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Rural neonatal abstinence syndrome jumps 600%
Neonatal abstinence syndrome among infants in rural areas increased 600 percent from 2004 to 2013 – more than double the increase in urban areas – according to a study by the University of Michigan.
Neonatal abstinence syndrome, or NAS, is the medical term for newborns suffering withdrawal symptoms because their mothers used addictive opiates or opioids during pregnancy.
Infants with NAS experience dangerous, even life-threatening withdrawal for days, or even weeks. They require specialized medical care to survive, and to minimize the same agonizingly intense withdrawal symptoms that adult addicts suffer when coming off opioids.
According to a report in MedPage Today, the Michigan researchers found that in rural areas, NAS soared from 1.2 cases per 1,000 hospital births to 7.5 per 1,000 hospital births – a greater than six-times increase. In urban areas it rose far less, from 1.4 cases per 1,000 to 4.8 per 1,000. But that’s still a 3.5-times increase, and is also of concern.
The researchers found similar results for hospital deliveries that were simply “complicated” by maternal opioid use during the same time period. There were far more complications in rural medical centers than urban ones. Complications rose from 1.3 to 8.1 per 1,000 rural hospital births, compared to 1.6 to 4.8 per 1,000 urban hospital births.
MedPage Today says the CDC released data earlier this year that supports these findings. The CDC found “significant increases in NAS for 25 of 27 states.”
Lower income as well as lack of experienced care
The University of Michigan researchers, led by Nicole L.G. Villapiano, MD, said the disparity between rural and urban areas is not just from a higher incidence of opioid abuse in rural areas. It also reflects a severe lack of funding for prevention and treatment facilities in rural areas compared to cities where treatment centers and prevention programs are more highly concentrated.
“Compared with their urban peers,” says the study, “rural infants and mothers with opioid-related diagnoses were more likely to be from lower-income families, have public insurance, and be transferred to another hospital following delivery. The proportion of infants diagnosed with NAS who were from rural counties increased from 12.9 percent in 2003/2004 to 21.2 percent in 2012/2013.”
These findings “highlight the urgent need for policymakers to appropriate funding for clinicians and programs that could improve access to opioid prevention and treatment services for rural women and children,” the researchers said. “Potential targets include increasing access to rural primary care buprenorphine distribution and programs supporting rural and critical access hospital treatment of women and infants affected by opioid use.”
Dessa Bergen-Cico, PhD, of Syracuse University in upstate New York, told MedPage Today that the rural increases revealed by the study are certainly the case in rural New York state, where in 2012, for example, NAS was much higher than in New York City.
“Prevention, harm reduction, and treatment is grossly underfunded and virtually unavailable in rural communities,” Bergen-Cico told MedPage Today. “I live in a rural area of central New York and I have been finding discarded needles along the roadside for the past six years. There are little to no clean needle distribution centers or needle collection facilities in rural areas, yet opioid use is quite prevalent and overdose deaths occur regularly.”
The best way to prevent increasing rates of neonatal abstinence syndrome may be to directly target opioid addiction, Bergen-Cico added. “It is not medically recommended for a pregnant woman to stop using heroin or opioids if she is physically addicted because it is too stressful on the baby. We have to develop new and innovative means of reaching people in our rural communities abusing opioids,” she said.
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