Two decades ago, drug companies reassured the medical community that patients would not become addicted to opioid pain drugs, so physicians prescribed them liberally to control pain. Now, 140 Americans die each day from opioid overdose. This rate is alarming enough that U.S. Surgeon General Jerome Adams recently recommended expanding the availability of an antidote drug, naloxone, to community members who interact with people at risk for overdose of prescription opioid, fentanyl or heroin. Municipalities from New York City to rural Vinton County, Ohio, meanwhile, are suing companies that manufactured and distributed opioid painkillers
As perinatal psychiatrists, we each treat the most vulnerable victims of the epidemic—pregnant women and their newborns. Opioid addiction in pregnant women mirrors the epidemic in our general population: one fifth of women enrolled in Medicaid have filled a prescription for an opioid during pregnancy; and in a 2016 survey, more than 20,000 pregnant women reported abusing pain medications or heroin. Exposure to chronic opioids during gestation can result in addiction and newborn withdrawal after birth. From 2000 to 2012, the rate of babies born in opioid withdrawal increased fivefold to nearly 22,000 newborns. That means that every 25 minutes, an opioid-addicted baby was born.
These infants require hospitalization and treatment for a variety of symptoms, including tremors, seizures, excessive and high-pitched crying, feeding and breathing problems, yawning, sneezing and diarrhea.
The recent U.S. Congressional spending bill assigned $4.65 billion to support state and local governments to combat the opioid epidemic in this country. Against the yearly cost of prescription opioid misuse of $78.5 billion, this allocation is a small step forward. More than two million Americans have opioid use disorder. Access to treatment and recovery services is limited, and 90 percent of addicted individuals do not receive treatment.
But things are very different elsewhere. Certainly other countries have citizens with addiction, but the opioid epidemic is primarily located in the U.S. and Canada, with public health concerns about its extension to Europe. One difference that has mitigated addiction in European countries is that the dispensing of prescription opioids is limited by regulatory restrictions. In contrast with drug use in the U.S, high-risk drug use in Italy is primarily injected heroin rather than prescription opioid drug misuse.
One of us (Emily Dossett) recently visited a drug treatment facility called Pandora in Firenze, Italy, which serves 17 female patients. On average, between 10 to 20 percent of its patients are newly pregnant, and later in pregnancy they are transferred to a specialized treatment center for perinatal women. Pandora is funded by Italy’s National Health Service that cites universal coverage, solidarity, human dignity, and health needs as its guiding principles. Every resident and legal immigrant in Italy has full access to a benefits package, which includes addiction treatment, regardless of age, income, gender or regione (state).
Addiction treatment services like Pandora’s are included. In some states in the U.S., the approach to pregnant women with opioid addiction is prosecution, but medical and obstetrical health organizations advocate a prevention and treatment rather than a punitive approach to encourage women to engage in intervention programs.
Certainly, access disparities exist within different parts of Italy, with addiction programs being more extensive in the northern and central Italian regions in large cities. Funding depends on taxes in an already heavily taxed nation.
But what Italy’s National Health Service does ensure is that citizens are free from the worry that they will go bankrupt from health care costs, not receive the treatment they need, or be forced to stay in an unfulfilling job just to keep insurance benefits. Many of our low-income American patients tell us that they worry about these possibilities when they walk into our clinics.
We are a long way from a National Health Service in the United States, but we should not discount its potential to support health as a fundamental right of every American, including the mothers of our next generation.