This study assessed management of neonatal abstinence syndrome (NAS) in California hospitals to identify potential opportunities to expand the use of best practices. We fielded an internet-based survey to birth hospitals in California. Most respondents reported having a written protocol for managing NAS, but fewer had protocols for pharmacologic management. Newer tools for assessing NAS severity were not common. About half reported using nonpharmacologic strategies. There was scope for increasing breastfeeding, skin-to-skin care, and rooming-in. A concerted statewide effort to facilitate implementation of best practices has strong potential to increase access to evidence-based treatment for these infants and mothers.