Opioid epidemic’s youngest victims are a growing group, new data show

Most stories covering the national opioid epidemic focus on the adult lives cut short or crippled by dependency. But one of the storylines that has received increasingly powerful coverage over the past year is the impact of the opioid epidemic on babies born to addicted and recovering mothers.

That growing focus on the epidemic’s youngest victims is on point, as a new research letter published in JAMA Pediatrics this week confirms. The study looks at how rates of babies born with neonatal abstinence syndrome (NAS) are changing at both the national level and in Kentucky, one of a handful of rural states hit especially hard by the epidemic. The condition occurs when babies are exposed to drugs in the womb, followed by symptoms of withdrawals in the first weeks of life.

Researchers found rising rates of NAS at both levels, but Kentucky’s rate has risen much faster than the national average. At the national level, the rate of babies born with NAS more than doubled from 2008 to 2013, from 2.8 births per 1,000 to 7.3 per 1,000. Compare that to Kentucky, where about 5 babies per 1,000 were born with NAS in 2008. By 2014, that had risen to 21 per 1,000 — a fourfold increase in six years. The data come from a random sample of national impatient data, as well as Kentucky impatient data.

So what’s going on in Kentucky to account for such higher rates the country at large? I put that question to lead researcher Dr. Joshua Brown at the University of Kentucky College of Pharmacy, who pointed out that it has more to do with rural areas, which are disproportionately impacted by the opioid epidemic — and that’s true even within Kentucky.

Rural areas are home to especially high rates of babies born with opioids in their system. In Kentucky’s Appalachia region, the rate is about 50 births per 1,000, more than twice the state’s overall rate.

“We expect the rural aspect is really driving it as well as the socioeconomic factors associated with that,” he said via email. “We’ve looked at that in more detail since, and we see that within Kentucky, rates in Appalachia are 50 per 1,000, or more than twice that of the state’s overall rate.”

For example, just across the Kentucky border at West Virginia’s Cabell Huntington Hospital, 139 out of 1,000 babies were born with neonatal abstinence syndrome in 2014, according to a Reuters investigation.

That fits a broader pattern in which poorer rural areas bear the brunt of the epidemic. About 10 states contribute half of all NAS cases, according to Brown, referring to states such as Alabama, Mississippi and West Virginia. “Although the population is lower in rural areas, the number of NAS births is equal to that of the metro areas simply because the rate is so high,” Brown said. “What we also observe is that there is less access to mental health treatment facilities in these areas.”

Babies born with NAS face a harrowing start to their lives. Intense crying and shrieking, jitteriness, tremors and diarrhea are common symptoms, and such babies often must spend several weeks or longer in the hospital as they endure withdrawal. In some cases, doctors prescribe methadone or morphine to ease their suffering and then wean them off those drugs. The lengthy hospital stays are far more expensive than a regular birth as well — $66,700 on average, according to the National Institute on Drug Abuse.

The problem has generated some impressive reporting over the past year. This spring, NPR and Kaiser Health News collaborated on a four-part series called “Treating the Tiniest Opioid Patients,” which looked at the unique challenges posed by growing numbers of babies born with NAS, as well as how some hospitals were adapting, with special private rooms and a new emphasis on not shaming mothers for their perceived moral failings.

While most babies born with NAS recover from their symptoms, it doesn’t mean they’re out of harm’s way, as a deeply reported three-part Reuters investigation by Duff Wilson and John Shiffman emphasized last year. They wrote:

Doctors who specialize in these cases say the condition, while sometimes agonizing for the newborn, is treatable and needn’t result in long-term harm to the child. But a diagnosis made in the first days of the baby’s life should serve as a warning, they say. It often indicates that a mother is struggling with addiction, raising questions about a family’s ability to care for the infant.

The investigation identified 110 cases of preventable deaths since 2010 in families where the mother used opioids during her pregnancy. The tally includes more than three dozen suffocations and one horrifying instance in which an opioid- and meth-addled mother fatally put her baby in the washing machine with the laundry.

The Reuters series powerfully illustrates the ways in which the federal Keeping Children and Families Safe Act of 2003 has failed to curb such deaths, as intended. In many states, doctors don’t alert child protection services in cases where babies are born to mothers using or recovering from drug use. Often, it’s out of understandable concern that doing so would legally imperil the mother.

But if social workers aren’t made aware that a baby has been born into a family in which the parents are battling or recovering from addiction, they can’t take steps to monitor the child and ensure its well being. The lack of oversight can come to a tragic end. In too many cases, the gravest health risks babies face occur after they’ve left the constant supervision of the hospital and entered homes where poverty and relapse are constant threats. And as this week’s new numbers suggest, a growing number of infants experience such perilous homecomings.

[Photo by Harald Groven via Flickr.]