The number of US women who gave birth addicted to opioids has quadrupled in the last 15 years, increasing the number of infants who face a long, painful withdrawal at birth. However, reports The Guardian, as with many health problems in the US there is vast regional variation.
While the rate of women who gave birth addicted to opioids in Hawaii matched the national average, the rate increased 53-fold in West Virginia.
“These findings illustrate the devastating impact of the opioid epidemic on families across the US, including on the very youngest,” said Dr Robert Redfield, director of the US Centres for Disease Control and Prevention (CDC). “Untreated opioid use disorder during pregnancy can lead to heart-breaking results. Each case represents a mother, a child and a family in need of continued treatment and support.”
The study, compiled by the CDC, jibes with other research which has shown a disturbing rise in infants exposed to drugs and forced to withdraw at birth. It may also reflect a greater awareness of the condition among doctors, researchers warned. Between 1999 and 2014, researchers found that the number of mothers who went into labour at a hospital with an opioid addiction increased from 1.5 mothers per 1,000 deliveries to 6.5 per 1,000.
The report says the new government data comes from a subset of the Agency for Healthcare Research and Quality’s Healthcare Cost Utilisation Project, called the National Inpatient Sample. Only 28 states report to the project. Nevertheless, every state that had more than three years of data showed an increase in the number of mothers addicted to opioids at delivery.
States with the highest increases each year were Maine, New Mexico, Vermont and West Virginia. The lowest increases were in Hawaii and California.
The report says in Vermont, the rate of women who presented with an opioid addiction increased 97-fold, from 0.5 cases per 1,000 in 2001 to 48.6 in 2014. In West Virginia, the rate increased 53-fold, from 0.6 cases in 2000 to 32.1 in 2014.
Comparatively, in 2000 in Hawaii, 0.6 women per 1,000 went into labour addicted to opioids. In 2014, that rate increased to 2.4 women per 1,000. That is still a four-fold increase over 14 years, but far below Vermont’s 2014 rate.
“Even in states with the smallest annual increases, more and more women are presenting with opioid use disorder at labour and delivery,” said Dr Wanda Barfield, director of the CDC’s division of reproductive health. “These state-level data can provide a solid foundation for developing and tailoring prevention and treatment efforts.”
The report says researchers believe, in part, regional variation is reflective of opioid-prescribing trends. In West Virginia, doctors wrote 138 opioid prescriptions for every 100 people in the state in 2012. That could later translate to high rates of women addicted to opioids when they give birth.
Further, steep increases have forced doctors to rethink how they provide care for such infants. On average, infants with neonatal abstinence syndrome stay in the hospital for 17 days, according to a recent review. But their mothers are frequently released. That means mothers who go into labor addicted to opioids are often struggling not only with addiction, but with how to visit their infants that remain in the hospital.
The report says while untreated addiction can powerfully affect families, so can opioids prescribed for treatment. Many infants born to women in treatment on so-called replacement therapies, such as methadone and buprenorphine, will also suffer neonatal abstinence syndrome, according to the review. Replacement therapies are widely accepted as the most effective means of treating opioid addiction.
While all available data shows the problem is widespread, gaps in understanding remain. Only nine US states require hospitals to collect data on infants exposed to drugs, such as opioids.
[link url="https://www.theguardian.com/us-news/2018/aug/09/us-opioids-number-of-addicted-women-giving-birth-quadrupled-over-15-years"]The Guardian report[/link]
[link url="https://www.cdc.gov/mmwr/index.html"]CDC report[/link]
[link url="https://www.nejm.org/doi/full/10.1056/NEJMra1600879"]New England Journal of Medicine review[/link]