case study

OPIOID EPIDEMIC CASE STUDY 1

Opioid Epidemic Case Study

Gabriela M. Anthony

SPED 620.02

Brett Collins

OPIOID EPIDEMIC CASE STUDY 2

Opioid Epidemic Case Study

Summary of Topic:

Opioids are often prescribed to patients as pain relievers. This includes drugs such as

oxycodone, morphine, codeine and fentanyl. Heroin is a very common illicit opiate that is

derived from morphine. Regardless if the opioids are being used under the direction of a doctor

or not, prolonged use can lead to dependency and addiction. The misuse of prescription drugs

includes taking the medication in order to feel high, taking a prescription that is under another

person’s name, and taking the medication in doses other than what has been prescribed. Opioids

are highly addictive and prolonged use can have detrimental effects to a person's life. An

addiction to opioids can lead to overdose and even death (NIDA). While an overdose can be

While pregnancy is often a motivating factor for many women to get treatment for their

drug addiction, the reality is this is not the case for everyone. Mothers who are using drugs,

especially opioids, during pregnancy are putting their child at risk for developing an addiction.

Neonatal Abstinence Syndrome (NAS) is “a drug-withdrawal syndrome that most commonly

occurs after in utero exposure to opioids” (Tolia, 2015). The drugs are passed through the

mothers blood into the placenta. NAS is diagnosed using a “ standardized scale that scores the

infant on the presence and severity of common withdrawal symptoms” (Tolia, 2015). Once these

babies are born they will be cut off throm their supply this immediately endearing a state of

withdrawal. Their symptoms of withdrawal begin within the first 24-72 hours after being born

and often include; high-pitched crying, trembling, trouble sleeping, and many more. Healthcare

workers may rely on opiate replacement therapy if the child's symptoms are severe enough. They

may turn to “opioids such as methadone or morphine, and then weaned off over days to weeks”

(Wachman 2018).

OPIOID EPIDEMIC CASE STUDY 3

Critique of Current Scientific Evidence:

Despite the increasing prevalence of NAS, the long-term effects of maternal opiate

dependence have not been researched fully. No one seems to really be sure of how this can affect

a child’s development. Researchers believe long-term effects may include developmental delays,

motor problems, and/or behavioural problems however they have yet to find conclusive evidence

that would support these theories.

Another big issue with the research being done is that “the preponderance of evidence is based

on low-quality studies that are uncontrolled, use single-center or retrospective data, have small

sample sizes, or use quality improvement methodologies not designed for generalizability”

(Wachman, 2018). Tolia et al. article shares that studies are often limited to hospital records and

rarely turns to firsthand accounts.

One study stated that “To further select infants in whom drug withdrawal was the primary

reason for NICU admission, we classified infants as having the neonatal abstinence syndrome

only if the queried phrase was assigned in the first 7 days of life” (Tolia et al.). This however

may be detrimental to the research because according to Stanford Children's Health NAS

symptoms can begin to develop up to 10 days after birth. Additionally, the “severity of

withdrawal is estimated using various scoring systems, the most common of which is the

Finnegan Neonatal Abstinence Severity Score.” (Logan et al.). The diagnosis itself is often

estimated by healthcare providers when urine samples can be done in order to definitively

determine whether a newborn has traces of opiate in their system.This too would bring more

clarity and allow researchers to have more credible data.

OPIOID EPIDEMIC CASE STUDY 4

Application and Reflection:

In order to combat NAS more research needs to be done on its short and long-term

effects. Neonatal Intensive Care Units (NICU) need more resources to treat children with NAS.

While the cases have increased, new methods have not been developed to help treat newborns

who are dealing with withdrawals (Tolia et al.). NICUs should be a key source of information

regarding the effects of NAS.

There needs to be more intervention strategies for both the mother and child. First and

foremost there needs to be more focus on the opioid epidemic itself. The government better

regulate the distribution of opioids. Additionally, doctors who are prescribing opiates freely need

to be investigated, as they are enabling this behavior. There needs to be more education about

drug use and abuse. Fear mongering is not always the best way to get people to stay away from

things. Being open about the short and long-term effects of drug use people may deter people

from using.

The rise in Neonatal Abstinence Syndrome means that more women are continuing to

abuse drugs while pregnant. Support groups and rehabilitation facilities should be more widely

accessible especially to expecting mothers. This should extend after the child is born to help the

women with their sobriety. Children of parents with opiate addictions need to have a strong

support system whether this be extended family, their own support groups, or involvement in the

community.

OPIOID EPIDEMIC CASE STUDY 5

References

Logan, B. A., Brown, M. S., & Hayes, M. J. (2013). Neonatal Abstinence Syndrome. Clinical

Obstetrics & Gynecology, 56(1), 186–192. https://doi.org/10.1097/grf.0b013e31827feea4

National Institute on Drug Abuse. (2021, May 17). Opioids. National Institute on Drug Abuse.

https://www.drugabuse.gov/drug-topics/opioids.

Neonatal Abstinence Syndrome. Stanford Children's Health - Lucile Packard Children's

Hospital Stanford. (n.d.).

https://www.stanfordchildrens.org/en/topic/default?id=neonatal-abstinence-syndrome-90-

P02387.

Tolia, V. N., Patrick, S. W., Bennett, M. M., Murthy, K., Sousa, J., Smith, P. B., Clark, R. H., &

Spitzer, A. R. (2015). Increasing Incidence of the Neonatal Abstinence Syndrome in U.S.

Neonatal ICUs. New England Journal of Medicine, 372(22), 2118–2126.

https://doi.org/10.1056/nejmsa1500439

Wachman, E. M., Schiff, D. M., & Silverstein, M. (2018). Neonatal Abstinence Syndrome.

JAMA, 319(13), 1362. https://doi.org/10.1001/jama.2018.2640