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PNQIN Spring Summit 2021 - Day One - Shared screen with speaker view
Megan Miller, MD (she/her)
02:35:29
Yes - society needs to embrace more of a harm reduction model, but in order to do so, we need more safe spaces for families. It's very challenging in pregnancy.
Alicia
02:36:21
very challenging. we need more treatment facilities for mothers children and their families.
Sarah Ducie, Duffy Health Center
02:36:35
Yes thank you Alicia
Sarah Ducie, Duffy Health Center
02:36:38
We do!
Nicole Walden
02:37:29
Peer support/Recovery Coaches/Family Recovery Support Specialist play such a vital role in the family as a whole and the person walking in their recovery.
AmandaTa
02:38:02
I agree with the point about DCF. I think when I have the biggest struggle to engage parents is when I am working with them and then DCF removes the children. Its such a traumatic and all-encompassing event, and how can I be most supportive to that parent at a time when they are in such a vulnerable place
Miguel Nunez
02:41:31
In regards to child protection, Harm reduction does not work …..DCF's primary focus is the safety and well-being of the child.....If a parent is still using substances, even if its a through a harm reduction approach......it still puts that child or children at great risk of harm because of the ongoing substance use.
Miguel Nunez
02:42:24
The focus should be how can DCF and all of the parents providers work together to support the parent in their recovery and at the same time ensure the safety of the children.
Alicia
02:45:24
we need better ways to address safety that could possibly keep children with their families yet provide support and supervision. yes. agreed.
Brenda Dunlavey Cassella, DCF
02:50:51
Good point Miguel.
MMorgan
02:51:38
Any data on edibles and breastfeeding?
Colleen M
02:51:56
Is this only when cannabis is smoked? vs. ingested, applied topically, etc..
Carolyn Kalvinek
02:52:10
DCF always tries to keep children with family but at the same time even with support and supervision having an impaired caretaker is still a risk to the child and lots of incidents have occurred even with supervision. I believe of all the cases open with DCF only about 10 percent are cases in which a removal of a child occurs. DCF often asks hospital to help with supervising parents visits in the NICU but they often do not have capacity to do this
Mara Coyle
02:53:32
The ABCD study has more recent data published (2020/2021) that has demonstrated increased psychopathology and sleep disorders in 9-11 year olds whose mothers used marijuana products
AmandaTa
02:53:32
Yes! I have worked with many mothers who have stated the belief that smoking marijuana can have detrimental results, but that using cannabis infused oils or edibles do not have the same negative effects, so I would be interested to know if any studies have been done comparing cannabis when smoked, injested, etc.
Chasity Menard (She her hers)
02:54:22
Thank you Mara
Rachana Singh
02:57:25
Thanks Megan and Leela for the comprehensive review. This does become a problem with the vague guidelines from the guiding bodies. Recent animal data noted cardiovascular and growth changes in off springs of pregnant dams who were exposed to THC.
Rachana Singh
02:58:12
Lee, K., Laviolette, S. R, Hardy, D. B. Exposure to Δ9-Tetrahydrocannabinol during rat pregnancy leads to impaired cardiac dysfunction in postnatal life. Peds Res. 2021 in press.
Rachana Singh
02:58:50
https://www.nature.com/articles/s41390-021-01511-9
Allie Doyle (she/her) - PNQIN
02:59:13
Thank you Rachana, I will add this to the resource page for those interesting in reading!
Latisha Goullaud (she/her) - LCHC Moms Do Care
02:59:56
Thank you so much Megan and Leela for doing this topic justice! We can not move forward without looking at our past and CURRENT practices as they are the lens for everything we do.
Rachana Singh
03:02:02
Just wrote a commentary on this topic to encourage open dialogue without stigmatizing mothers and highlighting the need of better education not for the mothers but also healthcare providers so that efficient counselling can be done.
Rachana Singh
03:02:06
https://www.nature.com/articles/s41390-021-01591-7
Munish Gupta
03:02:29
The DCF working group data is very interesting, and great to see that DCF and colleagues are examining this. Is that statewide data?
Grace McGathey
03:03:11
I think it is so important to examine this data, thank you. I would also be interested to see how the MGB data compares to other hospital systems in the state given differences in patient demographics - I think the results could be potentially even more stark in hospital systems with more diverse patient populations
Davida Schiff (she/her)
03:04:04
@munish - this is was statewide data shared from this group: https://www.mass.gov/data-work-group
Melanie Crowley
03:05:57
CAn you speak to what the universal screening looks like?
Mary R Keller
03:05:58
At our hospital, we have a drug toxicology urine panel for our pregnant mothers that does not include Cannabis screening at the hospital. We strictly use our verbal screening tool.
Michelle Nicoli RN
03:10:05
The issue with a large medical system is that the community providers , unlike the hospital staff providers, continue to pick and choose who gets screened
Mary R Keller
03:11:23
Our providers use the same order.
Elizabeth Quinn
03:12:15
Cross reactivity is seen with immunoassay toxicology tests. For this reason when we use toxicology tests we use confirmatory testing but mass health has been threatening not to pay for the confirmatory testing.
Mara Coyle
03:12:24
And hopefully with their consent
Lisa Capra, (she/her)
03:12:53
we have seen cross-reactivity between fentanyl and labetolol in our lab
Alex Heinz
03:13:18
perhaps you can just clarify again for the group what you mean by universal screening (vs testing) since the language is often conflated? what tools are your hospitals using to screen? whats your workflow?
Brenda Dunlavey Cassella, DCF
03:13:19
What is the time it takes to get confirmatory testing? Is safety addressed by the medical system while waiting?
Amy’s Phone
03:13:56
Great presentation! Thank you all!
Amy Walker
03:15:36
Thank you! That was so informative and an important discussion
Lili Peacock-Chambers
03:16:20
Great presentation Leela and Megan! Thank you!
ksheridan
03:17:11
I try to group cannabis with alcohol and tobacco when counseling. Yes, they are all legal in this state. They each have different risks to you and your baby. We recommend not using ANY of them in pregnancy
Chasity Menard (She her hers)
03:17:36
well said
Stephanie Berkio Health Alliance
03:17:45
i agree well said
Ruth Jacobson-Hardy
03:18:05
Do you have any stories of success in assessing cannabis use disorder and helping pregnant people get into recovery or treatment services?
Mary R Keller
03:18:27
So much great information! I come away from these meetings with both more ways to approach patient care and more questions about what can we do better : )
Elizabeth Quinn
03:20:12
Is that data controlled for ses?
Mary R Keller
03:20:18
can we find those articles and share them with the group?
Mary R Keller
03:21:19
thank you for that! Mara
Mary
03:21:46
Was paternal use (pre conception) or in home during pregnancy use also noted? Thank you
Allie Doyle (she/her) - PNQIN
03:22:14
I will be adding any resources shared in the chat to the resource page. If anyone has any more resources they would like to add, please email adoyle3@bidmc.harvard.edu
kimberlyshapiro
03:23:15
Just to clarify; the DCF data is related to all 51A reports filed with DCF, not only reports filed for marijuana. The Data shows that disproportionality begins at the front door; it remains consistent - thru the life of a DCF case- it is not compounded or reversed by our work.
Fifi Diop, DPH
03:24:15
Georgia wants know if any of the studies looked at second hand cannabis exposure?
Mara Coyle
03:25:54
Winiger EA. Sleep Health 2020 Dec,6(6)787-789. PMID:32605891
Rachana Singh
03:27:39
It is also important to remember that impairment under influence of marijuana can have additional risks for the newborn and should be discussed with parents.
Munish Gupta
03:27:55
Much of the discussion thus far has been about negative impacts. Do studies also look at potential benefits of cannabis use for maternal health, mental health, dyadic health, etc.?
kimberlyshapiro
03:29:02
DCF is seeing an increase in children being accidentally poisoned - via oils and edibles. When counseling parents; please remember safe storage.
phelant
03:29:19
I have met a gentleman who freely stated that hehad cannabis use disorder
Elizabeth Quinn
03:30:01
Thanks Kim for highlighting that harm reduction includes reduction of harm to children!
Phoebe Wells (she/her)
03:30:21
Marijuana Anonymous meetings are not as widespread as AA, but there are meetings across the state and country which can be a very helpful resource. They have a good website and printed info
Leena Mittal (she/her)
03:30:34
@Munish there is a plethora of data for risk for exacerbation of mental health disorders with cannabis use. However there is emerging data for treatment of trauma related disorders and pain disorder with CBD products
Munish Gupta
03:30:55
any qualitative data from mothers or birth parents that have chosen to continue to use marijuana despite counselling?
Brenda Dunlavey Cassella, DCF
03:31:14
Doubled last years rate.
Julie Brachanow
03:31:56
I was extremely surprised to learn that MGH ARMS program for teenagers with sud, to find that a high percentage of patients are there for marijuana addiction
Kate MacMillan
03:33:08
There is some qualitative work: Beliefs and attitudes regarding prenatal marijuana use: Perspectives of pregnant women who report use https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6756431/
Grace McGathey
03:33:25
Anecdotally, the birthing people I know who continued to use marijuana for medical reasons were high SES and white and were not asked anything about their use
Kristen Reynolds
03:33:27
In my experience, women seem to feel it helps them manage nausea or insomnia during pregnancy. Also, I hear that people don't think it is as a big deal now that it is legal in MA.
NESST Staff
03:33:30
this matches what we hear.
Michelle Nicoli RN
03:34:04
As a former Nicu nurse most it seemed of our moms were using cannabis I find it doubtful that they all are hyperemetic
Constance
03:34:10
As an inpatient SW I find many moms use as a healthier alternative to psych meds such as benzodiazepines or having left behind other illicit substances that are known to be more harmful. So I often see it as harm reduction
Kristen Reynolds
03:35:20
I hear that from women frequently too
Michelle Nicoli RN
03:35:39
The side effects of antipsychotic and mental health medications are studied and known, the issue for me is. The. Unknown!
liz salisbury
03:36:35
Interesting to note, too, that we assess and treat infants for opioid exposure, but not for any of the psychiatric medications from which they may also be withdrawing
Nori Efremovski (she/her)
03:36:38
I agree Michelle … the unknown part is the issue!
Rachana Singh
03:37:58
As always a great session with amazing speakers and discussions. Cannot wait till joining again tomorrow :)
kimberlyshapiro
03:38:14
Great presentation. Thank you
Laura Lucarelli
03:38:15
The safety and long term outcomes from many of the psych meds we use in pregnancy are not known. So it is no different than cannibis.
liz salisbury
03:38:16
Thanks all - great speakers and discussion
Lisa Capra, (she/her)
03:38:18
Great conference! Thank you!
Munish Gupta
03:38:43
Tough. It seems there is still a lot unknown about the risks and benefits of prescribed psychiatric medications, and the warnings regarding their use in pregnancy are more strongly worded than we might think. @Leena, any comments?
Nori Efremovski (she/her)
03:38:45
Great first day … looking forward to tomorrow
Kathy Mahoney
03:39:13
Really helpful discussions, thank you everyone
Grace McGathey
03:39:17
@Munish, agree! Or even the known risks of some anti-nausea meds
Denise Henry
03:39:24
Zoom information for today, is the same for tomorrow
Amy Madden
03:39:42
Thank you! Great information on Day #1!
phelant
03:39:48
Thank you everyone for the great presentation
Leena Mittal (she/her)
03:39:54
I think there are several layers of stigma that are at play:
Constance
03:40:16
Thank you everyone! Always inspiring and informative.
Leena Mittal (she/her)
03:40:17
Stigma related to mental health conditions, psychiatric meds and also cannabis use
Miguel Nunez
03:40:26
The difference is that psychiatric medications can be monitored by the provider working with the parent,....how can the provider/pcp/ etc monitor the mother's cannabis use.?
bgarofalo
03:40:29
Great presentations, thank you
Allyson Gormley
03:40:43
Thank you everyone!
Mary R Keller
03:40:46
interesting enough there was a meta analysis that suggested that exposure could lead to possible heart defects and orofacial deformities in the first trimester. Soooo is it better than Cannabis??? TO be determined.
Georgia Simpson, OASH R1, she/her(s)
03:40:59
Thank you!
Stephanie Berkio Health Alliance
03:40:59
thank you to everyone very informative
Leena Mittal (she/her)
03:41:03
@Munish - I do think that maternal mental health should be valued much more highly than the relatively small risks associated with psychiatric medications, over all
Terri chiasson
03:41:04
THANK YOU
Mary R Keller
03:41:11
That was Zofran.....
Celia Cajuda
03:41:12
Excellent space for a complicated topic. Thank you so much for the opportunity.
Kali Vitek (she/her) - PNQIN
03:41:13
Thank you everyone for your presence and engagement today, and thank you to our INCREDIBLE speakers. We look forward to seeing you tomorrow!
Elizabeth Quinn
03:41:18
Most Psychiatric meds have registry perinatal data to inform use. When my patients choose cannabis over psych medications I am reminded of the stigma against psychiatric meds
Mary Lou Garcia
03:41:23
thank you so much great info
Rosanna
03:41:24
Thank YOU
Mary R Keller
03:41:37
Thank you everyone!
Emilie Laforest
03:41:46
Thank you for all this great information.
Mary R Keller
03:42:15
I have to work tomorrow... Hoping to be able to join but if I can't! Take care until next time!
Leena Mittal (she/her)
03:42:25
@ Elizabeth Quinn I totally agree
Margaret Fournier/People Inc
03:42:31
Thank you everyone! Very interesting! Looking forward to day 2
Donelle Clark
03:42:51
Thank you!
Jen Elizabeth Gilbert
03:43:04
420 ha ha
Allie Doyle (she/her) - PNQIN
03:43:10
Please email adoyle3@bidmc.harvard.edu with any resources you’d like shared, or if you have any follow up questions as well!
MMorgan
03:43:17
lol
Clare Grace Jones
03:43:29
I got it :)
Kali Vitek (she/her) - PNQIN
03:43:32
AMAZING
Jen Elizabeth Gilbert
03:43:37
np
Mary R Keller
03:43:37
hahahaha
Elizabeth Quinn
03:43:47
Thanks to Miguel and Brenda and a few others from DCE for a really interesting convo in the chat
Sarah Ducie, Duffy Health Center
03:44:07
Thank you!
Erin Carmody
03:44:22
Thank you!
Clare Grace Jones
03:44:22
Thank you so much!!!
Gina Gallagher (she/her)
03:44:32
Thank you everyone!
Sandy Beady
03:44:36
Thank you to all!!!
laurasternberger
03:44:38
very grateful for this opportunity to hear from you all about these important topics. and I know the power and history of this multi disciplinary network in studying, developing and sharing best practices-especially in the new frontiers of policy and practice
Kiki
03:44:40
Thank you all
Kasey Nolan
03:44:42
thank you all
Sarah Courtney She/Her
03:44:43
Thank you! This was excellent!
Wanda Jackson
03:44:46
Thank You
M Colleen Simonelli she/her
03:44:46
was great thank you for phenomenal day #1