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Rise In Drug-Dependent Newborns Tied To Rural Areas, Study Finds

An increase of drug dependency among newborns is largely being driven by use of opioids among women in rural areas, a new study finds.

Research out Monday documents instances of neonatal abstinence syndrome — when a newborn is dependent on drugs and undergoes withdrawal — increasing at higher rates in rural areas than in urban areas.

Newborns suffering from chemical dependency accounted for 7.5 per 1,000 hospital births in rural counties in 2013, up from 1.2 per 1,000 in 2004. By comparison, urban areas only saw an increase from 1.4 births per 1,000 to 4.8 per 1,000.

"While some state-level data has suggested that neonatal abstinence syndrome disproportionately affected rural counties, this is the first study to show that rural communities throughout America are particularly affected by this epidemic," said Dr. William Carey, a pediatric researcher cited by Reuters, who was not involved with the study.

The study also found opioid abuse caused more delivery-related complications in rural counties: 8.1 per 1,000 births by 2013 in rural hospitals, compared with 1.3 in 2004. Urban areas only saw an increase to 4.8 per 1,000 births from the 2013 rate of 1.6. Moreover, mothers struggling with opioid use often had lower incomes and were on public health assistance in rural areas.

Neonatal abstinence syndrome mostly affects newborns exposed to opioid use while in the uterus, according to the CDC. Symptoms can include seizures, fever and tremors with treatment programs often using methadone to wean the newborns off of dependency. Nationwide, cases have been on the rise with Vermont and West Virginia, in particular, showing rates of more than 30 births per 1,000 over the past few years.

But this recent study, published in JAMA Pediatrics, is the first to pin down the increase between rural and urban environments.

"Prior to our study, we had limited data from a few states like West Virginia and Tennessee that showed rising rates of neonatal abstinence syndrome in some rural counties," says lead study author Dr. Nicole Villapiano as quoted by Reuters. "What we didn't know was how the opioid crisis has affected rural moms and their infants across the country."

Researchers note that better reporting of infants' conditions could play a factor, "but this is unlikely to account for the rural/urban disparities" found in the study.

The New York Times adds:

"'The problem is accelerating in rural areas to a greater degree than in urban areas,' said Dr. Veeral Tolia, a neonatologist who works at Baylor University Medical Center who was not involved in the new report. ...

"This latest report, published in JAMA Pediatrics, concludes that for the first time, the increase in drug-dependent newborns has been disproportionately larger in rural counties.

"In the 1970s, withdrawal symptoms affected mostly babies of heroin-addicted mothers in cities such as Philadelphia and New York, Dr. Tolia said, adding, 'What this study shows is this has totally flipped.' "

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Jason Slotkin