Wednesday, May 2, 2012

Neonatal Abstinence Syndrome: Now I'm Really Mad

Now I'm really mad. 

For the last several years here at PRIUM, we've been working on the issue of prescription drug over-utilization.  We've confronted the issues of tolerance, dependence, and addiction and worked hard to develop solutions to help providers, patients, and payers stem the tide of opioid abuse.  We're passionate about what we do and we're known to get more than a little upset about the medical, societal, and economic impact of this seemingly intransigent issue. 

But our righteous indignation has reached new heights today as we've reviewed the new study from the Journal of the American Medical Association (JAMA) regarding neonatal abstinence syndrome (NAS).  According to JAMA, NAS is a "drug withdrawal syndrome in newborns following birth... characterized by a wide array of symptoms including increased irritability, hypertonia, tremors, feeding intolerance, emesis, watery stools, seizures, and respiratory distress." 

The statistics are sobering.  The study found that 16.2% of pregnant teens engage in some form of illicit drug use (7.4% among pregnant women aged 18 to 25).  The symptoms described above occur in about 60% to 80% of newborns exposed to opiates in utero.  Even worse, perhaps, than the incidence rates is the growth of the problem. The study is longitudinal in nature and tracked the incidence of NAS from 2000, 2003, 2006, and 2009.  In 2000, antepartum maternal opiate use occurred in 1.19 births per 1,000.  In 2009, that grew to 5.63 births per 1,000.  That's a 373% increase in less than a decade. 

Most of our cases come from work comp and I'm quite certain we don't see a  lot of pregnant mothers in our flow of cases.  I'm equally certain that OB/GYN docs aren't regularly prescribing opiates to expectant mothers.  The issue highlighted by JAMA is more an issue of illicit/illegal drug use.

But it speaks to the larger epidemic (and I don't use that word lightly - the CDC calls prescription drug misuse/abuse an epidemic).  I have no data to support this, but some portion of the drugs consumed by pregnant mothers are likely prescribed "legally," but eventually diverted.  These drugs are causing harm well beyond the direct costs associated with long term opioid use.  Perhaps if you suspect abuse/misuse/diversion on a particular claim, you might think about where those drugs might ultimately be consumed. 

So add another cost to the epidemic of opioid abuse.  Perhaps the saddest cost yet.

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