According to local health officials, 1 in 4 Huntington, West Virginia residents suffers from an opioid use disorder, in a state with the highest rate of opioid overdose deaths in the nation. In this small Appalachian town with a population of 49,000, located on the banks of the Ohio River, the raging opioid epidemic has directly affected more than 12,000 people, including women of childbearing age and pregnant ones.
Intrauterine exposure to prescription opiate painkillers or illicit opioids i.e. heroin can lead to neurodevelopmental, behavioral and/or phenotypic abnormalities in newborns which are consistent with opiate effect. These innocent babies, the most vulnerable victims of the epidemic, are born plagued by a spectrum of symptoms and signs associated with opioid withdrawal, medically known as the neonatal abstinence syndrome (NAS) whose clinical presentation varies with the maternal drug history, the opioid used as well as maternal, placental and infant metabolism.
Clinical data suggest that NAS will develop in 55% to 94% of newborns exposed in utero to opioids. The severity and incidence of NAS are usually greater in neonates exposed to methadone compared to those exposed to heroin or buprenorphine; still, severe withdrawal symptoms, including seizures have been described in 0-50% of buprenorphine-exposed newborns which peaked at 40 hours of age and were most severe at 70 hours of age.
The onset of symptoms associated with neonatal withdrawal from heroin typically commences within 24 hours of birth, while withdrawal from methadone often begins 24-72 hours of age, but this may be delayed until 7 days of age or later for both opioids. NAS symptoms include CNS irritability or excessive, high-pitched crying, sleep issues, tremors, hyperactive reflexes, seizures, sneezing and yawning as well as gastrointestinal problems such as diarrhea. These symptoms are usually exacerbated by hunger and excess environmental stimuli and they may last up to 6 months.
Dr. Sean Loudin, who serves as medical director of both Lily's Place in Huntington and neonatal therapeutic unit at Cabell Huntington Hospital, has seen first-hand the devastating effects of the opioid epidemic on the next generation, with skyrocketing rates of neonates suffering from NAS. Although a new research letter released this Monday suggests that 7.5 per 1,000 neonates born in rural areas are affected by NAS, Dr. Loudin says he's seeing almost 13 times this rate, with 1 in 10 babies suffering from neonatal withdrawal from heroin or other opioids.
According to this new report titled " Rural and Urban Differences in NAS and Maternal Opioid Use, 2004 to 2013" and published in JAMA Pediatrics journal, incidence rates of NAS increased nearly five-fold in the US between 2000 and 2012. Dr. Nicole Villapiano, a pediatrician from C.S. Mott Children's Hospital at the University of Michigan and the study's lead researcher expressed her concern for the growing disparity between urban and rural areas in terms of NAS.
The study revealed that incidence of newborns plagued by NAS increased from 1.2 to 7.5 per 1,000 births among rural babies and from 1.4 to 4.8 per 1,000 births among urban ones. The proportion of neonates with NAS born in rural areas dramatically increased from 12.9% in 2003 to 21.2% in 2014, nearly a seven-fold increase over the last decade. Dr. Villapiano also noted that the diverging trend emphasizes the urgent, stringent need of policymakers to allocate sufficient funding for programs aimed at improving access to opioid prevention and medication-assisted treatment for rural women struggling with an opioid use disorder.