Summary
As prescription opioid use and heroin use has reached epidemic proportions, there has been a corresponding
increase in infants born with neonatal abstinence syndrome (NAS). NAS is a postnatal withdrawal syndrome
usually caused by in utero opioid exposure, and one infant is born every 25 minutes in the United States with
signs of drug withdrawal. Nationally, NAS rates increased nearly five-fold from 2000 to 2012, and substantial
state-to-state and rural/urban variation exists. States have enacted a variety of policy responses to address the
dramatic rise in NAS rates, some of which directly target NAS or women of childbearing age, while others are
designed to decrease the overall number of individuals using opioids or suffering from opioid use disorder.
There has been a paucity of empirical studies examining to what extent different state policy approaches are
associated with variation in NAS rates at the sub-state level and within key subgroups (e.g., rural residents,
Medicaid-enrollees). Furthermore, it is not known whether policies differentially influence NAS rates among
socioeconomically disadvantaged individuals, populations who historically have been disproportionately
impacted by drug laws, populations with less access to healthcare, and different populations of women who
use opioids in pregnancy (e.g., who are prescribed opioid analgesics, receive medication-assisted treatment,
and/or have an opioid use disorder). In this proposal, we will use two complementary data sources to 1)
estimate NAS rates for key subgroups over time to determine variation in rates at the sub-state level using data
from multiple states; and 2) characterize the association between variation in NAS rates and state-level
policies likely to influence NAS overall and among historically disadvantaged populations. This exploratory
analysis will lay the groundwork for a subsequent R01 study that will assess the impact of state policies on
NAS rates overall and among key subgroups. The goal of this preliminary study and the planned subsequent
R01 proposal is to facilitate more informed policymaking to prevent adverse outcomes for women and infants
impacted by the opioid epidemic.