Pandemic may be making it harder for pregnant women who use opioids to get effective treatment

Opioid use in pregnancy has prompted new guidance from the American Academy of Pediatrics aimed at improving care for women and for newborns affected by their mothers’ drug use.

The number of affected women and infants has increased in recent years but they often don’t get effective treatment, and the coronavirus pandemic may be worsening that problem, said Dr. Stephen Patrick, lead author of the academy report released Monday.

“While we have been talking about the opioid crisis for years, pregnant women and their newborns seldom make it to the top of the heap. Infants are receiving variable care and not getting connected to services,” said Patrick, a Vanderbilt University pediatrician.

The academy’s report says pregnant women should have access to opioid medication to treat opioid misuse. Two opioids, buprenorphine and methadone, are effective treatments but pregnant women often face stigma in using them and doctors who prescribe them are scarce.

The academy says hospitals should have written protocols for assessing and treating opioid-affected newborns. Many don’t and practices vary widely.

Breastfeeding and other practices that promote bonding should be encouraged, and parent education and referral to services for affected newborns should be provided, the academy says. Its recommendations echo guidance from other medical groups and the U.S. government.

“This is a substantial public health problem that is still lacking solutions,” Patrick said.

According to the federal Centers for Disease Control and Prevention, 7% of U.S. women reported in 2019 that they had used prescription opioids during pregnancy. One-in-five of those women reported misusing the drugs while pregnant.

Some infants born to these women develop symptoms of opioid withdrawal, including tremors, fussiness and diarrhea.

By some U.S. estimates, nearly 80 affected infants are diagnosed every day and the numbers have tripled in recent years.

Patrick has done research suggesting that these infants may be at risk for developmental delays but says it’s possible those findings reflect use of alcohol or other drugs during pregnancy, poor prenatal care or stress.

“Getting into treatment may be getting even harder” because of the pandemic, he said. “There’s so much going on in the world that that issues involving opioid use are flying under the radar.”

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As Purdue Pharma Agrees to Settle with the DOJ, Revisit Its Role in the Opioid Crisis | Opioids, Inc. | FRONTLINE | PBS

In the latest chapter of a complex legal battle over who is responsible for the nation’s opioid crisis, Purdue Pharma, the manufacturer of the notorious painkiller OxyContin, has arrived at an $8.3 billion settlement with the federal government, pending court approval.

Announced in an Oct. 21 Department of Justice press conference, the settlement, if approved, resolves the federal government’s civil and criminal probes into Purdue Pharma, which is currently in bankruptcy; an additional settlement resolves a federal civil case against Purdue Pharma’s owners, the Sackler family.

“It’s also important to note that this resolution does not prohibit future criminal or civil penalties against Purdue Pharma’s executives or employees,” Jeffrey A. Rosen, the U.S. deputy attorney general, said at the press conference.

Under the settlement, Purdue Pharma admits guilt on three felony charges involving conspiring to defraud the U.S. and break anti-kickback regulations in how it marketed opioids. The settlement involves a $3.5 billion criminal fine and a $2 billion criminal forfeiture, as well as a civil payment of $2.8 billion, though actual monetary payments could be substantially less, once the company’s value is factored in. Separately, the Sacklers themselves will make a $225 million payment to the U.S.

The settlement “will require that the company be dissolved and no longer exist in its present form,” Rosen said, with the Sacklers barred from any controlling or owning role moving forward. Instead, if the settlement is approved by bankruptcy court, the company’s assets would become “owned by a trust for the benefit of the American public,” Rosen said. The new company would still be able to manufacture opioid drugs but would also be required to produce large quantities of medicines to treat and respond to addiction and overdoses, and would need to offer the latter as donations or “at cost.”

“Purdue deeply regrets and accepts responsibility for the misconduct detailed by the Department of Justice in the agreed statement of facts,” Steve Miller, chairman of Purdue Pharma’s board, said in a statement.

In a separate statement, Sackler family members who served on the Purdue Pharma board said they had “acted ethically and lawfully” and that they “reached today’s agreement in order to facilitate a global resolution that directs substantial funding to communities in need, rather than to years of legal proceedings.”

The statement also said, “Regarding the plea agreement between the government and Purdue, no member of the Sackler family was involved in that conduct or served in a management role at Purdue during that time period.”

A number of states’ attorneys general spoke out against the terms of the proposed settlement as inadequate and vowed to continue to pursue cases against the company and the Sacklers, which the federal settlements do not resolve.

Purdue Pharma has long been accused of being a driver of America’s opioid crisis. FRONTLINE’s 2016 documentary Chasing Heroin investigated how that crisis came to be, examining allegations about Purdue Pharma’s role in the early years of what has been called the worst drug epidemic in U.S. history.

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