University of Wisconsin–Madison Medical College of Wisconsin

The Burden of Neonatal Abstinence Syndrome, Opioids, and COVID-19 in Wisconsin

Peter Johnson, MD, MS; Erwin Cabacungan, MD; Ke Yan, PhD; Mahua Dasgupta, MS; Jennifer Broad, MPH; Madeline Kemp, MPH; Kelsey Ryan, MD

WMJ. 2023;122(5):456-463

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Introduction: Wisconsin experienced overlapping and accelerating epidemics of opioid use and COVID-19 after March 2020. We hypothesized that Wisconsin neonatal abstinence syndrome rates increased after March 2020 alongside other markers of opioid burden.

Methods: Retrospective cohort analysis examined deidentified Wisconsin census, birth certificate, death certificate, hospital discharge, Prescription Drug Monitoring Program, emergency medical service run, and COVID-19 diagnosis records spanning January 1, 2019, through December 31, 2021. January 2019 through March 2020 was considered before the onset of COVID-19 (pre); April 2020 through December 2021 was considered post-onset of COVID-19 (post). Wisconsin Department of Health Services guidelines defined 5 Wisconsin regions. Rates pre- to post-onset were compared with P values < 0.05 considered statistically significant.

Results: From January 2019 through December 2021, 190 072 infants were born in Wisconsin, of which 1205 were diagnosed with neonatal abstinence syndrome. Statewide opioid-associated deaths, emergency medical service runs, and emergency department visits all increased from the pre- to post-onset periods. Per-person Prescription Drug Monitoring Program rates decreased in both the total population and childbearing-age females (15-44 years), and statewide deaths in childbearing-age females increased significantly (P < 0.001). Statewide monthly neonatal abstinence syndrome incidence rates did not change significantly (6.68/1000 births to 6.10/1000 births; P = 0.16) but decreased significantly in the most populous Southeastern Region (8.13/1000 births to 6.37/1000 births; P = 0.02) of the state.

Conclusions: Opioid-associated morbidity and mortality increased in Wisconsin during the study period, including among females age 15 to 44 years. Despite increased opioid burden, neonatal abstinence syndrome incidence decreased in the Southeastern Region. Ongoing neonatal abstinence syndrome and opioid analysis may benefit from region-based contextualization.

Author Affiliations: Medical College of Wisconsin (MCW), Milwaukee, Wisconsin (Johnson); Department of Pediatrics, MCW, Milwaukee, Wis (Cabacungan, Ryan); Quantititive Health Sciences, MCW, Milwaukee, Wis (Yan, Dasgupta); Wisconsin Department of Health Services, Madison, Wisconsin (Broad, Kemp); Centers for Disease Control and Prevention/CSTE Applied Epidemiology Fellowship Program, Madison, Wis (Kemp).
Corresponding Author: Peter Johnson, MD, MS, Children’s Corporate Center, 999 N 92nd St, Suite C410, PO Box 1997, Wauwatosa, WI 53226; email; ORCID ID 0000-0002-1688-7967
Financial Disclosures: None declared.
Funding/Support: None declared.
Availability of Data and Material: Study materials available upon request.
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