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The Obama Administration’s Work to End Neonatal Abstinence Syndrome (NAS)

The Administration is taking steps to reduce Neonatal Abstinence Syndrome and other effects of the opioid epidemic so infants and their mothers can live healthy lives.

This month, the U.S. Department of Health and Human Services is issuing two new reports aimed at addressing Neonatal Abstinence Syndrome, or NAS. NAS is a condition that occurs when a baby was exposed to opioids in the womb, including some pain medication, heroin, and illicit fentanyl, and exposure is stopped abruptly following birth. From 2000 to 2012 the number of infants displaying symptoms of drug withdrawal after birth increased almost fivefold nation-wide.[1],[2] Babies with this condition can show symptoms such as seizures, rapid breathing, fever, and an excessive, high-pitched cry.[3] The dramatic rise in NAS cases goes hand-in-hand with the rise in mothers using opioids at the time of delivery.[4]

The United States is currently facing an opioid epidemic that claims tens of thousands of lives each year – and more than 28,000 in 2014 alone.[5] This epidemic does not discriminate by age, gender, race, geography, political party, or by whether or not a victim is pregnant.

The Obama Administration has been working tirelessly to end the opioid epidemic and has been working to address NAS. In August 2012, the Office of National Drug Control Policy brought together leaders from Federal, state, and local government, academic institutions, and stakeholder groups to review the situation and formulate a response.

This meeting was the first of many steps on the path to reducing NAS frequency, including the passage of the Protecting Our Infants Act of 2015, which directs the Department of Health and Human Services to recommend prevention and treatment strategies for prenatal opioid use disorders and NAS.

Preventing substance use from beginning in the first place is the best way to reduce opioid use disorders and the problems that stem from them. That’s why the Administration released the CDC Guideline for Prescribing Opioids for Chronic Pain in March 2016, which helps physicians safely and responsibly prescribe opioids. Hundreds of medical, nursing, and pharmacy schools are incorporating these guidelines into their curricula this year.

The President also prioritized NAS in the 2015 National Drug Control Strategy, which includes action items specifically targeted to address maternal substance use and NAS, including creating effective treatment guidelines for pregnant women, best practice solutions for child welfare programs, and the “Treating for Two” initiative that focuses on reducing unnecessary opioid risk during pregnancy.

This month, SAMHSA released two new reports to help clinicians working with pregnant and parenting women with opioid use disorder and their infants.  The first report, Advancing the Care of Pregnant and Parenting Women with Opioid Use Disorder and their Infants: A Foundation for Clinical Guidance, lays out the process for rating and reviewing evidence on clinical treatment. SAMSHA is seeking public comment on the document, which will be translated for clinicians to achieve maximum impact. The second report, A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders: Practice and Policy Considerations for Child Welfare and Collaborating Service Providers, will provide evidence-based recommendations for child welfare and health systems and encourage a collaborative approach among agencies and healthcare providers for treating women and their infants.

Also this month, the CDC reported new data showing that there is substantial variation in the number of NAS cases between states, which may reflect differences in opioid prescribing patterns, opioid use, or diagnostic coding.[6]  Understanding these rates is important for planning state responses.

Ending the opioid epidemic and its effects requires a greater focus on treatment than ever before.  The FY 2016 bipartisan budget law increased funding to address the opioid epidemic to $400 million, and this past February, the President called for $1.1 billion in new funding to address the opioid epidemic by supporting critical prevention, treatment, and recovery services. These funds will dramatically expand evidence-based treatment programs for opioid use disorder so that every American with this disease – including pregnant women – has access to the help that they need.

The Obama Administration will continue to work to address NAS so babies and their mothers with opioid use disorders can live healthy, productive lives.




[1] Patrick SW1, Schumacher REBenneyworth BDKrans EEMcAllister JMDavis 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.

[3] Medscape. Neonatal Abstinence Syndrome. Retrieved 03/29/2016 from

[4] Patrick SW1, Schumacher REBenneyworth BDKrans EEMcAllister JMDavis 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

[5] Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2014 on CDC WONDER Online Database, released 2015. Extracted by ONDCP at on Dec 22, 2015.

[6] Ko JY, Patrick SW, Tong VT, Patel R, Lind JN, Barfield WD. Incidence of Neonatal Abstinence Syndrome — 28 States, 1999–2013. MMWR Morb Mortal Wkly Rep 2016;65:799–802. DOI: