There’s been a disproportionately greater increase in opioid use among pregnant women in rural versus urban counties, according to a December 2016 study in the journal JAMA Pediatrics. The study, authored by Stephen Patrick, M.D., a neonatologist at the Monroe Carell Jr. Children’s Hospital at Vanderbilt, and colleagues from across the country, focused on data between 2004 and 2013.
Rates of neonatal abstinence syndrome (NAS) among babies exposed to opioids in the womb also increased disproportionately in rural counties, they reported. NAS—essentially drug withdrawal—increases the risk of premature delivery or low birthweight, as well as seizures, respiratory distress and difficulty feeding.
The study highlights an urgent need, Patrick says, “to develop means to support rural hospitals, especially critical access hospitals, which are on the front lines in providing care for mothers and infants impacted by the opioid epidemic.”
In a previous study published in 2015, he and his colleagues found that the incidence of NAS and maternal opioid use increased nearly fivefold in the United States between 2000 and 2012.
Tennessee, Kentucky, Mississippi and Alabama had some of the highest rates of NAS in the nation, exceeding in some cases 16 out of every 1,000 hospital births. In 2012, the cost of caring for these babies nationwide approached $1.5 billion, they reported.
“There are very few people in the United States like Dr. (Jessica) Young who are trained in obstetrics and also take care of pregnant women with opioid use disorder,” Patrick says.
“Nationwide, it appears we have obstetricians who are not comfortable treating addiction, and we have addiction medical specialists who are not always comfortable treating pregnant women,” he says. As a result, many patients are just “left out.”
The $1.5 billion spent annually on caring for babies with NAS exceeds the research budget of the National Institute of Child Health and Human Development, and is nearly a quarter of the total annual budget of the U.S. Centers for Disease Control and Prevention, he says.
“What if we put those dollars (spent treating babies with NAS) towards primary prevention and expansion of treatment?” he asks. “We might begin to see a difference there.”
Expanding health care services alone won’t solve the problem, Patrick cautions. Success will require research and understanding which systems of care and which policies are most effective at improving outcomes.
“This is a complicated epidemic,” he says. “It’s going to take a thoughtful response, thinking through some of the potential unintentional consequences for various interventions. We have to be persistent, we have to be compassionate and we have to be thoughtful about our approach going forward.”