Opioid Epidemic - Risk of birth defects and Neonatal Abstinence Syndrome Questions & Answers

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Opioid Epidemic - Risk of birth defects and Neonatal Abstinence Syndrome

Questions & Answers


According to United States Government Accountability office as of October 2017. * Opioid misuse, including the use of heroin and misuse of opioids prescribed for pain management, has been recognized by the federal government, states, researchers and others as a growing crisis in the United States. Opioid misuse has increased in recent years, so has the number of pregnant women who use opioids. The prenatal use of opioids by pregnant women- including opioid misuse, use of opioids prescribed for pain management, and use of certain medications given to treat opioid addiction- came produce certain disorders. 

Can prescribed opioids cause Birth defects?

As reported in the American Journal of Obstetrics and Gynecology Journal and consistent with previous investigations reported an association between early pregnancy maternal opiate analgesics in certain birth defects.  Links between maternal first trimester use of opioid analgesics and congenital heart defects in infants were found in three of four previous case-control studies.  Other studies have shown associations between first trimester opioid use and other defects such as oral facial clefts. *

What causes neonatal abstinence syndrome?

Almost every drug passes from the mother's blood stream through the placenta to the fetus. Illicit substances that cause drug dependence in the mother also cause the fetus to become dependent. At birth, the baby's need on the substance continues. However, since the drug is no longer available, the baby's central nervous system becomes overstimulated causing the symptoms of withdrawal.

Some drugs are more likely to cause NAS than others, but nearly all have some effect on the baby. Prescription Opiates, such OxyContin and non-prescribed opiates as heroin and methadone, cause withdrawal in over half of babies exposed prenatally.  Alcohol use causes withdrawal in the baby, as well as a group of problems including birth defects called fetal alcohol spectrum disorders (FASDs).

Has there been an increase in Opioid Prescriptions?

Opioid pain reliever sales quadrupled in United States from 1999 to 2010. From 2000 to 2014 opioid related overdoses among US adults increased to hundred percent. Opioid use to this during pregnancy has increased nationally in recent years. The prevalence of opioid use or dependence among pregnant women has increased from 1.7 per thousand delivery admissions in 1998 to 3.9 per thousand delivery admissions in 2011. Reflective of increasing maternal opioid exposure, the incidence of neonatal abstinence syndrome has increased approximately 400% nationally. *

Is there a connection between prescription opioid use and non-medical opioid abuse?

The nonmedical use of prescription opioids has become a significant public health issue throughout the country.  Not only because of the numbers of people using and abusing prescription opiates but also because of the increase rise of deaths from overdoses and related traumatic events.  In a relatively recent article in The New England Journal of Medicine “Relationship between Nonmedical Prescription-Opioid Use and Heroin Use” researchers found that heroin users were 3.9 times as likely to report nonmedical use of opioids in the previous year, and 2.9 times as likely to meet the criteria for abuse or dependence on opioids, as persons who did not use heroin.  Other studies noted that nonmedical use of multiple was associated with transitioning to heroin. Similarly, another study found that the incidence of heroin use among people who reported prior nonmedical use of prescription opioids was 19 times as high as the incidence among persons who reported no previous nonmedical use.  Additional studies involving persons from various geographic, economic, and drug-using backgrounds have shown similar patterns. 

In 2003, early researchers found that in Ohio, 50% of persons 18 to 33 years of age who had recently begun using heroin reported having abused opioids, primarily OxyContin, before initiating heroin use. A larger study involving young urban people who used injected heroin in New York and Los Angeles in 2008 and 2009 showed that 86% had used opioids non-medically before using heroin. Similar studies conducted in San Diego, Seattle, and New York showed that 40%, 39%, and 70% of heroin users, respectively, reported that they had used prescription opioids non-medically before initiating heroin use

Sadly, it appears that the analysis of patterns of nonmedical use of prescription opioids suggests that persons most often start with medical use of opioids.  Once they develop tolerance or access becomes harder, they move to more “efficient” routes of administration, such as smoking, injection or inhaling. By the time these individuals start heroin use, they find heroin to be more easily available, more potent, and more cost-effective than prescription opioids. Adding to this tragedy, is the effects of opioids on pregnant women and the complications that arise for their babies. 

• GAO - United states government accountability office- report to Congress “Newborn Health” October 2017.
• American Journal of Obstetrics and Gynecology.  “Maternal treatment with opioid analgesics and risk birth defects”. April 2011.
• Centers for Disease Control: grand rounds; “Public Health Strategies to Prevent Neonatal Abstinence Syndrome”; MMRW March 10, 2017
• New England Journal of Medicine. “Relationship between nonmedical prescription opioid use and heroin use”. January 14, 2016

Ms. Ramsey’s professional experience began as a Registered Nurse at Yale New Haven Hospital. While pursuing her Bachelor’s Degree, she was a counselor with the New Haven Rape Crisis Program.   Ms. Ramsey graduated from CUNY Law School, and is admitted in several different bars and continues toactively advocated for victims of health care negligence and defective medical devices.  She continues to speak and present publications for a number of organizations, including nursing and legal institutions. She received the Arnold Markle award by the Judicial District in New Haven, Connecticut, for her work with survivors of sexual assault.  She is a member of the Palm Beach County Sober Home Task Force, a Compliance Committee Member of the Florida Association of Recovery Residences and advocates for victims and survivors of substance use disorders.  Ms. Ramsey actively litigates cases involving catastrophic injuries and wrongful death on behalf of victims.

By Susan Ramsey