| dc.description | It’s my weekly volunteer shift at East Tennessee Children’s Hospital (ETCH) and another newborn was just admitted to the 3rd floor Neonatal Intensive Care Unit (NICU). In active drug withdrawal because he was exposed to his mother’s prescription opioid addiction in utero, the child’s first hours of life are marked by uncontrollable tremors, difficulty with the first feed, and the signature, piercing cry of Neonatal Abstinence Syndrome (NAS). In an attempt to reduce symptoms and stabilize their newest patient, the medical staff admit the infant to a special unit at ETCH built in response to a sweeping epidemic of NAS in Tennessee. In a private room designed to minimize light and sound that may lead to increased withdrawal symptoms, the nurses start the hours-old infant on a high dose of morphine to curb the initial withdrawal symptoms. Twenty-one days later and free of daily morphine doses, the baby is discharged and funneled into a constantly changing legislative system to determine where he will be placed. I wish I could say that this encounter was uniquely my own and that the patient was the first and only one in his situation, but that is far from the truth. While this infant was hospitalized, racking up a 50,000-dollar medical bill, ETCH received twenty more NAS patients. In conjunction with the US opioid crisis, NAS has reached epidemic levels in Tennessee and is ravaging communities across the state, especially in East Tennessee.
While the opioid epidemic has far-reaching effects nationally and even globally, Tennessee has been especially impacted. For nearly ten years, Tennessee’s mothers, babies, and communities have been gripped by the one of the highest rates of opioid addiction and NAS in the country. Acting out of both necessity and hope, Tennessee has led the way in many aspects of addressing the opioid and NAS crisis, from pioneering a comprehensive inpatient NAS treatment protocol to enacting multi-dimensional recovery programs for affected moms. However, as the epidemic continues to rage in all three regions of the state, there is still much work to be done in understanding the causes and outcomes of the crisis while finding new ways to respond to and mitigate its effects. The following piece will explore the literature surrounding the opioid epidemic and NAS in Tennessee by providing history and background, analyzing some root causes of the epidemic, highlighting several key interventions that have already been implemented, and offering recommendations for future NAS/opioid abuse reduction in Tennessee. In particular, I will argue for improved medical education through a structural competency approach. | en_US |
