Preventing Neonatal Abstinence Syndrome

The American opioid epidemic is nothing short of a catastrophe with as many as 78 people losing their lives everyday due to overdose. While the death rate is staggering and calls for immediate action to curb both prescription opioid and heroin abuse, there are in fact other statistics relevant to the opioid epidemic that may be even more troubling.

The vast majority of adults understand that if pregnant women drink alcohol they put their baby at severe risks, i.e. fetal alcohol spectrum disorder (FASD). Anything a mother puts into her body during the pregnancy, finds its way to the fetus. Keeping that in mind, with the exponential increase of opioid narcotic use, it stands to reason that more babies than ever are being exposed to prescription painkillers and/or heroin.

When a mother uses opioids during the pregnancy, they risk their baby being born with what is known as neonatal abstinence syndrome (NAS). This occurs when the baby no longer has access to their mother's supply of opioids that the fetus was accustomed to, in turn causing withdrawal symptoms to ensue. If any of you have experienced opioid withdrawal, you are fully aware of just how painful the symptoms can be.

Babies born with NAS face a series of complications that require extensive medical supervision to ensure that the baby can recover as painlessly as possible. Nevertheless, even after recovery is achieved there is no way of knowing what other problems may develop down the road. Unfortunately, a large percentage of pregnant women will use opioids throughout the course of their pregnancy. It is paramount that women who are addicted to opioids let their doctor know that they have a problem upon learning that they are with child—the risks are too high to stay mute.

Just to give you an idea of the severity of the problem, new research suggests that between 1999 and 2013, babies being born with NAS quadrupled in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC). In 1999, there were 1.5 NAS cases per 1,000 hospital births, but by 2013 there were 6 NAS cases per 1,000 births. In order to reduce the number of NAS cases each year, the CDC released the Guideline for Prescribing Opioids for Chronic Pain, which urges doctors to:

1. Consider nonopioid pharmacologic therapy for chronic pain management.
2. Discuss family planning and how long-term opioid use might affect future pregnancies before initiating opioid therapy in reproductive-aged women.
3. Prescribe the lowest effective dose when opioids are started.