October 20, 2017
FauquierHealth and the Mental Health Association of Fauquier County teamed up on October 11 for an all-day conference on “Addressing the Opioid Crisis: Treatment that Works.” The morning’s focus was on the particular vulnerability of women to opioid addiction – and the downstream effects on their babies, born addicted. The afternoon introduced best practices for treatment and recovery and shared the resources that are available in our region.
The major themes addressed were:
Mishka Terplan, MD, MPH, FACOG, FASAM, professor of the departments of Obstetrics and
|Dr. Mishka Terplan
Dr. Terplan said that pregnant women are motivated to stop using opioids for the sake of their babies. When they can’t, it is defined as addiction: a brain-centered disease whose symptoms are behaviors. He explained, “The salient feature of addiction is continued use in spite of adverse consequences.”
Although pregnant women are a population most in need of treatment, fewer than 20 percent receive it, according to Dr. Terplan. Screening is the first step, but most are never screened for opioid use disorder (OUD). Patients avoid screening because of a fear of discrimination or judgment; a previous bad experience with health care provider; a fear of Child Protective Services; or they don’t consider their use problematic. Some physicians can be resistant too, citing a lack of time or payment and lack of knowledge about what to do if a patient screens positive.
Addressing the audience next was Alta DeRoo, MD, FACOG, FASAM, associate professor, OB/GYN, at the University of Virginia. She is the director of OB/GYN at UVA Health System, at Culpeper Medical Center, and is an addiction medicine consultant. She spoke on the screening and treatment of opioid use disorders in pregnancy.
Dr. DeRoo began by quoting another sobering statistic: “The Virginia Department of Health reports 16 percent of pregnant members had substance use disorder.” She then gave specifics on treatment options, including the effectiveness of administering buprenorphine or methadone in combination with counseling to help pregnant women cope with opioid addiction.
Elsie Mainali, MD, PhD, neonatologist with Fauquier Health’s Family Birthing Center then
|Dr. Elsie Mainali
She drew a picture of what NAS babies endure after then are born. When an addicted baby is admitted to Fauquier’s NICU, the hospital’s neonatal team works to reduce the amount of stimuli the baby experiences. A baby born addicted must be:
In addition, caregivers can provide the following supportive therapies:
• Wrap or swaddle infant; use short-haired sheepskin with a soft cotton sheet
• Hold the infant firmly and close to the body
• Promote skin to skin contact and use of infant sling
• Massage infant or try relaxation baths
• Rock gently, talk, sing or hum softly
• Play heartbeat audiotapes
• Decrease stimulation at first signs of distress
• Feed on demand – give frequent small feeds with rests between sucking
• Change diaper frequently, use triple paste cream to prevent skin damage
• Use gentle suction if nasal secretions cause obstruction to ensure adequate respiratory function
• Weigh baby and assess hydration daily
Dr. Mainali joined the panel discussion that followed, which also included Dr. Terplan, Dr. DeRoo and Fauquier Health Emergency Department chairman Michael Jenks, MD. Panelists answered questions from the audience, which focused on MAT and related issues.
Nick Szubiak, MSW, LCSW, director of Clinical Excellence in Addictions and Integrated Health
Szubiak detailed how addiction develops, and also emphasized the important role of primary care physicians in screening, brief interventions and referral for treatment of substance use issues.
Ashley Clark, PhD, QMHP, program manager of Outpatient Mental Health and Substance Use
Services for Rappahannock Rapidan Community Services, was the final guest speaker. She ended the conference on a hopeful note by enumerating all of the services available in the area, from residential options to local supplemental services like:
• Infant Toddler Connection
• Fauquier Link
• Crisis Services
• Child Mobile Crisis
• Parent Café
New services coming online through Rappahannock Rapidan Community Services include
|Ashley Clark, PhD
Sallie Morgan, of the Mental Health Association of Fauquier, was enthusiastic about the forum. “We’ve heard a lot about the scope of the opioid crisis and its impact on this region, and now it is time to focus on solutions. The Surgeon General has defined the need to address opioid addiction and other substance use issues as a moral test of each community, and Fauquier is really rising to meet that test. Medical professionals and community members coming together to learn more about effective treatment is part of a larger, community–wide effort to offer prevention programs, treatment options, and support for individuals in recovery.”