The association between pill mill legislation and neonatal abstinence syndrome

Objectives: Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome in newborns who were primarily been exposed to drugs such as opioids in the mothers' womb. The NAS rate in the USA has increased over the past decade. With rising opioid use and opioid overdose deaths, many states adopted various policies to combat the opioid epidemic, including the pill mill legislation. However, its effect on NAS is not evident. This study examines the association between pill mill legislation and NAS rate in the USA. Methods: The study utilizes state-level hospital discharge data from Healthcare Cost and Utilization Project's (HCUP) Fast Stats database from 2008 to 2018, along with state-level socio-demographic and opioid-related health policy data. Analysis was conducted using a difference-in-differences regression approach. Key findings: The results indicate that pill mill legislation is associated with 4 additional incidents of NAS cases per 1000 newborn hospitalizations (P < 0.05), and 6.5 additional incidents of NAS cases per 1000 newborn hospitalizations among Medicaid payers (P < 0.05) in states with pill mill legislation compared with states without the legislation. Moreover, the results indicate that states with prescription drug monitoring programmes (PDMP) are experiencing lower incidents of NAS cases overall (P < 0.01), and among Medicaid and privately insured populations (P < 0.05) in comparison with states without PDMPs. Conclusions: These findings indicate that pill mill legislation has not been effective in reducing NAS rates in the USA. A comprehensive policy approach targeting opioid use among pregnant women may be needed to effectively reduce NAS rates in the USA.