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As more babies born addicted to opioids, rural areas hit hardest

Babies exposed to opioids in the womb may suffer from Neonatal Abstinence Syndrome, especially in rural areas
User anitapatterson / Morguefile

As more babies are born addicted to opioids, rural communities are being hit the hardest, according to a new studyfrom a University of Michigan pediatrician.  

Between 2004 and 2013, urban areas saw a four-fold increase in babies born with Neonatal Abstinence Syndrome (that’s the clinical term for a baby born addicted to opioids, including heroin and some prescription painkillers). Rural areas saw a seven-fold surge.

Those rural moms were also more likely to struggle financially and have less access to mental health care, says the study’s author, University of Michigan C.S. Mott Children’s Hospital Dr. Nicole Villapiano.

“We know that rural areas tend to be poorer, there tends to be higher rates of chronic disease burden, higher rates of mental health issues,” says Dr. Villapiano. “So that in addition to the challenges around access to care, especially primary care and mental health, that made it kind of a perfect storm for the opioid crisis to really be affecting moms and their babies in rural areas in a disproportionate way.”

Most babies with NAS can be treated relatively easily in the hospital or the intensive care unit, with nurses helping their withdrawal symptoms, including “increased irritability, hypertonia [injury to the central nervous system,] tremors, feeding intolerance…seizures, respiratory distress,” according to a previous study.

But in rare cases, babies can suffer long-term effects from NAS.

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“In the worst case scenario, some of these babies die, and there's a higher rate of mortality in this population,” says Dr. Villapiano. “Later in life, there may possibly be issues with attention, but more research is really needed to understand the long term effects.”  

This comes, of course, during the national epidemic of prescription opiate addiction and abuse, which “has particularly affected adolescent and young adult women of reproductive age,” according to a 2014 study in Maine.

“If you live in a rural area, it’s even more complicated, because prior to getting pregnant you might not have access to health insurance or healthcare that would get you the opportunity to get your opioid use disorder under control,” says Dr. Villapiano. “And the treatment is actually another opioid, something we put moms on to make their opioid use a medically managed situation.”  

Most experts recommend women get treatment involving “stable, daily dosing with methadone in a therapeutic setting…during pregnancy,” according to a previous study, in order to avoid acute withdrawal.

If pregnant women try to go cold turkey, that could lead a dangerous cycle of relapse and overdose, which is linked to miscarriage.

But that same effective methadone treatment also means the baby may still be born with NAS, because of the prolonged exposure to opioids in the womb.

So ultimately, Dr. Villapiano says, the goal is getting women help even before they’re pregnant.

“The communities that are hardest hit are very aware of this problem,” she says. “But there’s just not the resources or the workforce to help alleviate it. So they’re a little bit stuck.”

The study backs up Michigan’s own statistics, which show higher rates of NAS in rural areas like the Upper Peninsula. 

Kate Wells is a Peabody Award-winning journalist currently covering public health. She was a 2023 Pulitzer Prize finalist for her abortion coverage.
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