♪ hi, i'm lisa fletcher, and you are in "the stream." controversial comments from the attorney general overseas a problem in our nation, baby's dependent on drugs. ♪ recently indiana's attorney general suggested drug screening for pregnant women. his idea was met with statewide backlash, causing him to clarify

his position on a show. saying pregnant women are already given a drug screen that could easily be expanded. he added i'm asking them to do another screen to see if you are addicted to drugs that would harm you or your baby. they further clarified the position in an email to us stating . . . but at the core of his controversial comments is a really deeper issue. in indiana and neighboring states like kentucky, tennessee, west virginia, high levels of opioid drug use are leading to more and more infants born be neonatal abstinence syndrome. or they are born dependent on drugs. 19% of babies were born with

nas. that's nearly one in five, folks. and in indiana it costs hospitals an estimated $30 million every year. researchers estimate one baby is born every hour dependent on open out drugs nationwide. what can be done to handle this health crisis. our associate produce, wajahat ali is here shifting threw your comments. the community was kind of surprised. >> yeah. and our community has lots of empathy for the babies and the mothers. francis a loyal streamer says . . .

so a loyal stream team as you know you are the third host of the show. why because all of your online contributions drive this discussion. zone -- so join us. >> joining us is a high-risk obstetrician in west virginia. doctor patrick who is the author of the study we referred to. joining us also is the president of the prevents child abuse council in muncie, indiana.

and dr. david reagan is chief medical officer of tennessee's department of health, he is part of a task force specifically working on this issue. thanks to all of you for joining us. dr. patrick, what is this syndrome? are these baby's actually born as addicts? >> no we try to talk about baby's born dependent to medication. it's a withdrawal syndrome that newborns experience, and most commonly occurred when a baby has been exposed to opiates. so babies that are exposed to prescription drugs are at risk. >> five fold increase between 2000 and 2009 in neonatal abstinence syndrome. why such a spike? >> that's a question.

the centers for disease control and prevention describe over the last decade a four-fold increase in prescriptions written for painkillers, and the complicati complications. >> dr. reagan, some groups specifically some women's advocacy groups say these numbers are highly exaggerated? do you agree? >> no, i don't. in the last two years we have seen an 25% increase. so it is of historic proportions for us in tennessee and one which has not plateaued at this point. >> so you are expecting it to continue to accelerate. >> yes, we are estimating we will likely to have over 800 baby's born this year with the syndrome. >> ann says . . .

so doctor chafein i want to go to you on this. how is this effecting the rise in health care. >> well, everything you have heard -- i'm getting an echo -- is -- underestimates for west virginia. in 2009 the ahrq estimated there were 3 per thousand cases of nas in this country. at that point we were already at 30 per thousand in the hospital. a linear rise since then, 123

per thousand babies were withdrawing in my hospital in the first six months of this year. >> wow. who is responsible for this epidemic in pain reliever addiction? >> that's a good question. i don't have an answer. certainly there is a liberalism in prescribing pain medicine, and we know women get addicted harder and faster to any prescription, so many a woman has a broken arm, and gets 90 percocet with free refills, you just created an addict. >> pat, do you see any commonalities between the states where there is such an escalation in nas babies? >> what we found in our research is first of all a lot of the nas babies haven't been tracked

within our local hospitals, for example. we don't have good enough statistics to really give a genuine number effort in putting things forward, and we have been working on our problem in our community for about two years. i think it's very true about trying to educate people about writing prescriptions for pain pills. it's very important, and we have a wonderful group of physicians on our task force that are trying to educate their peers for example, about writing scripts. i think dr. chafin mentioned the idea that if you have a broken arm, you are going to get 90 days worth of meds. and those are the kinds of things we need to look. >> doctor could you describe in detail what it looks like when a

newborn is coming off of -- of having these drugs in his or her system? >> i think you have a pediatrician on the line that can probably address that better than i. we have a whole host of cuddlers that deal with these babies, but they are basically inconsolable. it includes nausea, vomiting, diarrhea, but what is most disturbing is the inconsolability of their crying and their muscle rigidity. this is not a baby that you want to hold for any -- for long period of time. >> dr. patrick, that has got to take an enormous emotional toll on the parents. >> it is very tough for families

to go through. it's very tough -- people -- >> hang on, back up. you mean they don't understand when they are using these drugs during their pregnancy that there will be a significant effect on their child? >> not always, and one important step was the fda created a new warning for long-acting opiate drugs so women can be informed that this is a potential risk to their baby. so that's an important point. i have certainly taken care of families where the mother didn't know that there was a risk for their baby. so it's very tough on the families. it's tough on the entire family. it's hard to see your child going through that. >> of course. >> and it takes a long time to get better, and even more scary is the fact that for the longer-acting opiates, including oxycodone, and others, they may

not start to withdrawal for four or five days after delivery. the baby may be sent home already. >> wow. states across america are all trying to figure out how to deal with this problem? and how can women be empowered to come forward and seek help. keep sending in your thoughts. we'll get to them right after the break. ♪ and i'm from dallas, texas, and i'm an anchor for al jazeera america. i started in a small television station in rural arkansas. it's a part of the country that often gets overlooked. but there are a lot of fascinating people there, a lot of fascinating stories there. i like that al jazeera will pay attention to those kinds of places. what drew me to journalism is i like the idea that we are documenting history. al jazeera documents it like none other. and to be a journalist, and to be part of a team like that? that's an incredible blessing.

>> obama administration officials said they need to enrol 2.7 u.s. redents between the ages of 18 and 35 in exchange plans to balance risks and hold down costs. will they enrol come 1 october - should they pay the face. >> joining me now is jen mishory, deputy director of young invincibles, she's in washington d.c. and yevgeniy feyman, a research assistant at the manhattan institute. thank you for being with us. i want to start with you yevgeniy feyman. the young people are crucial to the success of obamacare. >> absolutely. they'll balance out the risk pool, they'll keep premiums that need the insurance, and the administration is reaching out to them. >> jen, the young invincibles are in the 18-34 group.

♪ welcome back. we're talking about baby's in the u.s. born addicted to drugs, most specifically opiates. and waj we asked our community to weigh in to help these babies and their moms. >> yes, elizabeth says . . .

that's a minority opinion but it's an opinion. and jonathan says . . . >> yeah. so pat what is working on a local level in indiana? >> well, we have been working on this issue for the last couple of years, and we have started with your community looking at how we could get to reach this particular population, including any woman from the age of 12 to 45. because of its importance. and what we did was we put together a tool kit. we have a 12-minute video that has been done using our local

resources at our hospital and our local experts, for example, and we have also put together a good community education component, and it will -- we go out and we work with certain people in the community, asking them to then go out and do the presentations, and it covers everything from how to do a workshop, what nas, what are some general facts about the issue, for example, what came up was they are all addicts, and they should think first. we are looking at what addiction really is as well, and we have to recognize that they can't just be placed in rehab if they aren't ready and able to do it, and we do not have those facilities available for pregnant women for example. >> right. dr. reagan, i want you to jump in here.

about three quarters of a billion dollars are coming out of taxpayer's pockets every year to deal with these babies. what sort of intervenings are working to get a jump on treatment and contain some of these costs? >> a couple of things that are worth noting. the fda black box warning is very important. we want people to understand as been said, anyone can become addicted to these. i think in the medical profession over the past 15 to 20 years we have lost respect for the addictive potential of these medications. also we're trying to find ways to come alongside these women. the last legislative session, the safe harbor act was passed in tennessee and say if a woman

will come forward and say they are taking these prescriptions they can get help and if they stick with the program, they won't be charged in a legal way. >> when you say safe harbor act most people think this is about dropping your baby off at a hospital or fire station and facing no repercussions but this goes farther than that. >> we talk about an attorney general about wanting to have women undergo mandatory drug testing . . . dr. patrick, we're going to go

to you. mandatory drug testing is this the right prevention or an intrusion on women's rights. >> we started talking about costs. i think putting the costs towards the beginning of this problem is where things really need to start. a lot of these dependencies start way before pregnancy. so if we focus just on pregnancy, we're going to miss a lot. and urine drug tests are a snapshot. there is suggests to use a screening tool to identify where there is opiate tests. urine tests when it's positive, it means different things in different communities. so i think as we think through how we attack this problem, we need to think through all of the unintended consequences.

>> your clinic has take an unconventional approach to this problem. take about this. >> we were faced with a bunch of patients who were getting sub care or no care at all with a methadone clinic. so my partner and i started a maternal recovery center. we became [ inaudible ] medication assisted therapy providers for pregnant women, and so we enroll anybody that comes to us for help in a addiction program that has at its cornerstone, ongoing therapy throughout the pregnancy. >> how is it working? >> about half of the people accept the therapy, and about

half are not able to maintain the therapy. of the half that do, half of their baby's don't require treatment for addiction. however, the half of the babies that do require treatment for addiction are clean except for other medication and on their road to recovery. >> lisa the community has chimed in . . . dr. reagan i'll go to you with that question. under obamacare will there be a change here? will these women will treated? >> i don't know the answer to that question, but we have worked with our department here in tennessee and pregnant women

are given the number one priority for substance abuse treatment services. >> can i answer that question. >> yes, please. >> we know under the affordable care act it expands coverage to millions of people for substance abuse treatment and mental health treatment. millions more people will have access to this through additional people getting coverage as well as insurance market changes. >> pat, quickly kind of talk about the legislative component. we have ohio, tennessee, west virginia, indiana, all working to address these issues. how is that working out? >> well, i think it's an exciting process. we talk about education. we talk about costs, and the whole idea i believe is we saw -- i say all, those of us focusing on this issue have to

work together. our local small little task force that started two years ago, we decided there were five areas we were going to look at. one was the legislator. and one of the physicians had taken it upon himself to bring this to our indiana state medical association, and they in turn decided that they found a way to put together some legislation to cover the costs for our prescription education program. >> it's amazing how one person's initiative can really get the ball rolling. we want to talk more about what will happen if states don't get this under control. and we also want to think about some of the out of the box ways to help these babies and their moms. so think about that, and here are a couple of other stories we're following.

fsz millions who need assistance now. we appreciate you spending time with us tonight. up next is the golden age of hollywood going golden but elsewhere. why l.a.'s mayor has declared a state of emergency for the entertainment industry there. next. ç]

♪ we have a lot of babies that are withdrawing. a lot of babies that will be developmentally delayed because of this. so we'll have a whole society of children of drug addicted moms that will have learning disabilities, developmental disabilities, physical disabilities, and we are going to have to start paying attention. >> that was one nurse in ohio who treats babies with nas. since nas is growing across the

country, doctors and medical providers aren't sure what the impact will be. doctor is it too soon to know what the long-term effect will be on these kids? >> that's a great question. we have historical data on heroine and methadone, and there's no clearance that there is a problem long term. >> on social media, a lot of nay sayers, they are like, oh, yeah, this is like the crack scare of the '80s. what do you say about that? >> i think it's very important that we look at our past, and we don't underestimate our risk going forward. but learning from less sons in the past is important, and that we look and monitor and don't necessarily react when we don't

have the data to know. >> our community has chimed in. >> doctor chaffin, what are the consequences of states failing to get this problem under control? >> all we can say for absolutely sure is money. he is right. there's no long-term study that say there are serious problems at least that can be teased out from their socioeconomic environment, but as of about four years ago, a normal term baby cost $3,000. on average babies born with nas cost somewhere between 36 and $50,000, and that's a -- a tremendous cost when you look at

the number of babies who are being born with nas. >> it's a huge cost. dr. reagan we are talking about ways to move forward, and i know you have thoughts on long-term contraception. >> we found that a lot of these pregnancies were really not intended. and so considering if you know you are going to be on prescription pain medicine long term, considering long term reversible contraception is one way to deal with the unplanned pregnancies. many states, tennessee included have put up a database statewide of these prescription pain medicines being dispensed. and prescribers have to check that database prior to subscription. so they have the full history.

>> dr. chafin what happens if states don't get these addictions under control? >> they risk going broke. they risk a whole other generation of people being born into socioeconomic status that is not going to be favorable for going forward. >> all right. i would like to thank all of our guests. we are out of time, but what a great and informative discussion. thanks to all of our guests. until next time, waj and i will see you online. keep tweeting in your thoughts and questions for tomorrow's program. ♪

good evening, everyone. and welcome to al jazeera america. i'm john siegenthaler in new york. tonight americans are watching the clock and watching washington. >> the idea of putting the american people's hard-earned progress at risk is the height of irresponsibility and it doesn't have to happen. >> a warning from president obama. the impact felt on wall street as the markets tumble on shutdown fears. what else could happen if lawmakers can't agree. colorado flood victims might have to wait for federal help. and the