Rural Hospitals See Surge in Opioid-Dependent Babies

Cases have skyrocketed because of widespread maternal drug abuse, study says

Monday, December 12, 2016

MONDAY, Dec. 12, 2016 (HealthDay News) -- Rural U.S. communities are seeing a surge in infants experiencing opioid withdrawal at birth because of widespread drug abuse by pregnant women, a new study finds.

These tiny victims of the U.S. opioid epidemic are born addicted to heroin and powerful prescription painkillers such as OxyContin, Vicodin and Percocet. And this public health crisis is hitting rural residents harder than their urban cousins, researchers say.

Investigators found that from 2004 to 2013, rural communities experienced a nearly 80 percent higher rise in infant opioid withdrawal rates, relative to cities.

"The magnitude of the difference between rural and urban areas was not expected," said study lead author Dr. Nicole Villapiano of the University of Michigan. She is with its Institute for Healthcare Policy and Innovation.

This class of drugs, which also includes morphine and fentanyl, is highly addictive. And addiction risk can extend to an unborn child if women take opioids while pregnant.

Infant opioid withdrawal -- also called neonatal abstinence syndrome -- can lead to low birth weight and a higher risk for seizures, alongside breathing, eating and sleeping problems the first few weeks of life.

Some studies suggest that affected children may develop attention-deficit problems down the road, although long-term risk remains unclear, Villapiano noted.

According to background notes with the study, the rate of maternal opioid use and infant withdrawal rose fivefold between 2000 and 2012.

To explore any geographic differences, the researchers analyzed hospital discharge data collected between 2004 and 2013 by the U.S. Agency for Healthcare Research and Quality.

During that time, diagnoses of neonatal abstinence syndrome jumped from a little over one per 1,000 births to almost eight per 1,000 births.

In urban areas, the rates more than doubled, but this was a smaller increase by comparison -- from just under two per 1,000 urban deliveries to nearly five per 1,000 births.

The research team found that while rural infants accounted for just 13 percent of all neonatal opioid withdrawal cases in the country in 2003, that figure had risen to north of 21 percent a decade later.

The study doesn't evaluate the root causes of the trend, said Villapiano, but she suggested some possible contributing factors.

"We know that patients in rural areas tend to be poorer, have higher rates of chronic diseases, are more likely to smoke, drink alcohol, and suffer from drug addiction," Villapiano said.

"This in combination with the poor access to medical care . . . make patients in rural areas especially vulnerable to poor health outcomes," she said. Many of these women lack access to primary care doctors and specialists, "especially mental health and substance use specialists," she explained.

Mark Asbridge is an associate professor of community health and epidemiology at Dalhousie University in Halifax, Canada. He seconded those points.

"It's a combination of issues. One hypothesis is that the rate of pain in a community is often tied to the local labor market," Asbridge noted.

"The labor market in rural communities -- such as coal mining, logging, fisheries -- tends to produce more pain. That meant that before we really understood the addictive potential of opiates, these drugs gained a strong foothold in these rural areas," he explained.

To make matters worse, he said, general practitioners in North America lack an expertise in subjects like pain or mental health or addiction. And these are the care providers that patients usually see, especially in rural areas, Asbridge added.

"More pain, a lack of expertise, and more use. In rural communities, it's a perfect storm," Asbridge said.

Treatment for these at-risk babies and their mothers is imperative, the researchers said.

Pregnant women with opioid-use disorder may benefit from a combination of medication, like buprenorphine, and an addiction treatment program, the study authors suggested.

The March of Dimes notes that babies going through withdrawal are often given methadone or morphine to ease the cravings and discomfort.

The study was published online Dec. 12 in JAMA Pediatrics.

SOURCES: Nicole L.G. Villapiano, M.D., M.Sc., Robert Wood Johnson Foundation clinical scholar, Internal Medicine/Pediatrics Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor; Mark Asbridge, Ph.D., associate professor, department of community health and epidemiology, Dalhousie University, Halifax, Canada; Dec. 12, 2016, JAMA Pediatrics, online

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