# Mothers with Concurrent Opioid and Cocaine Use and Neonatal Opioid Withdrawal Syndrome

## TL;DR

This study finds that using both opioids and cocaine during pregnancy increases the risk of neonatal opioid withdrawal syndrome and longer hospital stays for infants.

## Contribution

The study provides new evidence that concurrent opioid and cocaine use during pregnancy worsens neonatal outcomes compared to opioid use alone.

## Key findings

- Infants exposed to both opioids and cocaine had 6.5 times greater odds of developing NOWS.
- Cocaine use was associated with an average 15-day increase in hospital stay for term infants.
- Opioid and cocaine use was linked to longer hospital stays and higher NOWS rates compared to opioid-only use.

## Abstract

Background: Polysubstance use, particularly combining opioids with stimulants such as cocaine, is rising among individuals with substance use disorders. This practice aims to balance cocaine’s stimulant effects with opioids’ sedative effect, potentially decreasing adverse outcomes. We hypothesized that concurrent exposure to cocaine and opioids would reduce the risk of neonatal opioid withdrawal syndrome (NOWS) compared to opioid use alone. Methods: This analysis draws from an ongoing prospective study of maternal substance use (SUD) at Regional One Health’s perinatal center in Memphis, TN, and included mothers and their infants born between 2018 and 2022. Maternal SUD was identified via screening questionnaires, urine toxicology, or umbilical cord tissue analysis. Participants were grouped into using (a) opioids with cocaine (OwC) and (b) opioids without cocaine (OwoC). Univariate and regression analyses were conducted to assess the risk of NOWS. Results: A total of 353 infants were born to 342 mothers, with 31% (110/353) of the infants born to women who used cocaine along with opioids. While maternal demographics were similar, the OwC group had significantly lower rates of prenatal care, chronic pain history, and MOUD enrollment (p = 0.03). Infants in the OwC group had significantly higher rates of NOWS (p < 0.01), longer hospital stays (p < 0.01), and 6.5 times greater odds of developing NOWS (p < 0.001). NOWS was associated with an average 15-day increase in the length of stay for term infants (95% CI: 11.2, 18.8; p < 0.001). Conclusions: Contrary to our hypothesis, our study highlights the significant impact of maternal cocaine use on the increased likelihood of NOWS and extended hospital stays for affected infants.