The Journal of the Arkansas Medical Society Med Journal Feb 2019 Final 2 | Page 16

Figure 3. Opioid Prescriptions Filled Per Capita By Women of Reproductive Age, Arkansas, 2014 Source: Arkansas Prescription Monitoring Program of NAS diagnosis per 1,000 births. We also found large differences in NAS rates between coun- ties. In some counties, not a single of case NAS was reported between 2010 and 2014. In others, almost 14 of every 1,000 babies born were di- agnosed with NAS. Other indicators of prescrip- tion drug abuse, like death rates, show some variation from county to county, but not to this extent. Large disparities in NAS rates raise ques- tions about reporting issues of the condition in different areas. Put your business or service in the hands of 4,400 Arkansas physicians. Prescription opioid use during pregnancy is a risk factor for NAS. 2 Between 2014 and 2016, Arkansas had the second-highest opioid prescribing rate in the U.S. 3 According to the Arkansas PMP, reproductive-age women filled between 0.36 and 2.11 opioid prescriptions per capita in 2014. During the same year, the rate was 2.70 among women of all ages. The extent to which prescription opioids may have contrib- uted to the recent increase in NAS diagnoses warrants further investigation. Depending on the results, interventions to prevent NAS in the fu- ture may want to focus on opioid prescribing to women of reproductive age. Limitations These findings are subject to several limita- tions. First, the way NAS is diagnosed may vary from one hospital to another. Second, births to Arkansas residents that occur in out-of-state hospitals are not reported to the Arkansas Hos- pital Discharge Database, which may result in undercounting of NAS cases, especially in border counties. Third, babies that are transferred from a birth hospital to different hospital for follow-up may be counted twice. Fourth, and perhaps most importantly, the PMP database does not include information about pregnancy status. From the data we analyzed, we cannot tell if women who were prescribed opioids were pregnant. Conclusions For more advertising information, contact Penny Henderson at 501.224.8967 or [email protected] CDC guidelines encourage providers to weigh the risks and benefits of opioid therapy prior to prescribing opioids. The benefits of opioids, such as temporary pain relief, are well known. This article offers a population-level view of one of the risks associated with opioid pre- scribing to women of reproductive age. In Arkan- 184 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY sas, approximately three out of every 1,000 ba- bies born in 2014 were diagnosed with NAS, and the rate is even higher in certain sub-populations. With the second-to-highest prescribing rate in the U.S., Arkansas may be able to reduce NAS rates by improving the prescribing of opioids to women of reproductive age. References 1. Jansson LM, Velez M. Neonatal Abstinence Syndrome. Current opinion in pediatrics. 2012;24(2):252-258. 2. Kellog A, Rose CH, Harms RH, Watson WJ. Cur- rent trends in narcotic use in pregnancy and neonatal outcomes. Am J Obstet Gynecol. 2011;20493):259.e1-259.e4. 3. Centers for Disease Control and Prevention. Annual Surveillance Report of Drug-Related Risks and Outcomes — United States, 2017. Surveillance Special Report 1. Centers for Disease Control and Prevention, U.S. Depart- ment of Health and Human Services. Pub- lished August 31, 2017. Accessed Septem- ber 11,2017 from https://www.cdc.gov/ drugoverdose/pdf/pubs/2017-cdc-drug-sur- veillance-report.Pdf. The views expressed in this paper are not necessarily those of the Arkansas Department of Health. This report was supported by the Grant or Cooperative Agreement Number, 1 NU- 17CE924869-01, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. VOLUME 115