The opioid epidemic has prompted a surge in addicted pregnant women, as well as the need for withdrawal from the drugs for their newborns, a condition known as neonatal abstinence syndrome.
Instances of NAS tripled over the decade ending in 2009 and the cost of caring for these infants skyrocketed to $1.5 billion in 2012, with about 80 percent of that tally paid for by Medicaid.
Dennis Welsh, CEO of tiny Down East Community Hospital in Machias, Maine, was dismayed at how frequently he found such births occurring after coming aboard in spring 2015 as chief executive. More than a quarter of babies born there suffer from NAS.
“The addiction is so powerful and the availability of these drugs is so remarkable that it's really a plague,” Welsh says. “You take it a step further when you’re a pregnant mom and you’ve got a young child growing in you, and you’re passing that addiction on to them to the point where they have to be detoxed in their first days of life. It’s disheartening to say the least.”
Across the country, hospitals are seeking new ways to address this issue. Legislators, too, have taken notice, with Congress in November having passed the Protecting Our Infants Act, which directs federal agencies to gather and share best practices on how to treat the syndrome.
The typical approach to treating NAS is to wean a newborn off opioids. Some fear that doing so before delivery could lead to premature birth, fetal distress or even death of the baby. But a recently released study from the University of Tennessee Medical Center found that detoxification of mothers doesn’t harm the baby, as previous outdated studies had concluded, says lead author Craig Towers, M.D. Trying such a new approach could save tens of millions of dollars in health care costs, theorizes Towers, who is also a maternal-fetal medicine specialist in the division of maternal-fetal medicine at UT Medical Center. Tennessee is paying $60 million each year to treat these infants, at an average cost of about $60,000 per case.
One thing that was clear, Towers says, is the importance of behavioral health treatment. In the study, about 70 percent of babies were born with NAS without the mom having had post-detox behavioral health follow-up care. That rate stood at about 17 percent with follow-up care, the study found.
Elsewhere, researchers are hunting for less costly non-pharmacologic ways to treat this patient population. The Boston Children’s Hospital/Boston Medical Center Combined Residency Program in Pediatrics found in a recent study that increased contact between a mother and her newborn immediately after birth helps to decrease NAS symptoms — tremors, irritability, lack of appetite, vomiting, diarrhea and insomnia.
Lead author Mary Beth Howard, M.D., says such an approach to treating opioid-dependent babies also may have an added benefit of helping moms to kick their drug habit.