In response to the dramatic increase of opioid use by pregnant women concurrent with the current epidemic of opioid use disorders, in January 2018 the National Institute on Drug Abuse (NIDA) hosted a workshop on Neonatal Abstinence Syndrome (NAS), or Neonatal Opioid Withdrawal Syndrome (NOWS), in Bethesda, Maryland. Sixteen leading investigators representing pediatrics, child psychology, genetics and genomics, and neurodevelopment participated in the workshop. Attendees of the workshop included program staff and intramural researchers from NIDA, National Institute of Neurological Diseases and Stroke (NINDS), National Institute of Mental Health (NIMH), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and National Institute on Alcohol Abuse and Alcoholism (NIAAA). The workshop consisted of four keynote presentations and two panel discussions. The presentations and discussions covered a wide range of urgent issues regarding how maternal opioid exposure affects the embryonic and fetal brain, resulting in NAS/NOWS and potentially neurocognitive disorders in neonates. Much of the discussion of clinical studies was focused on the current challenges arising from the increasing incidence of NAS/NOWS nationally; from the confounding factors in diagnoses and treatment of NAS/NOWS, to the fast-evolving practice and medication choices for the treatment of pregnant women with opioid use disorders (OUD). For translation and basic research, the workshop covered research efforts to understand acute and long-term consequences of maternal opioid use on embryonic, fetal and neonatal brains. This included studies to identify and validate environmental and genetic risk factors for NAS/NOWS; how emergence of the endogenous opioid system in the developing brain is impacted by maternal opioid use; and the cellular and molecular mechanisms underlying brain and cognitive disorders caused by maternal opioid use.
The workshop identified several specific areas of focus that would have high impact on OUD by pregnant women and the incidence and consequences of NAS/NOWS:
- Developing and validating non-opioid and/or non-pharmaceutical therapies for pregnant woman and for neonates affected by maternal opioid exposure;
- Promoting research on maternal polydrug use (a major confounding factor hindering studies);
- Identifying long-term (including transgenerational) consequences of maternal opioid exposure in adolescent and adult life;
- Establishing innovative approaches for cohort recruitment, retention and management for NAS/NOWS, both for clinical studies and for basic studies;
- Advancing state of art genetic and genomic studies to identify genetic variants associated with NAS/NOWS;
- Promoting novel research that can develop and validate new animal models of NAS/NOWS for mechanistic research of brain and behavioral disorders.