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In the studies, newborns suffering from NAS were treated with opiates (morphine, methadone, paregoric, or tincture of opium), sedatives (phenobarbitone, diazepam or chlorpromazine) or supportive care only. None of the studies compared opiate treatment with placebo.

Of the randomized and "quasi-random" studies analyzed, "the evidence is not high quality," Osborn says, and unanswered questions remain. For example, in infants treated with an opiate, the addition of phenobarbitone may reduce withdrawal severity, but more research is needed using a higher initial dose of opiate, and to examine the effects of phenobarbitone on infant development.

In the 1999 U.S. National Household Survey on Drug Abuse, 3.4 percent of pregnant women reported illicit drug use in the past month, which according to authors represents some 3,000 current pregnant heroin users in the U.S., similar to Australian figures. Between 48 percent and 94 percent of infants exposed to opiates in the uterus develop clinical signs of withdrawal

"The interesting information," Osborn says, "suggests that these infants can be treated without admission to the special care nursery unless withdrawal is complicated and that this is facilitated by use of morphine instead of phenobarbitone. This helps keep mothers and babies together, helps in educating the mothers in mothercraft skills and to recognize signs of infant withdrawal, and helps in assessment of the quality of the mother-infant interaction in a supervised environment."