Huge Increase In Maternal Opiate Use In Nine Years

Five times as many pregnant women were using opiates in 2009 compared to 2000, while during the same period the number of newborns with a diagnosis of drug withdrawal syndrome, neonatal abstinence syndrome has increased 3-fold, researchers from the University of Michigan Health System, Ann Arbor, Michigan, reported in JAMA (Journal of the American Medical Association). The authors added that hospital charges related to neonatal abstinence syndrome (NAS) have increased considerably.

According to a recent USA-wide study, 16.2% of pregnant teenagers and 7.4% of pregnant mothers aged from 18 to 25 took illegal drugs, the researchers explained.

Neonatal abstinence syndrome, or NAS is a set of problems that newborns experience when they are exposed to addictive prescription or illegal drugs while they were in their mother’s uterus. NAS occurs because the mother, while pregnant, took addictive drugs (prescription or illegal), such as cocaine, diazepam, marijuana, opiates (heroin, codeine, methadone), barbiturates, or amphetamines.

The drugs pass through the placenta and reach the embryo/fetus. Along with the mother, the baby becomes addicted. When the problem is related to alcohol, doctors may use the term Fetal Alcohol Syndrome.

The authors explain that low birth weight and higher mortality are also associated with illicit drug use during pregnancy, especially opioids.

The following signs and symptoms may be associated with neonatal abstinence syndrome:

• Feeding intolerance
• Hypertonia (heightened muscle tone)
• Irritability
• Respiratory distress
• Seizures
• Tremors

60% to 80% of newborns who had been exposed to methadone or heroin while in the womb are reported to have NAS signs and symptoms.

However, there are not national estimates on how many newborns in the USA have NAS symptoms due to maternal opiate use.

Stephen W. Patrick, M.D., M.P.H., M.S., and team carried out a study to look at the patterns in the national incidence of NAS and maternal opiate usage at the moment of childbirth, and to characterize trends in national health care expenditures linked to NAS during the first nine years of this century.

The researchers found that between 2000 and 2009:

• The rate at which newborns were diagnosed with NAS rose from 1.20 per 1,000 hospital births per year to 3.39 per 1,000.
• The number of pregnant mothers using or dependent on opiates rose from 1.19 per 1,000 hospital births per year to 5.63 per 1,000.
• The amount hospitals charged, on average for newborns diagnosed with NAS rose by 35%, from $39,400 to $53,400
• Estimates for total hospital charges nationwide, adjusting for inflation, rose from $190 million to $720 million
• It was estimated that 14,539 babies were born with NAS in 2009

The researchers wrote:

“Compared with all other hospital births, newborns with NAS were significantly more likely to have respiratory diagnoses (30.9 percent), to have low birth weight (19.1 percent), have feeding difficulties (18.1 percent), and have seizures (2.3 percent). Newborns with NAS were also more likely to be covered by Medicaid (78.1 percent) and reside in zip codes within the lowest income quartile (36.3 percent).”

In an Abstract in the same journal, the authors concluded:

“In conclusion, newborns with NAS experience longer, often medically complex and costly initial hospitalizations. The increasing incidence of NAS and its related health care expenditures call for increased public health measures to reduce antenatal exposure to opiates across the United States.

In addition, further innovation and standardization of treatment of NAS may mitigate NAS symptoms and reduce hospital LOS. States are poised to seek innovative solutions to decreasing the burden of NAS, because the majority of hospital expenditures for this condition are shouldered by state Medicaid programs.”