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Over the last two decades, the number of delivering mothers using or dependent on opiates has increased dramatically, giving rise to a five-fold increase in the proportion of babies born with neonatal abstinence syndrome (NAS). First, the current study documents NAS trends in the United States and their substantial variation across states. Second, it explores the relationship, if any, between the adoption of prescription drug monitoring programs (PDMPs) and reductions in NAS incidence across the United States. We find that the introduction of operational PDMPs reduced NAS incidence in the United States by 10%. We also examined the effects on birth outcomes, infant mortality, and other pregnancy complications and find little evidence of any effect of PDMPs on birth weight, premature births, and infant mortality.