NLM Director’s Comments Transcript
Increased Use of Opiates Impact Newborn Health: 07/02/2012

Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

Here is what's new this week in MedlinePlus.

Newborns who need treatment for withdrawal symptoms from narcotic medicines (taken by their mother during pregnancy) increased sharply during the past decade, finds a pioneering, nationwide study recently published in the Journal of the American Medical Association. The study and an accompanying editorial suggest the costs to take care of newborns experiencing withdrawal from narcotic (or opiate) drugs also increased significantly from 2000-2009, which create an important public health cost and clinical care burden in the U.S.

The study’s authors explain opiate drugs are narcotic medicines taken (in this context) by pregnant women usually to reduce pain.

The JAMA study is the first to assess changes in the number of newborns who need treatment for withdrawal from opiate drugs, which also is called neonatal abstinence syndrome (NAS). The information from the current research additionally is a pioneering effort to assess the impact of opiate use during pregnancy on: health care organizations, pregnant women, families, newborns, physicians, and health care costs. The authors used nationally representative samples from the Kids’ Inpatient Database and the Nationwide Input Sample to determine the incidence of NAS and maternal opiate drug use.

Overall, the study found maternal opiate drug use increased from 1.19 to 5.63 per 1000 hospital births between 2000-2009. The study also found about 13,500 babies a year were born in 2009 with symptoms of withdrawal from opiates.

The study found newborns with NAS are more likely than other hospital born infants to have low birthweight, respiratory complications, and to be covered by Medicaid. The study’s six authors add by 2009, almost 78 percent of charges for NAS were attributed to state Medicaid programs.

The study also found average hospital charges for newborns with NAS increased from $39,400 to $53,400 from 2000-2009. The reported, average costs to treat newborns with NAS reflect an adjustment for inflation. Newborns with NAS stayed an average of 16 days in the hospital compared to about three days for all other infant births during the study period.

Moreover, the study’s six authors explain there have not been significant improvements in the availability of new medicines or other clinical treatments to care for newborns with NAS, or to assist pregnant mothers who take opiate medications.

An editorial accompanying the study suggests the lack of new treatments, higher costs, expansion of NAS, and the increased number of pregnant women who take opiate drugs (and we quote): ‘pose a crisis of care for affected fetuses and newborns’ (end of quote).

The editorial accompanying the study adds (and we quote): ‘(opiate) medications provide superior pain control for cancer and chronic pain, but have been overprescribed, diverted, and sold illegally, creating a new opiate addiction pathway and a public health burden for maternal and child health’ (end of quote).

The editorial’s authors conclude at least two strategies are needed to improve health outcomes for pregnant women who take opiate drugs and their newborns.

First, the editorial’s authors suggest there is a need for new efforts to diagnose and intervene earlier in a woman’s pregnancy if there is any evidence of opiate drug use. The authors suggest these efforts might include: better protocols to determine opiate dependence, improvements in methadone treatment, assessing a patient’s adherence to treatment, improved alcohol use monitoring, and increased access to psychiatric care. Second, the editorial’s authors suggest NAS needs to be identified earlier in newborns and more aggressive opiate replacement should be provided.

The editorial’s co-author Marie Hayes Ph.D. (University of Maine) told the New York Times in an article about the study (and we quote): ‘the incidence (of opiate use among pregnant women) has gone crazy and I think it has the potential to become a national or international issue’ (end of quote).

A link to a handout about NAS is available in the ‘patient handouts’ section of MedlinePlus.gov’s pregnancy and substance abuse health topic page. More helpful tips about NAS can be found in a related encyclopedia page available within MedlinePlus.gov’s pregnancy and substance abuse health topic page.

MedlinePlus.gov’s pregnancy and substance abuse health topic page additionally contains links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to related clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. From the pregnancy and substance abuse health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.

To find MedlinePlus.gov’s pregnancy and substance abuse health topic page, type ‘pregnancy and opiates’ in the search box on MedlinePlus.gov’s home page, then, click on ‘Pregnancy and substance abuse (National Library of Medicine).’

MedlinePlus.gov also contains related health topic pages on: pregnancy and medicines, reproductive health, drug abuse, and pain relievers.

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