Rural U.S. babies hardest hit by opiate addiction at birth

[December 13, 2016]  By Lisa Rapaport

As a growing number of U.S. babies are being born suffering withdrawal syndrome after exposure to prescription opiates or heroin in utero, rural infants appear much more at risk than city newborns, a new study suggests.

Researchers focused on what’s known as neonatal abstinence syndrome, a condition akin to withdrawal that develops when babies essentially become addicted to drugs their mothers use during pregnancy.

For rural babies nationwide, the rate of neonatal abstinence syndrome surged from 1.2 cases per 1,000 hospital births in 2004 to 7.5 cases per 1,000 births by 2013, the study found. The increase wasn’t as pronounced for city infants, rising from 1.4 cases per 1,000 births at the start of the study period to 4.8 cases per 1,000 by the end.

While other research has pointed to a recent rise in U.S. babies born with opiate withdrawal issues, the current study highlights the disproportionate burden borne by rural infants, said lead study author Dr. Nicole Villapiano, a pediatrics researcher at the University of Michigan’s C.S. Mott Children’s Hospital in Ann Arbor.

“Prior to our study, we had limited data from a few states like West Virginia and Tennessee that showed rising rates of neonatal abstinence syndrome in some rural counties,” Villapiano said by email. “What we didn’t know was how the opioid crisis has affected rural moms and their infants across the country.”

A report earlier this year from the U.S. Centers for Disease Control and Prevention (CDC) showed a sharp spike in neonatal abstinence syndrome stretching back over a longer period of time, from 1.5 babies for every 1,000 births in 1999 to 6 cases per 1,000 births.

CDC researchers also found wide variation in neonatal abstinence syndrome by state, ranging in 2013 from 0.7 cases for every 1,000 births in Hawaii to 33.4 cases per 1,000 in West Virginia.

In the current study, researchers examined nationally representative hospital records, including 4,192 rural and 19,752 urban babies born with neonatal abstinence syndrome.

The proportion of infants diagnosed with neonatal abstinence syndrome who were from rural counties increased from 13 percent to 21 percent during the study period, researchers report in JAMA Pediatrics.

Over that period, the frequency of hospital deliveries complicated by maternal opioid use rose from 1.3 to 8.1 cases per 1,000 hospital deliveries among rural mothers and from 1.6 to 4.8 per 1,000 hospital deliveries among urban mothers.

It’s possible at least some of the increase stems from increased awareness of the condition, not just a surge in opioid use among mothers, the authors note.

While the study didn’t look at health outcomes for babies born suffering from drug withdrawal, these infants often require intensive medical care. (See Reuters’ 2015 special report “Helpless and Hooked” here: reut.rs/1NSc7uC)

These babies may have central nervous system issues like seizures and tremors, gastrointestinal problems and feeding difficulties, breathing challenges, as well as unstable body temperatures.

Typically, they remain in the hospital for several weeks after birth and receive low doses of methadone, a medicine designed to wean addicts from opiates.

“It is clear that neonatal abstinence syndrome is a growing problem across the country,” said Dr. William Carey, a pediatric researcher at Mayo Clinic Children’s Center in Rochester, Minnesota.

“While some state-level data has suggested that neonatal abstinence syndrome disproportionately affected rural counties, this is the first study to show that rural communities throughout America are particularly affected by this epidemic,” Carey, who wasn’t involved in the study, added by email.

Substance abuse is generally higher in rural communities, where an inability to afford or access care as well as the stigma associated with addiction may mean fewer mothers get the help they need to stop using heroin or abusing prescription painkillers during pregnancy, said Dr. Joshua Brown, a researcher at the University of Florida College of Pharmacy in Gainesville who wasn’t involved in the study.

“If state health authorities will acknowledge the lack of treatment access and how this leads to them footing the bill for these babies, it may lead them to improve access to treatment clinics in rural areas,” Brown said by email.

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