The number of infants born with opioid withdrawal syndrome has increased more than 300% over the last decade, according to the findings of new research that highlight one of the many impacts of the growing painkiller abuse epidemic in the United States.
In a study published in the CDC’s Morbidity and Morality Weekly Report on August 12, health officials indicate that an increased focus on narcotic painkiller abuse interventions for pregnant women is needed to protect the unborn children.
Researchers analyzed hospital inpatient delivery discharges compiled from the State Inpatient Databases of the Healthcare Cost and Utilization Project (HCUP) from 1999 to 2013. There were a total of 28 states with publicly available data in the HCUP.
Data indicates that there were significant increases in neonatal abstinence syndrome (NAS) in the U.S. during that time.
Overall, NAS incidence increased 300% from 1999 to 2013. There was an increase from an average of 1.5 cases of NAS per 1,000 live hospital births in 1999 to 6 per 1,000 hospital births in 2013.
Neonatal abstinence syndrome is a postnatal drug withdrawal syndrome that occurs primarily among infants after birth who were exposed to narcotic painkillers during pregnancy. While other drugs have been implicated in NAS, it is most often attributed to in utero opioid exposure.
NAS can result from maternal prescription opioid use, opioid abuse, and medication-assisted treatment. The most common opioids abused include OxyContin, Vicodin, Percocet and fentanyl, as well as other illicit opioids, such as heroin. Research published in July was in line with these findings, concluding the use of high potency opioids, such as Percocet, has increased by 11%.
Significant increases in NAS incidence occurred in 25 of 27 states that had at least 3 years of data. The annual NAS rate changed from a range of 0.05 to 3.6 cases in 1999, among Hawaii and Vermont respectively, up to a range of 0.7 to 33.4 cases by 2013, in Hawaii and West Virginia.
During the time period of the study, nearly 30 million hospital births occurred in 28 states and nearly 75,500 NAS cases were recorded. In 1999, nearly 2,500 cases occurred among 1.6 million births. By 2013, more than 8,000 NAS cases were identified among 1.3 million births.
Opioid Epidemic Concerns
Symptoms of neonatal abstinence syndrome include central nervous system irritability, autonomic overactivity, gastrointestinal tract dysfunction, high-pitched crying, seizures, feeding difficulties, and temperature instability.
During 2012 and 2013, three of 25 states reported NAS incidence rates greater than 30 per 1,000 births. Those were among Maine, Vermont, and West Virginia. However, rates did not change significantly in California and South Dakota.
Interventions have lead to some improvements in the opioid epidemic, but other problems persist. Research indicates despite a decrease in opioid abuse overall, an increase in opioid overdose deaths increased in recent years.
The CDC highlights other reports that estimate the incidence of NAS across the U.S. described a national increase of NAS of more than 380%. Researchers say the data indicates interventions are needed to help prevent opioid dependence and abuse among pregnant women.
A study published in June indicated doctor monitoring programs help to decrease the rate of narcotic painkillers that are prescribed. The program that monitors doctor’s prescribing habits decreased prescriptions by more than 30%.
The report also highlights several doctor interventions that may be necessary to help curb the epidemic, include focusing on non-opioid therapy for pain, discussing family planning and future pregnancies and how they may be affected before beginning opioid therapy for women of reproductive age, and prescribing the lowest effective dose of opioids when it is necessary.
A total of 48 states have or will implement prescription drug monitoring programs to help reduce inappropriate narcotic painkiller prescribing and overdose deaths. Florida, Georgia, Kentucky, and Tennessee made NAS a reportable condition to state health departments. Researchers say this can help target prevention and treatment measures, including access to medication-assisted treatment.