacists is necessary.

“Those surveyed did feel a responsibility for NAS and for preventing it, but most felt they were not adequately prepared to address it,” Click said. 

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