The number of babies born addicted to opioids has increased at a much higher rate in rural communities than in urban areas, according to a new study published in the journal JAMA Pediatrics.
The findings also show that rural mothers and infants with opioid-related diagnoses were more likely to come from lower-income families, have public health insurance, and must often transfer to another hospital following delivery.
Over the last two decades, the U.S. has seen a surge in prescriptions for opioid pain relievers like Vicodin and Opana. In recent years, opioid-related complications, both from painkillers and street drugs like heroin, significantly increased in the U.S., including among pregnant women and their infants.
Newborns exposed to opioids in the womb may experience painful withdrawal symptoms after birth, known as neonatal abstinence syndrome. Symptoms include seizures, low birthweight, breathing, sleeping, and feeding problems. These infants have higher risk of adverse outcomes and longer, costlier hospital stays compared to healthy infants.
“The opioid epidemic has hit rural communities especially hard and we found that these geographical disparities also affect pregnant women and infants,” says lead author Nicole Villapiano, M.D., a pediatrician at University of Michigan C.S. Mott Children’s Hospital.
“Our study highlights an urgent need to fund providers and programs that will help improve access to opioid prevention and treatment services for rural women and children. Maternal opioid use requires special attention given the poor outcomes and high costs. If we can provide resources to the areas that need them the most, we can do more on the frontlines to address the opioid crisis for our most vulnerable patients.”
For the study, researchers from the University of Michigan C.S. Mott Children’s Hospital and Monroe Carell Jr. Children’s Hospital at Vanderbilt University tracked newborns treated for opioid-related complications over 10 years.
They discovered that in rural areas, the rate of newborns with neonatal abstinence syndrome increased from nearly one case in 1,000 births from 2003-2004 to 7.5 from 2012-2013. This increase is nearly 80 percent higher than the growth rate of such cases in urban communities.
The findings show that rural infants accounted for over 21 percent of all infants born in the U.S. with neonatal abstinence syndrome between 2012 and 2013 — a large spike from 2003 when rural infants made up only 13 percent of the neonatal abstinence syndrome cases.
The nation saw similar regional trends in maternal opioid use. In 2012, maternal opiate use in rural counties was nearly 70 percent higher than in urban areas — eight per 1,000 childbirth hospitalizations compared to 4.8 in urban counties.
Furthermore, the researchers found that compared to urban peers, rural infants, and mothers with opioid-related diagnoses were more likely to come from lower-income families, have public insurance, and be transferred to another hospital following delivery.
Villapiano says that families in urban areas typically have better access to treatment and addiction services that can help affected babies have better outcomes.
“We need to consider what kind of support moms with opioid disorders have in rural communities,” she says.
After a baby is born with signs of opioid withdrawal, it is important that community hospitals are adequately staffed and resourced to treat women and infants impacted by opioid use, the authors note.
“As a nation, there is an urgent need to develop strategies tailored to rural communities focused on prevention and expansion of treatment,” says senior author Stephen W. Patrick, M.D., M.P.H., M.S., assistant professor of pediatrics and health policy at Vanderbilt University.
“We need to develop means to support rural hospitals, especially critical access hospitals, that are on the front lines in providing care for mothers and infants impacted by the opioid epidemic.”