The University of Tennessee Graduate School of Medicine, Knoxville

Research Supports Safe Opiate Detoxification During Pregnancy

Collmann StudentsdiscoveryCraig Towers, MD, Professor in Obstetrics and Gynecology's Division of Maternal-Fetal Medicine, has shown evidence that maternal opiate detoxification during pregnancy significantly improves pregnancy outcome, without putting the fetus at risk. The results of his research have been published in the American Journal of Obstetrics and Gynecology.

Dr. Towers says opiate addiction is a national epidemic and is especially prevalent in Appalachia. "As opiate addiction increasingly creeps into the pregnant population, mothers expose their unborn babies to drugs that often cause Neonatal Abstinence Syndrome (NAS)," said Dr. Towers. "It is estimated that the cost of caring for a baby with NAS in its first year of life is 15 to 20 times more costly than care costs for a healthy baby."

Dr. Towers also says the current general practice in obstetrics is to avoid withdrawal of opiate addicted pregnant women for fear this process would harm the fetus, a practice based upon dated and limited data. He says his research is "unique as it evaluates opiate detoxification during pregnancy through four different methods."

During the study, Dr. Towers's goal was to determine if maternal opiate detoxification during pregnancy was harmful and if it could significantly lower the incidents of NAS, without putting the fetus at risk. He evaluated the detoxification of 301 opiate addicted pregnant patients, and of those patients, there was no fetal death related to the process.

"It is proven that opiate addiction can cause fetal growth harm as well as addiction and withdrawal," said Dr. Towers. "Identifying opiate addicted pregnant women, getting them into a program that can first medically withdraw them and then be supported by follow-ups to further aid a drug-free lifestyle is of paramount importance."

According to Dr. Towers, while detox is slightly more costly than drug maintenance, the nationwide cost for treating one NAS newborn is approximately $60,000. Through monitored detox, if the fetal harm is minimal and the number of NAS cases could be cut significantly, the healthcare cost savings nationwide could be substantial.

"In Tennessee alone, one thousand NAS cases occur annually. Decreasing this by 50 percent, at a minimum, could save approximately $30 million per year," said Dr. Towers.

Dr. Towers unveiled his research findings at the Society for Maternal-Fetal Medicine's annual meeting in Atlanta. "Doctors in attendance from around the world received the information well, yet it is a very emotional topic around the country," he said.

According to Dr. Towers, if a detoxification program is adopted by The American Congress of Obstetricians and Gynecologists, a new protocol for maternity care would need to be created. Dr. Towers said that the results of his research leads to the belief that a focus of maternity care should be shifted to spend more money towards detoxing the opiate addicted mother rather than the baby after delivery.

"In order for this to happen, a behavioral health component would need to be added to the protocol," said Dr. Towers.

Simulation Center Earns National Reaccreditation

Collmann StudentseducationThe University of Tennessee Center for Advanced Medical Simulation (UTCAMS) has been reaccredited as a comprehensive Accredited Education Institute (AEI) by the American College of Surgeons (ACS). An ACS-AEI addresses the educational needs of a broad spectrum of learners and advances the science of simulation-based education. UTCAMS continues to be the only AEI-accredited simulation center in Tennessee.

The primary goal of the ACS-AEI program is to establish criteria that reflect adherence to the accepted components of simulation based education (SBME) and research, thus enhancing the quality of healthcare education and, ultimately, improving the quality and safety of patient care. Learners have the opportunity to gain a high level of expertise and confidence in a risk-free environment with the benefit of immediate assessment and feedback from instructors. The AEI accreditation program is a voluntary peer-review process. Institutions that successfully complete the process are accredited for a period of three years. To remain accredited for another three years, an institution continues to demonstrate compliance with 31 criteria in 4 standards: Learners and Scope of Educational Programs; Curriculum Development, Delivery of Effective Education, and Assessment; Administration, Management and Governance; and Advancement of the Field. Through this national reaccreditation, UTCAMS reinforces the mission of the UT Graduate School of Medicine for excellence in education, patient care, and research.

UTCAMS was established in late 2007 and currently is housed in a 6,500 square-foot facility at The University of Tennessee Medical Center. Co-Medical Directors Leonard Hines, MD, FACS; and Paul Huffstutter, MD, FACS; Administrative Director Melinda Klar, RN, and Skills Coach Judy Roark, CST, have led the development of the center. In October 2015, Nicole Kissane-Lee, MD, joined the team as Assistant Medical Director. Dr. Kissane-Lee's education includes a fellowship in Advanced Laparoscopic and Bariatric Surgery at Massachusetts General Hospital and a fellowship in Medical Simulation at Brigham and Women’s Hospital. She also received a Master's Degree in Education from Harvard University. 

The UT Center for Advanced Medical Simulation offers a setting for physicians, nurses, technicians and other healthcare providers throughout the region to improve individual skills and practice team skills critical to patient safety. It also enables advanced education for residents, fellows, and medical students from the Graduate School of Medicine and other institutions. In addition to virtual reality technology, the center also provides low- and mid-fidelity training equipment essential for refining skills for virtually all healthcare professionals.

Watch a video tour of the UT Center for Advanced Medical Simulation.