Rural Babies Increasingly Affected By Opioid Epidemic Interview with:
Nicole Villapiano, MD, MSc

Robert Wood Johnson Clinical Scholar
Internal Medicine/Pediatrics
Institute for Healthcare Policy & Innovation
University of Michigan What is the background for this study? What are the main findings?

Response: Over the past few years, research has highlighted that the opioid epidemic is accelerating at a rapid pace across the United States, including in rural areas. What we don’t know is how the opioid crisis is affecting rural moms and their infants.
As a doctor that takes care of kids, I was concerned about this. So our team took on this study to explore the differences in rates of maternal opioid use and neonatal abstinence syndrome in rural and urban areas of the US from 2004-2013.

Neonatal abstinence syndrome is what happens to babies who are exposed to opioids in their mothers’ womb. When these babies are born and no longer have opioid exposure from mom, they go through a period of opioid withdrawal. These babies can have symptoms that range from difficulty taking a bottle, jitteriness, difficulty sleeping, irritability, and discomfort to more serious problems like prematurity, difficulty breathing, and seizures. Symptoms can last several days to many weeks. Babies with neonatal abstinence syndrome are in the hospital longer than the average newborn, and sometimes require special treatment to help control their symptoms. What is the background for this study? What are the main findings?

Response: Our study showed that in 2004, that rate of neonatal abstinence cases in the United States was the same in rural and urban areas. Back then, for every 1000 babies born, one would be born with neonatal abstinence syndrome. In the ten years that followed, we know that rates of Neonatal Abstinence Syndrome increased across the board, but we saw that in rural areas, there was a nearly 7-fold increase in neonatal abstinence syndrome, whereas in urban areas the increase was under a 4-fold. What should readers take away from your report?

Response: This study alerts us to the growing problem of opioid use in rural areas. Our research shows that the opioid crisis in the US is having an impact on pregnant women and their children, and unfortunately, rural areas, which we know don’t have the resources to deal with these problems, have been hit the hardest. What recommendations do you have for future research as a result of this study?

Response: There are three main things we can do to respond to the disproportionate increase in neonatal abstinence syndrome in rural areas.
First, we need to be develop creative solutions aimed at preventing opioid abuse in rural communities.
Second, we need to more uniformly help rural moms with opioid addiction and dependency get appropriate treatment during pregnancy.
Third, we should equip rural communities with the skills and workforce to holistically support mom and baby after birth. Is there anything else you would like to add?

Response: This summer, the Comprehensive Addiction and Recovery Act was signed into law, and we now have the opportunity in to make sure that these provisions are working to protect rural moms and babies.

This law describes policies that promotes creation of an opioid abuse grant program with emphasis on getting funding to rural areas hardest hit by the opioid crisis. It also includes provisions specifically aimed at improving access to treatment for pregnant women using opioids.

The opioid funding passed in the 21st Century Cures act this week would be put to good use implementing the provisions of CARA.

It’s my sincere hope that as the new administration takes a closer look at their health priorities in the coming months, that addressing the root causes of rural-urban health disparities like we see with neonatal abstinence syndrome moves towards the top of their list. Thank you for your contribution to the community.


Villapiano NLG, Winkelman TNA, Kozhimannil KB, Davis MM, Patrick SW. Rural and Urban Differences in Neonatal Abstinence Syndrome and Maternal Opioid Use, 2004 to 2013. JAMA Pediatr. Published online December 12, 2016. doi:10.1001/jamapediatrics.2016.3750

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on December 12, 2016 by Marie Benz MD FAAD