New findings from an American research team indicate that even short-term use of prescription opioid medications during pregnancy can lead to neonatal abstinence syndrome, a condition normally associated with illicit/illegal opioid drug consumption. Researchers, addiction specialists and public health officials are well aware that improper consumption of any opioid (whether classified as a street drug or a medication) can lead to problems associated with uncontrolled opioid addiction. In a study published in April 2015 in the journal Pediatrics, researchers from several American institutions gauged the impact that even short-term, legitimate use of an opioid medication during pregnancy has on the odds that a newborn child will experience an opioid withdrawal-based condition called neonatal abstinence syndrome (NAS).
Opioid Withdrawal
All opioid drugs and medications can produce dependence and addiction by making lasting alterations in the chemical output of an interconnected brain area called the pleasure center. People dependent on an opioid substance have a physically established need to keep using that substance, but generally don’t suffer negative consequences related to this need. In contrast, people affected by opioid addiction have dependence accompanied by a dysfunctional and uncontrolled level of opioid intake. Opioid-dependent and opioid-addicted people share at least one prominent attribute: a susceptibility to opioid withdrawal when their brains don’t receive the accustomed amount of an opioid drug or medication. Withdrawal is a collection of symptoms (i.e., a syndrome) that essentially functions as a warning from the brain that it’s not getting its established substance-related needs met. In a person affected by opioid use disorder (diagnosable opioid abuse and/or addiction), the presence of withdrawal constitutes one of 11 potential symptoms of his or her condition. Whether they appear in an addicted or physically dependent person, early stage indications of opioid withdrawal include problems such as sleeplessness, an anxious or agitated mental state, excessive sweat or tear production, achy muscles and a runny nose. Late-stage indications of withdrawal in opioid consumers include diarrhea, stomach or abdominal cramps, nausea and vomiting, the involuntary skin response known as “goose bumps” and pupil dilation.
Neonatal Abstinence Syndrome
When a pregnant woman consumes any one of a range of addictive, mind-altering substances, that substance will ultimately pass through filters inside the placenta and enter the fetal bloodstream. Neonatal abstinence syndrome occurs when a newborn accustomed to the presence of an opioid substance in his or her bloodstream loses access to that substance at birth and subsequently goes through withdrawal. Symptoms commonly associated with the onset of NAS include diarrhea, fever, muscle tremors and convulsions, an inability to feed properly, unusually strong muscle reflexes, repeated crying, sweating, vomiting, poor weight gain and unusually mottled skin. Depending on the impact of a range of factors, neonatal abstinence syndrome can last for as little as a few days or for as long as half a year.
Prescription Opioids and NAS
In the study published in Pediatrics, researchers from Vanderbilt University, the Vanderbilt Center for Health Services Research, the Tennessee Department of Health and the U.S. Department of Veterans Affairs assessed the potential of opioid painkiller use during pregnancy to set the stage for neonatal abstinence syndrome in newborn babies. The researchers undertook this project, in part, to compare the NAS risks associated with legitimate opioid medications to the NAS risks associated with the use of opioid street drugs. They also wanted to explore the ramifications of a widespread spike in opioid medication prescribing in the first 10-plus years of the 21st century. The researchers used data gathered from 112,029 pregnant women living in Tennessee in 2009, 2010 or 2011; 31,354 of these women legitimately used an opioid medication at least once during their pregnancies. After analyzing their data, the researchers concluded that prescription opioid use during pregnancy is “strongly associated” with the onset of neonatal abstinence syndrome. In turn, the researchers linked the presence of NAS to unusually low birth weight in affected children. In addition to consuming prescription opioids for even a short amount of time, women particularly likely to give birth to newborns with the syndrome share factors that include cigarette use and consumption of antidepressant medications known as SSRIs (selective serotonin reuptake inhibitors). Whether or not their children develop NAS, women who use prescription opioids while pregnant are also more likely to smoke cigarettes, have a history of depression and/or have a history of a diagnosable anxiety disorder.
