Study: Babies exposed to narcotic pain relievers more likely to experience drug withdrawal syndrome

Pregnant women are commonly being prescribed opioids - narcotic pain relievers such as hydrocodone - which results in an increased likelihood of neonatal abstinence syndrome (NAS), a drug withdrawal syndrome that opioid-related infants experience shortly after birth, according to a study in Pediatrics.

The large retrospective cohort study, led by a team at Vanderbilt University Medical Center, also study found that opioid type and duration of exposure combined with tobacco use or selective serotonin reuptake inhibitor use (for treating depression and anxiety) augmented risks for NAS.

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Lead author Stephen Patrick, MD, MPH, assistant professor of Pediatrics and Health Policy in the Division of Neonatology with the Monroe Carell Jr. Children’s Hospital at Vanderbilt, and colleagues looked at 3 years of data from TennCare, Tennessee’s Medicaid program, and assessed records for 112,029 pregnant mothers. over 30% of women were prescribed at least 1 opioid pain reliever in pregnancy. Of the babies with NAS, 65% had mothers that legally filled prescriptions for opioid pain relievers. Infants exposed to opioids were more likely to be born low birthweight and with complications.

Dr Patrick“We also wanted to look at what might change an infant's risk of developing drug withdrawal,” Dr Patrick said. “We found that duration of short-acting opioid [ie, hydrocodone], number of daily cigarettes smoked, and selective serotonin reuptake inhibitor use all increased risk of NAS.”

The study shows that compared to women with no opioid exposure, the pregnant women who took opioid pain relievers were more likely to be white, have anxiety or depression, suffer from headache or migraine and have musculoskeletal disease. Ninety-six percent of the women prescribed opioids were prescribed short-acting medications, while 2% received maintenance doses and less than 1% received long-acting opioids.

“Managed care organizations need to focus on working with providers to ensure that opioid prescribing in pregnancy is necessary and appropriate,” he said. “Infants exposed to opioids are at an increased risk for costly complications. When possible, short-acting opioid use should be limited and smoking cessation efforts should be encouraged.”

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Nationwide, the amount of prescriptions for opioid drug use has quadrupled. In 2012, an estimated 259 million prescriptions were written for opioid pain relievers in the United States. As a population, every $1 spent on short-acting opioid pain relievers was associated with $50 spent caring for infants with drug withdrawal. National healthcare expenditures for treating babies with NAS are estimated to be about $720 million a year, according to previous work done by the same researchers.

Tennessee began taking action against overprescribing and doctor shopping for opioids in 2006 when it created a prescription monitoring database, though it was an optional resource for providers and pharmacists. The state strengthened laws in 2013, mandating that providers and pharmacists use the system. Currently 49 states have similar drug monitoring programs. Missouri is the only state without one.

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