An Ounce of Prevention for Mothers and Newborns: Reducing In-Utero Opioid Exposure in Missouri

Infants born with severe opioid withdrawal resulting from maternal use during pregnancy often suffer from Neonatal Abstinence Syndrome. NAS is estimated to occur in 55 to 94 percent of neonates among mothers who either misused or were prescribed opioids to manage pain during pregnancy. Harm to the infant can occur during the pregnancy and following delivery. Prior to birth, fetuses with opioid exposure are more likely to experience structural growth abnormalities and miscarriage. Infants with NAS experience higher neonatal intensive care unit admission rates and an average hospital stay of 17 days at birth. In addition, depending on the severity of the mother’s opioid use, 60 to 80 percent of newborns with NAS require pharmacological treatment to physically support the infant through the withdrawal until opioids are out of the system.

The Medicaid program pays for more than eight out of every 10 newborns with NAS in Missouri. It is estimated that the additional hospital costs associated with NAS for labor, delivery and neonatal care amounted to $10 million in additional spending by Missouri’s Medicaid program in 2016 alone. New data and surveillance techniques designed to detect the actual prevalence of NAS in Missouri suggest this figure could be underestimated by a factor of as much as four.

During its 2018 regular session, the Missouri General Assembly enacted legislation that provides Medicaid coverage up to 12 months of additional postpartum substance abuse and related mental health treatment to new mothers. To qualify, the mother must receive substance abuse treatment within 60 days after giving birth and must adhere to the treatment. The coverage is subject to state appropriations and federal authorization. This approach to treating the growing epidemic of substance use disorder in Missouri will positively impact outcomes for thousands of families across the state while saving the health care
system long-term, downstream costs. However, similar legislative action could be targeted upstream, to prevent the increasing incidence of Missouri infants exposed to opioids before birth.

Taking steps to ensure potential, expectant and new mothers have the resources needed to overcome substance use disorder is a critical step to reducing health care and societal costs associated with NAS. Providing low-income, uninsured women with substance use recovery resources before pregnancy occurs, or as early in the pregnancy as possible, would prevent NAS from occurring — dramatically improving outcomes for these children and potentially saving the system millions in downstream medical, social services, foster care, law enforcement and educational spending.