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Drug addicted newborns: a national disgrace

Robin Wulffson MD's picture
opiates, drug abuse, heroin,Oxycontin, Vicodin, prescription drugs, illegal drug

Opiates such as Oxycontin and Vicodin are potent pain killers that are frequently prescribed for patients suffering from chronic pain, cancer, or postoperative pain. Unfortunately, they are often abused either by individuals who have a prescription or obtain them from illegal sources. They also are highly addictive. Sadly, many pregnant women take these drugs during pregnancy. After delivery, the affected infants go through withdrawal, which may be fatal.

According to a new study by researchers at the University of Maine, the number of US newborns with drug withdrawal is on the rise because of the mothers’ abuse of prescription medication as well as illegal substances such as heroin. They published their findings online on April 30 in the Journal of the American Medical Association (JAMA).

The researchers note that overdose mortality and dependence rates are highest among disadvantaged, young adults in rural areas in locations such as Maine and Kentucky. In addition, young women are almost twice as likely as men to abuse opiate medications. The result of this sad statistic is that among women who abuse the drugs during pregnancy, their newborns suffer from drug withdrawal, which has been termed the neonatal abstinence syndrome (NAS). The researchers note that the incidence of NAS in the United States soared from 1.20 per 1,000 hospital births per year in 2000 to 3.39 per 1,000 hospital births per year in 2009. The situation has impacted healthcare throughout the US, primarily for state Medicaid budgets.

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To treat the affected infants, methadone treatment programs to control withdrawal symptoms have escalated. In addition, prescription monitoring programs have been implemented to identify opiate medication use patterns (i.e., opiate prescriptions are tracked and individuals who are “shopping” for physicians to prescribe opiates are identified). If infants do not undergo a methadone treatment program, they may require to long-term care for the resultant developmental and behavioral disorders; thus, placing an added financial burden on state resources. Even infants who undergo a withdrawal program may have long-term difficulties in critical regulatory areas of sleep, feeding, and autonomic function (the portion of the nervous system that regulates involuntary action in areas such as the intestines, heart, and glands).

The study points out that over the last decade, no improvement in NAS treatment efficiency has occurred (measured by length of stay (LOS)). In addition, during the same period, healthcare expenditures for NAS have increased. The investigators reviewed hospital complications of NAS infants, which concurred with previous studies that the syndrome was linked to increased rates of prematurity, respiratory disease, and seizures. They noted that opiate withdrawal is often exacerbated (worsened) by the mothers’ use of other drugs during her pregnancy such as antidepressants and other psychiatric medication. They explain that the withdrawal from these medications is milder than opiates; however, the combined withdrawal complicates newborn care and often extends LOS. In addition, NAS Neonatal abstinence syndrome withdrawal severity affects adaptation to postnatal life in

The study authors reported that 60-80% of newborns exposed in utero to opiates develop NAS and require prolonged hospitalization, averaging 16 days; however, considerable uncertainty exists regarding the best treatment course should be for these infants. They note that hospitals and healthcare professionals are impacted by the increase in NAS incidence; thus, they can expend substantial efforts to develop improved treatment protocols.

Reference: JAMA