Infant narcotic exposure (neonatal abstinence syndrome) is increasing faster in rural areas than urban ones

January 26, 2017  |  General

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The explosion of narcotic abuse over the past decade or so has led to a marked increase in the death rate from overdoses. More people taking narcotics also inevitably means some of them are pregnant women, and the drug crosses the placenta to affect her baby. When someone addicted to narcotics suddenly stops taking them the result is acute narcotic withdrawal syndrome, a very painful and even dangerous thing. This is what happens when a baby is born to a mother who has taken significant amounts of narcotics during pregnancy — the drug supply is cut off when the umbilical cord is cut. Within a day or so the infant experiences acute withdrawal symptoms, termed neonatal abstinence syndrome (NAS). The incidence of this has risen dramatically, the CDC says by over 300% in the last decade. The incidence of NAS varies widely by state. West Virginia is the highest, affecting 3.3% of all births, closely followed by Maine and Vermont, which also have rates higher than 3%. Those are very disturbing statistics. Hawaii has the lowest rate.

The symptoms of NAS are variable and depend to some degree on the extent of the mother’s drug habit, and therefore the doses the infant was exposed to before birth. These symptoms include irritability, a peculiar high-pitched cry, tremulousness, difficulty sleeping, sweating, poor feeding, vomiting, and diarrhea. Not all infants have all the symptoms; most of them have several, though. We can confirm the diagnosis with tests on the infant (or mother) looking for opioids. Infants with mild symptoms often do not require specific therapy. If the symptoms are more severe we give the infant sufficient narcotic to relieve the acute symptoms and then gradually reduce the dose over time to wean the child’s brain from the need for the drug.

A recent study highlights another aspect of the drug epidemic. It indicates that, whereas 5-7 years ago the increase was uniform between urban and rural parts of the country, since then rural America has been much harder hit. The graph above is from that study. It also shows the related finding, as expected, that maternal opioid use parallels the increases in NAS. The observation that the raw numbers are very similar points out another thing: women who use opioids during pregnancy have a very high risk of giving birth to an infant afflicted with NAS. Some studies suggest the risk is well over 90%.

Much has been reported in the media about the epidemic, and it is an epidemic, of drug abuse washing over rural America, particularly West Virginia and Maine. This comes at a high cost to innocent babies. One area of particular concern is that we don’t know at this time if NAS affects a child’s brain permanently. It would not surprise me at all if it did.


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