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22 December 2016

United States: Rise in Infant Drug Dependence Is Felt Most in Rural Areas

Two Massachusetts sisters, including one reaching into
crib, who were born dependent on methadone.  Their
mother is a recovering heroin addict.  Credit:
Peter Pereira/Standard-Times, via Associated Press
Rise in Infant Drug Dependence Is Felt Most in Rural Areas
by Catherine Saint Louis, The New York Times, 12 December 2016

As the opioid epidemic sweeps through rural America, an ever-greater number of drug-dependent newborns are straining hospital neonatal units and draining precious medical resources.

The problem has grown more quickly than realized and shows no signs of abating, researchers reported on Monday. Their study, published in JAMA Pediatrics, concludes for the first time that the increase in drug-dependent newborns has been disproportionately larger in rural areas.

The rising rates are due largely to widening use of opioids among pregnant women, the researchers found.

From 2004 to 2013, the proportion of newborns born dependent on drugs increased nearly sevenfold in hospitals in rural counties, to 7.5 per 1,000 from 1.2 per 1,000. By contrast, the uptick among urban infants was nearly fourfold, to 4.8 per 1,000 from 1.4 per 1,000.

“The problem is accelerating in rural areas to a greater degree than in urban areas,” said Dr. Veeral Tolia, a neonatologist who works at Baylor University Medical Center in Dallas and was not involved in the new report.

Other recent studies have underscored the breadth of the problem. The hospital costs associated with treating addicted newborns rose to $1.5 billion in 2013, from $732 million in 2009, according to a study in the Journal of Perinatology.

Some neonatal intensive care units, called NICUs, now devote 10 percent of their hours to caring for infants who have withdrawal symptoms.

Hospitals in the eye of this storm are commonly underresourced, experts said.

“Typically, rural hospitals that deliver babies have traditionally focused on the lower-risk population in areas they serve,” said Dr. Alison V. Holmes, an associate professor of pediatrics at Geisel School of Medicine at Dartmouth.

“But when you’re getting to a point of having a substantial proportion of mothers taking opioids and babies at risk for opioid withdrawal, it becomes a strain on the regional system.”

Using data from 2012 and 2013, a recent federal study found states like West Virginia, Maine and Vermont had particularly high rates of what is known as neonatal abstinence syndrome. It includes such symptoms as irritability, breathing problems, seizures and difficulties taking a bottle or being breast-fed.

In the 1970s, withdrawal symptoms affected mostly babies of heroin-addicted mothers in cities such as Philadelphia and New York, Dr. Tolia said. “What this study shows is this has totally flipped,” he added.

Babies may be born with symptoms of withdrawal from any number of drugs, including certain antidepressants or barbiturates, after prolonged use by their mothers during pregnancy. But the new report found that rates of infant drug dependency are rising in tandem with maternal opioid use in particular.

Doctors frequently prescribe opioids to mothers-to-be to treat back pain or abdominal pain. Nearly 42 percent of pregnant women in Utah on Medicaid were prescribed opioids, and roughly 35 percent in Idaho, a 2014 study found.

Maternal opioid use was nearly 70 percent higher in rural counties than urban ones, the new report found.

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