More Drug-Dependent Babies Are Born in Rural Areas, According to Study

By Paul Gaita 12/16/16

Maternal opioid use was nearly 70% higher in rural towns and counties than in urban areas.

Doctor holding the head of newborn baby.

As opioid use among pregnant women continues to rise, so too has the number of babies born with drug dependencies, taxing the funds and resources of hospitals and their neonatal intensive care units (NICUs). But a new study has shown that the vast majority of these infants are being born in rural areas, though urban regions have also experienced an uptick in dependent babies.

The study was published on Dec. 12 in JAMA Pediatrics, and showed that between 2004 and 2013, the number of babies born with drug dependency increased from 1.2 per 1,000 hospital births to 7.5 per 1,000.

The number of babies born dependent in urban areas rose during the same period from 1.4 per 1,000 to 4.8. Additionally, in 2012, maternal opioid use was nearly 70% higher in rural towns and counties than in urban areas.

Their findings corroborate recent data from a federal report which found that between 2012 and 2013, states with large rural areas like West Virginia and Maine experienced high rates of neonatal abstinence syndrome, a condition in which infants experience withdrawal symptoms including seizures and difficulty in feeding. A second study, published in 2014, showed that a significant number of pregnant women on Medicaid in states like Utah and Idaho were prescribed opioids to treat back and/or abdominal pain due to pregnancy.

NICUs must now devote more of their efforts to caring for dependent infants. A study published by the New England Journal of Medicine in 2015 found that on a national level, staff hours devoted to these babies has risen from less than 1 to 4%. In some areas, NICUs now devote between 10 and 20% of their time treating these infants.

The burden is far more challenging for rural-area hospitals. As Dr. Alison V. Holmes, associate professor of pediatrics at the Geisel School of Medicine noted, "Typically, rural hospitals that deliver babies have traditionally focused on the lower-risk population in areas they serve. 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."

That strain includes the financial toll taken by increased care for dependent babies. A study by the Journal of Perinatology found that hospital costs for treating newborns with dependency issues rose from $732 million in 2009 to $1.5 billion in 2013.

President Obama made efforts to provide a solution to the problem by signing the Comprehensive Addiction and Recovery Act (CARA) into law this year, which carried a requirement for federal officials to fund programs that would improve treatment for pregnant women in rural areas. But a host of problems need addressing, including the availability of treatment drugs like methadone and buprenorphine, which are less easily obtained in such areas.

For many medical professionals, the core issue remains the reduction of opioid abuse. According to Dr. Anne Johnston, associate professor of pediatrics at the University of Vermont, "One has to appreciate that behind every incidence of neonatal abstinence syndrome, which is relatively easy to recognize and relatively easy to treat, there’s a case of a mother dependent on opioids, and that’s complex to treat."

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.