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GAO Report Highlights the Need for Federal Action to Address Neonatal Abstinence Syndrome

October 06, 2017

The rising opioid crisis has increased in the number of infants born and diagnosed with neonatal abstinence syndrome (NAS)—a withdrawal condition that affects infants and their families, hospitals, health care providers who treat them as well as federal and state taxpayer who pay for more than 80 percent of NAS-related medical and other treatment costs.

The Government Accountability Office (GAO), as directed by requirements included in the Comprehensive Addiction and Recovery Act of 2016, examined NAS in the United States and related federal government response. For this study, GAO reviewed the U.S. Department of Health and Human Services (HHS) documentation and interviewed HHS officials. GAO also conducted site visits to four states—Kentucky, Vermont, West Virginia, and Wisconsin—selected based on several factors, including incidence rates of NAS and geographic variation. GAO interviewed stakeholders from 32 organizations, including health care providers and state officials in the selected states. GAO’s culminating report describes the hospital and non-hospital settings for treating infants with NAS and how Medicaid pays for services, describes recommended practices and challenges for addressing NAS, and examines HHS's strategy for addressing NAS.

Key Report Findings and Recommendations

GAO’s report finds that while experts consider NAS to be an expected and treatable result of women’s prenatal opioid use, to date, there currently is no national standard of care for screening or treating NAS. In interviewing stakeholders and reviewing literature, GAO identified several recommended practices for addressing NAS, including the following:

  1. Prioritizing non-pharmacologic treatment, such as allowing the mother to reside with the infant during treatment, to facilitate the mother-infant bond
  2. Educating mothers about prenatal care, treatment for NAS, and available resources for after an infant’s discharge
  3. Educating health care providers about the stigma faced by women who use opioids during pregnancy and about how to screen for and treat NAS
  4. Using a protocol in a hospital or non-hospital setting for screening and treating infants with NAS

Additionally, in examining the federal government’s efforts to address NAS—prevent and treat this syndrome by promoting the aforementioned recommended practices, GAO noted that HHS identified key recommendations to help guide its efforts—such as providing medical education to health care providers about how to treat these infants. However, in GAO’s evaluation of the HHS’ strategy to address NAS, GAO found that HHS had no timeline for developing an implementation plan. GAO concluded that it is unclear how the HHS will implement these recommendations, if at all.

The GAO recommended that HHS expeditiously develop a plan to implement these recommendations related to addressing NAS. In response to this recommendation, HHS concurred that it should expeditiously address NAS, but noted implementation of the strategy is contingent on funding.

Pennsylvania

Hospitals, specifically birthing hospitals, can play unique interface in preventing and treating NAS. HAP is actively involved in addressing the challenges here in Pennsylvania. HAP participates on Pennsylvania’s Multidisciplinary Workgroup on Infant Substance Exposure (MDWISE). Through this workgroup, a wide range of community stakeholders, health care and substance use treatment providers, state and county courts, law enforcement, child protective, and social service agencies work collaboratively to minimize prenatal exposure to substances, improve NAS treatment and to improve social and health outcomes for infants, children, and families. MDWISE aims to develop the coordinated policy agenda and service infrastructure needed to address substance use prevention, screening and treatment, and care coordination.

For more information about HAP’s participation in Pennsylvania’s MDWISE, contact Jennifer Jordan, HAP’s vice president, regulatory advocacy.

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