Pharmacologic Therapy Among Opioid-Exposed Infants: Disparities By Race

Abstract

Research Objective: The incidence of neonatal abstinence syndrome (NAS), a condition associated with in utero exposure to opioids, has been increasing over time. Traditional treatment for NAS combines a formal assessment of symptoms called the Finnegan score and pharmacologic therapy with opioids for infants with scores above a set threshold. Previous research has established that black patients are less likely to receive pain medication relative to white patients. This study examines potential disparities in the receipt of pharmacologic therapy with opioids among infants with prenatal opioid exposure or a diagnosis of neonatal abstinence syndrome among black and white infants.

Study Design: This is a prospective cohort design utilizing electronic health record data. Chi‐square and logistic regression models assessing the relationship between pharmacotherapy and race were adjusted for insurance status, gender, maximum Finnegan score received, year of treatment, and facility.

Population Studied: A sample of infants who were diagnosed with NAS (defined as ICD‐9: 779.5 or ICD‐10: 96.1) or opioid exposure (defined as ICD‐9: 760.73 or ICD‐10: P04.49) within a large metropolitan hospital system between the years 2008 and 2018 was obtained. Of those infants diagnosed with opioid exposure or NAS (N = 2518), 667 did not have a Finnegan score reported, resulting in a sample loss of 26%. The sample was then limited to black and white infants, dropping an additional 66 observations and resulting in a final sample of N = 1785. All data were taken from the infant’s electronic health records.

Principal Findings: Chi‐square tests show that there is no significant difference in receipt of pharmacologic therapy with opioids by gender, or insurance status, but a significantly smaller proportion of black infants receive pharmacologic therapy (P < .001) relative to white infants. In the adjusted logistic model, black infants have significantly decreased odds (OR 0.42; [95% CI: 0.24, 0.73]) of receiving pharmacologic therapy relative to white infants.

Conclusions: The health disparities literature has shown that the pain of black patients is undertreated compared with white patients. This study shows that disparities in the use of opioids start in the newborn period for pharmacologic treatment of neonatal abstinence syndrome. To our knowledge, this study is the first to show that the disparity in opioid prescriptions begins at infancy.

Implications for Policy or Practice: New trends in NAS management involve an increased focus on nonpharmacologic therapy, such as breastfeeding, skin‐to‐skin contact, soothing, and swaddling. Some hospitals are moving away from the traditional Finnegan scoring and toward a simplified diagnostic model, which only prescribes pharmacologic opioid therapy when infants are not able to eat, sleep, or be consoled. It is important to monitor this transition in NAS management to ensure that treatment paths are determined by the severity of symptoms rather than race. Ensuring equal access to family‐centered NAS models where families are able to room in and provide optimal nonpharmacologic care to their infant should be prioritized. Increased education regarding potential racial biases in prescribing practices and efforts to standardize the care and treatment of opioid‐exposed infants are recommended.