States Consider Neonatal Abstinence Syndrome Prevention and Treatment

February 04, 2020|10:49 a.m.| ASTHO Staff

Opioid abuse or dependence among pregnant women has doubled over the years, with an increase of 1.7 per 1,000 delivery admissions in 1998 to 3.9 in 2011. Exposure to opioids in utero can lead to neonatal abstinence syndrome (NAS), a withdrawal syndrome in newborns with symptoms that include tremors, irritability, feeding difficulties, vomiting, dehydration, and increased sweating. Cases of NAS grew from 1.2 to 5.8 per 1,000 hospital births between 2000 and 2012.

A baby was born with NAS every 15 minutes in 2014. In addition to poor health outcomes, NAS also results in increased costs and burdens on hospitals, particularly on neonatal intensive care units (NICU). In 2012, a full-term infant without complications had an average length of stay of two days and hospital charge of $3,500. An infant with NAS had an average hospital stay of almost 17 days and hospital charge of $66,700. Infants with NAS cost hospitals an estimated $1.5 billion in 2012, with Medicaid programs paying for about 80 percent of those cases. While NAS is often associated with exposure to opioids, it’s important to note that it can also be caused by exposure to medication assisted therapy (MAT), cocaine, amphetamines, or barbiturates during pregnancy—NAS should be viewed in relation to broader substance use prevention and treatment efforts.

States are adopting a variety of policies to address NAS. In 2019, state legislation trended toward standardizing screening and treatment for mothers and newborns, adding the diagnosis of NAS to the list of notifiable conditions, reporting requirements and safe care plans for infants with NAS and their caregivers. More information about these trends can be found in ASTHO’s State 2020 Legislative Prospectus on NAS. For the 2020 state legislative sessions, ASTHO anticipates more legislation around the development of standardized NAS clinical definitions; guidelines to diagnose and treat NAS; license requirements for specialized NAS treatment facilities; and treatment programs addressing the mother-infant dyad. Below is an overview of proposed NAS-related legislation ASTHO has observed so far this year.

Prevention, Screening, and Treatment
Some states are considering legislation that would create and fund evidence-based screening and treatment addressing substance use during pregnancy and mitigating the effects and costs of NAS. Bills in Delaware (SB 122 and SB 201) would create the Delaware Perinatal Quality Collaborative that would work to improve pregnancy outcomes for women and newborns. In Wisconsin, a set of bills (AB 649 and SB 580) would require the Medical Examining Board to issue guidelines regarding best practices for NAS treatment.

The New York legislature is considering multiple bills addressing screening and treatment of pregnant women for substance use disorder and newborns for NAS. One bill (A 6766) would require the Department of Health to conduct educational and outreach programs on NAS, and include information about the importance of screening, intervention, and counseling for pregnant women. Another bill (A 7955) would enact the “Children and Recovering Mothers (CHARM) Act,” which would provide guidance, education, and assistance to healthcare providers caring for expectant mothers with substance use disorders and would screen newborns for substance abuse exposure. A similar bill (S 7145) would direct physicians to screen newborns for NAS.

The New York legislature is also considering a bill that would enact the “Budgeting for Opioid Treatment in New York Act” which would provide an excise task of one cent per milligram on prescription opiates. The bill would also require that all taxes collected be deposited in the Opiate Addiction Trust Fund that would fund addiction treatment, prevention, and recovery programs--including facilities to provide care for babies born with NAS. West Virginia proposed several bills to fund NAS screening and treatment. Similar to New York’s proposed bill, West Virginia’s SB 622 would impose a tax on wholesale opioid distributors and mail order pharmacies at a rate of one cent per dose. Sixty percent of the tax revenue would be appropriated to the addiction and neonatal addiction care fund. Another bill in West Virginia (HB 4418) would require the secretary of the Department of Health and Human Resources to identify and allocate funds to health care facilities or offer health services to children under one year of age suffering from NAS. Finally, West Virginia’s HB 4420 would create the Opioid Litigation Fund, which would go to children born with NAS and come from funds the state receives from litigation or settlements relating to opioids.

State health agencies can engage with communities, hospitals, and providers to support evidence-based practices to decrease opioid use during pregnancy and prevent NAS. Health agencies can also utilize data, develop education materials, implement outreach programs, and release guidelines to raise awareness and promote impactful interventions. ASTHO will continue to track legislative activity as states continue to advance policies addressing this important public health topic.