More than 130 people in the United States die every day from opioid overdoses. In 2017, overdoses claimed the lives of more than 47,000 Americans. That same year, an estimated 1.7 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers. An additional 652,000 suffered from heroin use disorder.
In addition to rampant opioid misuse and related mortalities, a less-recognized byproduct of opioid crisis is the rise of neonatal abstinence syndrome: a complex disorder that occurs when newborns enter drug withdrawal due to mothers’ use of drugs during pregnancy. Neonatal abstinence syndrome results in a varied constellation of symptoms including excessive crying and irritability, vomiting, sweating, sleep difficulties, and more. These newborns are also more likely to have respiratory complications, low birthweights, and possible birth defects or seizures.
Rise in neonatal abstinence syndrome
From 2004 to 2014, in conjunction with the dramatic spike in opioid overdoses, an estimated 32,000 infants were born with neonatal abstinence syndrome. Said another way, approximately one baby suffering from opioid withdrawal was born every 15 minutes during that time. The national rate of mothers who were hospitalized at the time of their delivery due to OUD more than quadrupled from 1999-2014.
During the same period, hospital costs from neonatal abstinence syndrome likewise grew, from $190 million in 2000 to $1.45 billion in 2012. The rising frequency and costs of neonatal abstinence syndrome point to the need for programs and measures that reduce prenatal exposure to opioids, such as harm reduction strategies focused on expanding the availability of medication-assisted therapy to improve maternal, fetal, and neonatal outcomes.
Solutions to reduce neonatal abstinence syndrome
One of the difficulties in preventing and treating neonatal abstinence syndrome is the lack of specifically targeted programs to help pregnant mothers, yet studies have demonstrated that effective interventions include the development, implementation, and adherence to a standard treatment protocol. While optimal treatment of neonatal abstinence syndrome remains undetermined, making medication-assisted treatment programs more widely accessible to pregnant women enables health care providers to promote evidence-based practices that reduce the burden of neonatal abstinence syndrome, and also optimize outcomes for mothers and their infants.
Specifically, randomized controlled trials of treatment for opioid use disorder during pregnancy have shown an association between buprenorphine and improved outcomes. In the largest of these trials, peak neonatal abstinence syndrome scores were significantly lower in infants whose mothers were treated with buprenorphine. Buprenorphine treatment among mothers resulted in mean neonatal treatment of 4.1 days with a hospital stay of 10 days, compared to 9.9 days and 17.5 days, respectively with methadone. Moreover, observed differences between the two forms of medication-assisted treatment were statistically significant. The mean gestational age and birth weight among newborns with buprenorphine were considerably higher compared to methadone, suggesting that “prenatal buprenorphine treatment results in a clinically less severe neonatal abstinence syndrome than treatment with methadone.”
There are practical interventions for the treatment of neonatal abstinence syndrome, including medication-assisted treatment with buprenorphine, that require the comprehensive support of a care team. As studies have demonstrated the importance of consistent adherence to buprenorphine treatment protocols and medication regimens, there is a clear need to implement scalable, patient-centered approaches that expand buprenorphine care--and avoid the negative health, economic, and societal impacts of neonatal abstinence syndrome. With increased adherence to medication-assisted therapy, patients are more likely to stay engaged in care, and yield better long-term health outcomes.
While there is no “one size fits all,” the most effective modalities to reduce the prevalence of neonatal abstinence syndrome should focus on harm reduction through increased access to these clinically proven strategies. With the support of care teams that encourage adherence to medications for opioid dependence, first-line treatment options like buprenorphine can help expectant mothers navigate pregnancy, and mitigate the dangers of relapse to prevent neonatal abstinence syndrome.