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1 1 (March 12, 2019)

handle is hein.crs/govyfh0001 and id is 1 raw text is: L Congressional Research Service ~ Informing the legislative debate since 1914 March 12, 2019 Opioid Use and Neonatal Abstinence Syndrome The prevalence of opioid use disorder (OUD)-problematic opioid use leading to clinically significant impairment or distress-among pregnant women has gradually increased as the nation's opioid epidemic has unfolded. This has led to increases in several adverse outcomes for infants, including neonatal abstinence syndrome (NAS). Recent efforts by both Congress and the U.S. Department of Health and Human Services (HHS) have focused on addressing the rising rate of NAS. NAS is a withdrawal syndrome that often occurs when newborns no longer receive a substance, such as an opioid, that was administered in utero. According to a 2014 Pediatrics article focusing on opioid use and NAS, NAS symptoms can occur within 24 to 72 hours of birth and may last up to several months, depending on the type of opioid exposure (e.g., heroin, methadone, or buprenorphine). Such symptoms can include tremors, feeding and sleeping difficulties, temperature instability, and hyperirritability. While other substances (e.g., alcohol) have been associated with NAS, opioids are one of the most common substances associated with this syndrome. According to a 2018 Centers for Disease Control and Prevention (CDC) analysis, the national prevalence (new and existing cases) of OUD during pregnancy increased from 1.5 OUD cases per 1,000 hospital births in 1999 to 6.5 OUD cases per 1,000 hospital births in 2014. New cases (incidence) of NAS have also increased over a similar time period. From a national perspective, a 2012 JAMA study found that the incidence rate of NAS has increased significantly, from 1.2 cases per 1,000 hospital births per year in 2000 to 3.4 cases per 1,000 hospital births per year in 2009. However, the incidence rate of NAS has varied by state (see Figure 1). These select data are among the most recent national and state-level estimates available. Figure I. Incidence Rate of NAS per 1,000 Hospital Births in 25 States, 2012 and 2013 NAScasse 1D00 )hospital births, 2012-2013 ,' H -M - Nodat -. .1 5.0 51-10b 10-1-30.0 >30.0 Source: Ko et al., 2016, Incidence of Neonatal Abstinence Syndrome - 28 States, I999-20I3, MMWR. Note: 2013 incidence rates are reported, except 2012 data reported for four states (Maine, Maryland, Massachusetts, and Rhode Island) without 2013 data. NAS Screening and Treatment No specific NAS screening guideline has been uniformly endorsed or adopted in clinical practice. Health care providers typically diagnose NAS using statistically validated scoring tools (e.g., Finnegan Neonatal Abstinence Scoring Tool) that score severity based on observed symptoms in the infant. Medical literature points to the importance of hospitals and nurseries adopting standard screening protocols, as well as properly training staff on the correct use of validated scoring tools. NAS is a treatable condition that may require both pharmacologic (e.g., methadone) and non-pharmacologic care (e.g., gentle handling and feeding on demand). According to a 2017 Government Accountability Office (GAO) report, there is no national standard of care for NAS treatment. However, the American Academy of Pediatrics (AAP), a professional organization of pediatricians, recommends that infants with NAS should initially be treated with non-pharmacologic care, as pharmacologic treatment may be necessary only for severe cases. In addition, multiple research studies highlight the importance of involving mothers during treatment. The AAP further recommends that case management services (which assist the infant and caregiver in obtaining necessary medical, educational, and other services) can ensure that quality care is provided within each treatment stage. Gaps in Research on Screening and Treatment Several recent reports have identified a lack of research on standardized, uniform screening tools and treatment protocols. In 2016, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) at the National Institutes of Health (NIH) held a workshop with invited experts to review research gaps on opioid use in pregnancy, NAS, and childhood outcomes. The workshop proceedings cited gaps specific to NAS, including the need for more objective screening tools and the most effective types of non-pharmacologic and pharmacologic therapies to use in different clinical scenarios. In 2017, HHS highlighted similar research gaps in screening tools and treatment protocols, including the need for further development of objective screening tools and how exposure to different opioid types and/or other substances during pregnancy may affect the severity and treatment of NAS. According to a 2015 GAO report that examined federally funded research on prenatal drug use, executive agency officials and experts also cited NAS screening and treatment research gaps. Reasons for these gaps included difficulties conducting research among pregnant women with substance use disorders, as well as other research areas beyond prenatal drug use receiving funding priority (the report did not specify these other areas). ittps://crsreports.congress.gov

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