Treating infants of mothers with opioid dependence

As more infants are born to mothers with dependence on prescription pain medications, the costs of treatment for babies with neonatal abstinence syndrome (NAS) have increased dramatically, suggests a report in the March/April issue of the Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine. The journal is published by Wolters Kluwer.

“At our institution, costs associated with treating infants with NAS are exponentially higher than the costs associated with infants not affected,” write Dr. Kay Roussos-Ross, Assistant Professor of Obstetrics and Gynecology, and colleagues of University of Florida College of Medicine, Gainesville. The researchers believe their findings support recent recommendations to screen or test for substance use in pregnant women.

Rising Treatment Costs for Neonatal Abstinence Syndrome

Nonmedical use of prescription opioid pain medications during pregnancy has increased fivefold since the late 1990s, according to a recent study. Some infants born to women with opioid use disorder will develop neonatal abstinence syndrome — symptoms and complications related to withdrawal from the opioid pain medication to which they were exposed in utero.

Dr. Roussos-Ross and coauthors analyzed cost trends for infants with NAS at one university-affiliated hospital between 2008 and 2011. They identified 160 opioid-exposed newborns: 40 in the first year of the study, 57 in the second year, and 63 in the third year.

Ninety-five of the infants were exposed to “opioid agonist” drugs — methadone or buprenorphine — given during pregnancy to treat the mother’s opioid use disorder. The rest were exposed to various “short-acting” prescription opioids taken illicitly by the mother.

In each year, about 50 to 60 percent of opioid-exposed infants developed symptoms of NAS. These infants remained in the hospital after birth for an average of 23 days, compared to the usual post birth stay of one or two days for a normal healthy newborn. For opioid-exposed infants who did not develop opioid withdrawal symptoms, the average hospital stay was about five days.

The total costs of treatment for NAS rose sharply: from about $1.1 million in the first year, to $1.5 million in the second year, to $1.8 million in the third year. These costs were 15 to 16 times higher than of healthy infants.

The rising rates and costs of NAS reflect the ongoing “opioid epidemic” in the United States. The results add to other recent studies showing high costs for treatment for babies born to women with opioid dependence. Those previous studies found that most of the costs are paid by state Medicaid programs.

Dr. Roussos-Ross and coauthors suggest some steps to help address the high financial and human costs associated with neonatal abstinence syndrome. They encourage doctors to be “proactive in screening for drug use, urging women who use chronic opioids to actively engage in family planning and contraception, and encouraging pregnant women who use opioids to seek substance treatment.”

The researchers note that although universal screening for drug use during pregnancy has been recommended by major specialty organizations, it is not yet standard practice. They also call for studies to improve the management of NAS and for follow up of evidence that buprenorphine may lead to better treatment outcomes, in comparison to methadone, in the treatment of pregnant women with opioid use disorder.

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New test detects drug use from fingerprints

Research published in the journal Analyst has demonstrated a new, non-invasive test that can detect cocaine use through a simple fingerprint. For the first time, this new fingerprint method can determine whether cocaine has been ingested, rather than just touched.

Led by the University of Surrey, a team of researchers from the Netherlands Forensic Institute (NL), the National Physical Laboratory (UK), King’s College London (UK) and Sheffield Hallam University (UK), used different types of an analytical chemistry technique known as mass spectrometry to analyse the fingerprints of patients attending drug treatment services. They tested these prints against more commonly used saliva samples to determine whether the two tests correlated. While previous fingerprint tests have employed similar methods, they have only been able to show whether a person had touched cocaine, and not whether they have actually taken the drug.

“When someone has taken cocaine, they excrete traces of benzoylecgonine and methylecgonine as they metabolise the drug, and these chemical indicators are present in fingerprint residue,” said lead author Dr Melanie Bailey from the University of Surrey. “For our part of the investigations, we sprayed a beam of solvent onto the fingerprint slide (a technique known as Desorption Electrospray Ionisation, or DESI) to determine if these substances were present. DESI has been used for a number of forensic applications, but no other studies have shown it to demonstrate drug use.”

Researchers believe that the applications for this test could be far-reaching. Drug testing is used routinely by probation services, prisons, courts and other law enforcement agencies. However, traditional testing methods have limitations. For example, blood testing requires trained staff and there are privacy concerns about urine testing. Where bodily fluids are tested, there can be biological hazards and often a requirement for particular storage and disposal methods. Often these tests also require analysis off-site.

“The beauty of this method is that, not only is it non-invasive and more hygienic than testing blood or saliva, it can’t be faked,” added Dr Bailey. “By the very nature of the test, the identity of the subject is captured within the fingerprint ridge detail itself.”

It is anticipated that this technology could see the introduction of portable drug tests for law enforcement agencies to use within the next decade.

“We are only bound by the size of the current technology. Companies are already working on miniaturised mass spectrometers, and in the future portable fingerprint drugs tests could be deployed. This will help to protect the public and indeed provide a much safer test for drug users,” said Dr Bailey.