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Protecting babies born to opioid abusers: Is there an app for that?

During the 2018 legislative session in Annapolis, medical groups opposed a draft of a bill for a smartphone app for parents struggling with substance abuse. (Matt McClain/The Washington Post)

Elizabeth Stahlman was on maternity leave in 2016 when she heard about a Pennsylvania infant who died of starvation days after both of the baby’s parents fatally overdosed on opioids.

If only someone had checked in, she thought, the child — from a town about an hour from her home in rural Western Maryland — may have lived. What if someone had been monitoring?

After she returned to her job as a community development director for the city of Frostburg, Stahlman began working with Del. Michael W. McKay (R-Allegany) on legislation for a mobile app to help social-service officials verify whether parents with a history of drug addiction can safely care for their newborns.

“It’s a tool to help fill in the gaps,” said McKay, who plans to seek co-sponsors for the bill this week. “We are trying to strengthen families dealing with an addiction and give them the best chance to start off firing on all cylinders.”

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The “I’m Alive Today” app would be used for parents whom social workers deem most at risk. It would send them automated prompts asking, “Are you able to care for your child?” If the parent didn’t respond affirmatively, the app would alert the case manager to check in.

Physician groups and medical societies opposed the first draft of the bill during the 2018 legislative session in Annapolis, citing concerns about wasted resources, invasion of privacy and potentially punishing parents who had not done anything wrong.

But McKay, whose district encompassing Allegany and Washington counties has been hit hard by the opioid epidemic, says he has revised the legislation in ways he thinks will win over detractors.

The number of babies born to opioid-addicted mothers nationwide quadrupled between 1999 and 2014, according to the Centers for Disease Control and Prevention. Among those states that report data to the federal government, Maryland has one of the highest rates of substance-exposed newborns in the country.

More than 2,330 Maryland babies born in 2017 showed signs of prenatal substance exposure, which can lead to long hospital stays and withdrawal symptoms such as vomiting, tremors and sweating.

State law requires hospitals to report such cases to local social-service departments, which work closely with families to provide resources for addiction treatment and access to government-subsidized programs to assist with child care.

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In Maryland, once doctors confirm that infants are drug-exposed, their mothers are referred to social workers who can help devise safety care plans, arrange home visits and access treatment, if necessary. That’s where McKay’s app would come into play.

The app “would require a daily (or more frequent) check-in, verifying someone is conscious in the household,” Stahlman said, according to a transcript of her testimony to the General Assembly in March. “This would be a stopgap measure to help protect the innocent children that are born into homes of addiction.”

The medical community, including the Maryland chapter of the American College of Obstetricians and Gynecologists, opposed the 2018 measure because it required parents to use the app if the mother had been convicted of opioid possession.

The bill assumed that such a conviction would mean a parent was negligent in the care of their children, the organization said.

Davida Schiff, who works with substance-exposed newborns at Massachusetts General Hospital for Children, said monitoring parents through artificial intelligence is not the proper way to protect a child.

Tools to help addicted parents work best, she said, if they avoid being punitive and blaming the parent dealing with the substance-abuse disorder, involve in-person therapies and promote communication across social-service and health-care agencies.

She noted that there could be multiple reasons a parent would not respond to the prompt from the app, and said many infants are exposed to opiates in utero because their mothers are in recovery and being treated with opiates such as methadone, which reduces withdrawal symptoms while blocking the narcotic euphoria.

“What happens if the mother loses her phone?” Schiff said. “We know that women are fearful of child welfare responses to their drug use. To me, anything that risks them not engaging in care is not what we want.”

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Yet scientists say technology can help address some of the problems substance abuse and addiction bring into a community or a family. Brandon Bergman, a research scientist and associate director of the Recovery Research Institute at Massachusetts General Hospital, has been studying how mobile apps and social media platforms help people struggling with substance abuse disorders.

Bergman said technology can lead to more efficient uses of limited health-care dollars and provide a way for people to easily access help for their addictions. But, he said, these programs must be tested scientifically to prove that they work.

Last year, for example, the Food and Drug Administration approved a mobile medical app,
reSET-O, after clinical trials showed that it was effective in providing behavioral therapy for people with substance abuse disorders. The app is designed to teach drug users how to avoid situations that can lead to relapse, rewire their cravings and develop new habits that lead to abstinence.

Bergman said technologies that help reduce the social isolation and stigma of addiction, such as the social media platform Sober Grid, can help individuals connect with others in recovery.

“There is a bit of a disconnect traditionally between substance-abuse-related policy and what the science is ready to show,” Bergman said. “Things get rolled out because we are looking for a solution to a problem, but there are ways we can be more confident that something will work because it’s been tried or tested scientifically.”

Stahlman’s app idea has not been tested by medical experts.

“It’s well-intentioned,” said Gene Ransom, chief executive of the Maryland State Medical Society. “But we have to be careful it doesn’t drain resources from things that are proven to work to help drug-addicted mothers.”

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