Abuse of Opiates Soars in Pregnant Women
By PAM BELLUCK
Published: April 30, 2012
The fast-growing abuse of prescription drugs has reached maternity wards in hospitals across the country, with the number of pregnant women addicted to opiate drugs — and the number of babies born experiencing withdrawal symptoms — rising sharply over the last decade.
Stuart Isett for The New York TimesMany infants suffering opiate withdrawal are hospitalized for weeks.
A new study in The Journal of the American Medical Association has quantified the growth of the problem for the first time, as well as the increase in the costs of treating these newborns.
The study estimated that every hour a baby is born in the United States with symptoms of withdrawal from opiates — roughly 13,500 babies a year. The condition, known as neonatal abstinence syndrome, can cause seizures, breathing problems, dehydration, difficulty feeding, tremors and irritability. Many infants are hospitalized for several weeks while doctors treat them with methadone or morphine to gradually wean them from their dependence on the drugs that their mothers used.
“The incidence has gone crazy and I think it has the potential to become a national or international issue,” said Marie J. Hayes, a clinical neuroscientist at the University of Maine, and an author of an editorial accompanying the study. “People who previously might not have used heroin or the needle are more likely to use prescription opiates.”
It is unclear whether babies exposed to opiates in the womb will experience long-term consequences. In the 1980s, there was alarm over whether babies born to cocaine-addicted mothers would suffer developmental problems or other damaging effects, but studies later showed that such problems were far from certain and much more likely if the child had to contend with economic hardship, family instability, poor education and other factors.
The new study looked at two large databases that included a representative sample of patients from across the country and found that the number of pregnant mothers using opiate drugs jumped fivefold from 2000 to 2009. The number of infants with neonatal abstinence syndrome nearly tripled in the same period. The average cost of taking care of each infant climbed to $53,400 from $39,400, adjusted for inflation. Medicaid paid for more than three-quarters of the cases, since many of the women were low-income.
“These babies require a tremendous amount of nursing care,” said Dr. Mark Hudak, chairman of pediatrics at the University of Florida College of Medicine in Jacksonville and an author of new guidelines on neonatal abstinence syndrome issued by the American Academy of Pediatrics this year.
Infants in the study spent an average of 16 days in the hospital, usually in neonatal intensive care units, which are especially expensive because of the specialized nursing care. Since 2000, the length of time infants spend in the hospital has not decreased, suggesting that doctors have not yet learned how to make treatment for withdrawal more efficient, said Dr. Stephen Patrick, an author of the study and a neonatologist in the University of Michigan Health System.
“Are there other places in the hospital that can treat them?” like standard pediatric wards or outpatient clinics, Dr. Patrick asked. “Are there different medications or ways to treat them?”
Dr. Hudak recommends trying to soothe babies first by cuddling them and placing them in darkened rooms. If that is unsuccessful, the newborns are given methadone, morphine or another drug related to what the baby was exposed to in utero; the drug is tapered off gradually until the baby is weaned. That process requires careful monitoring. “These drugs are very easy to overdose babies with,” Dr. Hudak said. “There have been deaths.” And if babies are weaned too soon, “they can wind up getting rehospitalized.”
Still, despite the risks, studies suggest it is more effective to give the babies a drug related to what their mothers were taking, rather than just treating the symptoms of the babies’ withdrawal — seizures and breathing problems, for example, said Hendrée E. Jones, a Johns Hopkins University researcher in psychiatry and behavioral sciences.
But the experts agreed that the best approach is to deal with women’s drug addictions before they are pregnant.