CANADA’S NEW OPIOID CRISIS

RESEARCH UNCOVERS AN ALARMING RATE OF ADDICTION IN NEWBORNS

Canada has higher rates of babies born addicted to powerful narcotic painkillers they were exposed to in the womb than the United States, England or Western Australia, according to disturbing new research into rising rates of neonatal drug withdrawal syndrome.

It affects up to 80 per cent of infants born to women who use opioids — drugs such as oxycodone, hydromorphone and fentanyl that are behind a dramatic rise in overdose deaths.

Because opioids cross the placenta, the concentration in the fetus’s blood is the same as it is in the mother’s. At birth, the placenta is cut off and with it the baby’s drug supply.

Soon after, the babies become jittery, irritable and have difficulty breathing. They cry more and their heart rate is faster. They can also experience seizures and respiratory distress.

“Basically, they’re in withdrawal,” said Dr. Astrid Guttman, chief science officer at Toronto’s Institute for Clinical Evaluative Sciences (ICES) and a pediatrician at the Hospital for Sick Children.

They are weaned off the drugs with morphine, the amount reduced as signs of withdrawal diminish.

The syndrome affects the babies of women who take opioids or are being treated for opioid dependence with methadone.

Some use the drugs illicitly. Others were prescribed them by doctors for chronic pain or other conditions, but then became addicted.

Regulators have accused doctors of “undisciplined,” inappropriate and arbitrary prescribing of the painkillers, often in excessively high doses. Doctors in Canada are the second highest prescribers of opioids in the world, behind only the U.S.

In the new study, researchers measured neonatal drug withdrawal in four jurisdictions — England, Western Australia, the U.S. and Canada. The Canadian data came from Ontario.

The rates stabilized in England and Australia from the early 2000s, but rose steeply in the U.S. and Ontario during the late 2000s.

The rate was 5.1 per 1,000 live births in Ontario in 2011 — 667 babies — nearly double the rates in England and Western Australia (2.7 per 1,000 births) and higher than the U.S. (3.6).

In 2002, the rate in Ontario was less than one, or 0.9 babies born into withdrawal for every 1,000 live births.

The high prevalence in Ontario may reflect increased recognition and reporting of maternal drug use, the researchers said.

“We do know Ontario has an increasing problem with opioid addiction,” said Guttman, one of the study’s co-authors. “But we’re also a little more aware of the problem. There’s much more awareness of this, so we may also be picking this up a little bit more.”

The researchers relied on Ontario data only. Guttmann said she has not seen numbers or trends from other provinces.

However, because Ontario accounts for 40 per cent of the Canadian population, “whatever is going on in Ontario would certainly be reflected in overall Canadian numbers.”

The findings, published in the journal, Archives of Disease in Childhood Fetal & Neonatal Edition, are “very worrying,” she said. “I think again it’s a signal that we need to really be doing more around what is a real problem with opioid dependence.”

It is especially a problem of young mothers.

ICES research shows neonatal drug withdrawal is five times higher among babies born to mothers who delivered their first baby before they were 19, compared with older mothers. The rates in Northern Ontario communities are 10 times those for other parts of the province.

In Ontario, two-thirds of the babies born in drug withdrawal were born to mothers prescribed methadone. “Since 2000, prescription opioids have supplanted heroin addiction as the mean reason for starting methadone in Toronto,” the authors write.

“The majority of the mothers aren’t on heroin — they’re on codeine and other opioids that they’re getting either legally, or illegally,” Guttman said.

Hospitals are working to safely monitor and treat the addicted babies, she added. “They certainly need to be under close care, and watched closely by nurses.”

Babies born in drug withdrawal are at increased risk of neglect, her team writes.