From 2000 to 2012 the number of infants displaying symptoms of drug withdrawal after birth increased approximately fivefold nationwide.[i],[ii] Neonatal Abstinence Syndrome (NAS) results in more complicated and longer initial hospitalizations than other newborns experience.
Today, to assist these infants and their mothers, the President signed bipartisan legislation: “The Protecting Our Infants Act of 2015,” which had been introduced by Senate Majority Leader Mitch McConnell (R-KY) and Senator Bob Casey (D-PA) and by Representatives Katherine Clark (D-MA) and Steve Stivers (R-OH).
Because prevention and treatment efforts vary widely from state to state, the new law will help identify evidence-based approaches to care for these babies and their mothers. The law requires the Department of Health and Human Services to conduct a study and develop recommendations for preventing and treating prenatal opioid use disorders and NAS. In addition, the Centers for Disease Control and Prevention will continue to assist states in improving the availability and quality of data collection related to NAS, and encourage public health measures aimed at decreasing its prevalence.
The law builds upon ongoing efforts by the Obama Administration to make sure affected pregnant women have access to prenatal care and mothers and their babies have safety and stability, as well as access to evidence-based treatment.
Research shows that NAS can have origins in the use or misuse of legitimate medical prescriptions or treatment for substance use disorders, as well as in the use of drugs without an approved medical use, like heroin. In addition, the majority of people report the prescription pain medications they use non-medically are obtained from friends and relatives. This suggests that NAS rates may be altered by reducing overprescribing and opioid diversion.
Among women who are pregnant, illicit drug use is low, reported at 5.4 percent, however research shows that proportionately more pregnant women with opioid use disorders are entering substance use disorder treatment than prior to the opioid use epidemic. Research also shows that approximately two thirds of these women do not receive the standard of care for pregnant opioid users: medication-assisted treatment with methadone or buprenorphine.
Reducing new non-medical prescription drug use is essential for decreasing the number of infants born with NAS. Two pillars of the Administration’s 2011 Prescription Drug Abuse Action Plan are especially relevant to this: prescriber education and monitoring. Prescriber education on safer opioid prescribing is required in only eleven states. Increasing prescriber education requirements will create a more informed workforce that will take measures to reduce unnecessary prescribing and consider alternatives to opioid prescribing for pain medications in women of childbearing age, where clinically appropriate, including non-pharmacological therapeutic options.
Expanding prescription drug monitoring programs (PDMPs) to help prescribers identify active substance use and, where necessary, creating linkages to treatment can also help address NAS. Only a small number of states mandate use of PDMPs. However where they do, evidence is starting to show decreases in the percentage of patients who obtain pain medicines from multiple providers and pharmacies. Research shows certain types of medicines – especially long acting ones -- are closely tied to NAS incidence. By consulting the PDMPs, providers can know well in advance about possible prescription drug exposure for medicines known to put infants at greater risk. OB/GYNs can and should make use of PDMPs as a way to understand patient drug use and the risks for having a NAS birth, even if they are not prescribing controlled substances.
The Department of Health and Human Services is currently providing guidance to strengthen the capacity of states and local jurisdictions to improve the safety, health, and well-being of substance exposed infants, with an emphasis on opioid dependent women, and the recovery of pregnant and parenting women and their families. The 18-month initiative, funded by the Substance Abuse and Mental Health Services Administration, is supporting state efforts to strengthen collaboration and linkages across child welfare, addiction treatment, medical providers, early child care, and education systems in Connecticut, Kentucky, Minnesota, New Jersey, Virginia and West Virginia (https://ncsacw.samhsa.gov/technical/sei-idta.aspx)
As part of the 2015 National Drug Control Strategy, the Administration is taking additional actions to help reduce the rate of NAS, including developing collaborative guidance for states, tribes, and communities on best practices for child welfare; developing treatment guidelines for opioid-dependent pregnant women; focusing the “Treating for Two” initiative on reducing unnecessary opioid risk during pregnancy; and publishing guidelines for the use of opioids in treating chronic pain that addresses special populations including pregnant women.
Learn more about the prescription opioid and heroin epidemic here: http://www.hhs.gov/opioids.
[i] Patrick SW1, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA. 2012 May 9;307(18):1934-40. doi: 10.1001/jama.2012.3951. Epub 2012 Apr 30 available at
[ii] Patrick SW1, Davis MM2, Lehmann CU3, Cooper WO4. Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. Perinatol. 2015 Aug;35(8):650-5. doi: 10.1038/jp.2015.36. Epub 2015 Apr 30.
All other data references: 2015 National Drug Control Strategy (pgs 99-101)