Neonatal abstinence syndrome

Neonatal abstinence syndrome (NAS) is the withdrawal state that can affect a baby after exposure to opioids during pregnancy. In Dopesick, it appears not as an abstract complication but as a point where addiction treatment, pregnancy, newborn care, and family life meet. The book follows both the uncertainty faced by an expectant mother and the clinical and social arrangements surrounding babies born after prenatal opioid exposure.

Definition and Clinical Context

The account describes NAS as a painful withdrawal state that can require an extended hospital stay. It can occur after a pregnancy in which the mother used heroin, but exposure to medication-assisted treatment does not eliminate the possibility. The condition therefore complicates any simple distinction between illicit drug use and treatment: a medication can support a pregnant patient’s recovery while the newborn may still need care as exposure ends after birth.

The book’s discussion of care in Roanoke gives this possibility a concrete scale. About half of babies born there to mothers receiving medication-assisted treatment required neonatal intensive care, usually including methadone administered twice daily. Their average hospital stay was 7.7 days. These figures describe a local care burden, not a universal outcome for every opioid-exposed baby; the account presents them to show that treatment during pregnancy and withdrawal after birth can coexist.

Tess Henry’s Pregnancy and Treatment

Tess Henry’s experience places the clinical issue within the barriers to finding appropriate care. Nearly seven months pregnant when she left jail in June 2015, she initially stayed with her mother, Patricia Mehrmann. After that arrangement and an attempt to live with the baby’s father proved unsuccessful, the family found the Life Center of Galax, one of the few Virginia facilities then accepting patients on medication-assisted treatment. Private insurance covered most of the $20,000 cost, while Tess’s father paid the $6,500 deductible from what remained of her college-savings fund.

Tess was taking Subutex, a form of buprenorphine then recommended for some pregnant patients. In the book’s account, it was considered safer for the baby than Suboxone at that time, because it contained buprenorphine without the added naloxone; the trade-off described was a greater potential for misuse by the mother. Having spent the first half of her pregnancy addicted to heroin and the second half taking Subutex, Tess feared her baby might develop NAS and need prolonged hospital care. Her worry illustrates that successful entry into treatment could reduce some risks without guaranteeing an uncomplicated birth or removing uncertainty about the newborn’s needs.

Guidance changed as practice developed. In 2017, the Virginia Board of Medicine recommended that pregnant patients use Subutex for no more than seven days before transitioning to Suboxone. The shift matters within the book’s account because medication choices were not fixed rules outside history: clinicians’ recommendations changed as standards evolved, while families navigated the consequences of those decisions in real time.

Hospital Care and Family Outcomes

The book’s figures also follow babies beyond the hospital. Fifty-five babies with NAS were born at Carilion between 2015 and 2016. Of those, 37 went home with a parent, five went home with another caregiver, and 13 went directly into foster care; two of the 37 initially discharged to a parent later entered foster care. The figures do not establish why each placement occurred, but they show that newborn care could lead into different caregiving arrangements, and that a discharge home did not always settle a child’s longer-term situation.

Babies receiving methadone typically tapered off their low doses within three months. That treatment detail complicates the public shorthand of NAS as a condition defined only by an initial hospital episode: for some newborns, care continued through a medication taper, while caregivers and medical staff managed the transition. The account also notes that babies and families could encounter stigma, making the condition a social experience as well as a clinical one.

Significance in the Book

NAS gives the broader opioid crisis a generational dimension. The book moves from adults’ dependence and attempts to obtain treatment to the newborns who may need care after prenatal exposure. The numbers from Roanoke and the placement outcomes make visible both the scale of the need and the range of lives affected, without treating all exposed babies as having the same medical course or family outcome.

Tess’s story, in particular, shows why access to treatment cannot be separated from the circumstances of pregnancy. Reaching a facility able to accept her required family coordination, insurance, and substantial out-of-pocket payment; even after admission, the possibility of NAS remained. The condition thus marks neither proof that treatment failed nor a single predictable result of maternal addiction. In Dopesick, it is a point of connection between clinical decisions, hospital resources, family support, and the continuing effort to care for children born amid the opioid crisis.