More Babies Born Addicted to Opiates

May 1, 2012— -- More babies in the U.S. are being born with symptoms of opiate withdrawal than were seen a decade ago, researchers found.

The number of newborns with neonatal abstinence syndrome (NAS) tripled between 2000 and 2009, and the number of mothers using opiates at the time of delivery rose five-fold over that period, Dr. Stephen Patrick of the University of Michigan in Ann Arbor and colleagues reported online in the Journal of the American Medical Association.

"This serves as a reminder that this is really a public health emergency that requires attention from multiple levels from the federal government, from state government, and from researchers," Patrick told The JAMA Report.

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Recent data have shown that about 16 percent of pregnant teens and about 7.5 percent of pregnant women ages 18 to 25 use illicit drugs. Most neonate withdrawal problems have been tied to maternal opiate use, although other drugs have been implicated, the researchers wrote.

To determine the incidence of NAS and maternal drug use, Patrick and colleagues looked at data from the Kids' Inpatient Database and the Nationwide Inpatient Sample, both from 2000-2009.

They found that the incidence of NAS rose significantly over that time, from 1.20 per 1,000 births to 3.39 per 1,000.

Maternal opiate use at delivery also increased during that period, jumping from 1.19 to 5.63 per 1,000 births.

"This observation is consistent with the trend of increasing opiate use across the U.S., which is not limited to illicit drugs," Patrick and colleagues wrote, citing CDC data showing a quadrupling of sales and deaths related to opiate painkillers between 1999 and 2008.

Data also showed that mothers on opiates at the time of delivery were more likely to be covered by Medicaid than other insurance, and Medicaid was also the primary payor for the majority of hospital charges for NAS in infants.

Because Medicaid is administered by the states, they "are in a unique position to be innovative in solutions to decrease the number of opiates that are used in the state and to make sure care is more efficient for babies after they are born," Patrick told The JAMA Report.

Newborns with NAS were more likely than other newborns to have low birthweight, respiratory complications, feeding difficulties, and seizures, the researchers noted.

And those difficulties were costly: Mean hospital charges for these infants rose from $39,400 to $53,400 between 2000 and 2009, compared with a rise from $6,600 to $9,500 for all other hospital births over that time.

Patrick and colleagues noted that length-of-stay for these infants remained unchanged over that time, at a mean of about 16 days.

The findings "call for increased public health measures to reduce antenatal exposure to opiates across the U.S.," they wrote.

The study was limited by the accuracy of the data in the databases and by the potential for increased clinician awareness of the condition contributing to the increase in incidence.

In an accompanying editorial, Marie Hayes PhD and Dr. Mark Brown of Eastern Maine Medical Center in Bangor said more research is needed into pharmacologic treatments for addicted mothers and identification and management strategies for newborns with NAS.

"Future directions in NAS research must address the need for clinical trials of new medications to establish optimal protocols for maternal opiate dependence, with particular focus on methadone treatment induction of the mother early in pregnancy, maternal adherence to treatment, ancillary alcohol use monitoring, and psychiatric care," they wrote.

"Postnatally, early identification and aggressive opiate replacement in infants with early signs of NAS may help to decrease severity and length of stay," they added.