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Background

The Opioid Epidemic

Opioid use in pregnancy has escalated dramatically in recent years, paralleling the epidemic observed in the general population. Over the last decade, prescription opioid misuse and illicit heroin use have skyrocketed. The number of overdose deaths involving opioids was five times higher in 2016 than it was in 1999 (“Understanding the Epidemic”, 2018).

Although men still abuse opioids at higher rates, the largest increase in heroin use between 1999 and 2010 was among women. From 1999 to 2010, the percentage of women who died of prescription painkiller overdose rose more than 400% compared to a 265% increase among men (“Prescription Painkiller Overdoses”, 2017; Saia et al., 2016). As more women misuse prescription and illicit opioids, the numbers of pregnant women doing so has risen as well: from 2000 to 2009, the US saw a five-fold increase in opiate use during pregnancy (Forray, 2016).

 

What is Neonatal Abstinence Syndrome?

With opioid use during pregnancy on the rise, infants are at an increased risk of in utero exposure and of developing withdrawal symptoms at birth, a condition known as neonatal abstinence syndrome (NAS). Between 1999 and 2013, NAS incidence increased 300% from 1.5/1,000 hospital births to 6.0/1,000 hospital births (“Incidence of NAS,” 2016). By 2012, 1 infant was born every 25 minutes, on average, experiencing signs of withdrawal, which also accounted for an estimated $1.5 billion in additional healthcare expenditures (Patrick & Schiff, 2017).

Anywhere from 45 to 94% of infants exposed to opioids in utero can be affected by NAS (Forray, 2016). Infants who are also exposed to other illicit drugs, alcohol, nicotine, and selective serotonin reuptake inhibitors (SSRIs) are at increased risk of NAS (Desai et al., 2015).