Health Policy and Advocacy
Neonatal Abstinence Syndrome: Update on Federal Legislation and Organizational Initiatives
Julie Sundermeier, DNP APRN NNP-BC
It is estimated that every 25 minutes a baby is born suffering from neonatal abstinence syndrome (NAS) or opioid withdrawal (U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, n.d.). Maternal exposure to opioids can be caused by both nonprescription and prescription medication for pain control, but the subsequent neonatal withdrawal has resulted in an increased length of stay, higher hospital costs, and variable neonatal treatment approaches. The federal government is taking steps to combat NAS, which increased nearly five-fold from 2000 to 2012 (Patrick et al., 2012), and to improve public awareness of this epidemic.
- The Nurturing and Supporting Healthy Babies Act is the most recent legislation regarding NAS. This bipartisan bill was introduced in April 2016, with bills in both the House of Representatives (H.R. 4978) and the Senate (S. 2872). The Nurturing and Supporting Healthy Babies Act, or NAS Healthy Babies Act, would expand knowledge of the care of NAS babies, including the prevalence of NAS in the United States, the number of NAS babies covered by Medicaid, the settings for care for NAS babies, and access to care for NAS babies under state Medicaid programs. The bill also directs the Government Accountability Office to identify any federal obstacles to care for NAS babies.
- The Centers for Disease Control and Prevention (CDC) recently published the CDC Guideline for Prescribing Opioids for Chronic Pain. This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses (1) when to initiate or continue opioids for chronic pain; (2) opioid selection, dosage, duration, follow-up, and discontinuation; and (3) assessing risk and addressing harms of opioid use. This report contains recommendations specific to pregnant women (Dowell, Haegerich, & Chou, 2016).
- The CDC’s Treating for Two initiative aims to improve the health of women and babies by providing a site for professionals and mothers to identify the safer medication to use if pregnant, including the use of opioids during pregnancy. The initiative aligns with three key drivers of safer medication use in pregnancy: better research, reliable guidance, and informed decisions (CDC, 2016).
- The Cradle Act is another bill recently introduced in both the House (H.R. 3685) and Senate (S. 2542). This bill would direct the Centers for Medicare and Medicaid Services to establish new guidelines for residential pediatric recovery centers that treat babies with NAS. The Cradle Act also recognizes the importance of counseling, specialized training, and other activities that encourage bonding between infants and new mothers.
- The Protecting Our Infants Act of 2015 was successfully passed by Congress and signed into law on November 25, 2015. This legislation will help identify evidence-based approaches to prevention and care for NAS babies and their mothers, while cataloguing the long-term effects of prenatal opioid exposure on children. In addition, the law authorizes the CDC to provide technical assistance to states to improve the availability and quality of data collection and surveillance activities regarding NAS (March of Dimes, 2015).
As neonatal caregivers, we can advocate for our patients and families and support legislation to reduce the incidence of NAS. You can follow the progress of current legislation at https://www.congress.gov.
Centers for Disease Control and Prevention. (2016). Treating for two. Available at http://www.cdc.gov/pregnancy/meds/treatingfortwo/index.html. Accessed May 3, 2016.
Cradle Act, H.R. 3865, 114th Congress (2015–2016).
Cradle Act, S. 2542, 114th Congress (2016).
Dowell, D., Haegerich, T. M., & Chou, R. (March 18, 2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. Morbidity and Mortality Weekly Report (MMWR), Recommendations and Reports, 65(1), 1–49. doi: http://dx.doi.org/10.15585/mmwr.rr6501e1
March of Dimes. (2015). Protecting Our Infants Act of 2015 (S. 799/H.R. 1462) [Fact sheet]. Retrieved from www.marchofdimes.org/materials/Protecting-Our-Infants-Act-Fact-Sheet-May-2015.pdf. Accessed May 3, 2016.
NAS Healthy Babies Act, H.R. 4978, 114th Congress (2015–2016).
NAS Healthy Babies Act, S. 2872, 114th Congress (2016).
U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse. (n.d.). Dramatic increases in maternal opioid use and neonatal abstinence syndrome. Retrieved from www.drugabuse.gov/related-topics/trends-statistics/infographics/dramatic-increases-in-maternal-opioid-use-neonatal-abstinence-syndrome. Accessed May 3, 2016.
Patrick, S. W., Schumacher, R. E., Benneyworth, B. D., Krans, E. E, McAllister, J. M., & Davis, M. M. (2012). Neonatal abstinence syndrome and associated health care expenditures: United States, 2000–2009. JAMA,307(18), 1934–1940. doi:10.1001/jama.2012.3951.