More babies born addicted to painkillers
Expectant mothers’ use of opioids has risen dramatically and children suff er, doctors say
The newborn babies are inconsolable, their frantic, high- pitched cries a telltale sign of a newborn in the throes of drug withdrawal.
Canada’s baby specialists are witnessing an alarming new phenomenon: growing numbers of infants being born dependent on prescription painkillers and other opioids.
Rates of neonatal abstinence syndrome, or NAS, have doubled in Canada, the latest fallout of the rise in legitimate and illicit use of prescription opioids across the country. Most of NAS is due to opioids, drugs that include oxycodone, the active ingredient in OxyContin and its successor, OxyNEO.
In Ontario, the rate of postnatal drug withdrawal increased to 4.3 babies per 1,000 births in 2010, from 1.3 in 2004, according to a provincial task force. NAS was diagnosed in 654 babies in Ontario in 201011, up from 171 newborns in 2003- 04.
Long hospital stay
“The numbers are very, very significant — you hear it from all over the province, and all over the country,” says Dr. Gideon Koren, director of the renowned Motherisk Program at Toronto’s Hospital for Sick Children.
“The burden is huge,” says Koren, who will speak on the issue at the Canadian Paediatric Society’s annual meeting in London, Ont., this week. “These kids stay in hospital sometimes months to get them off the drug.”
At The Ottawa Hospital, “we are part of the whole nation’s trend — we’re beginning to see a lot more cases coming in,” says Dr. Pradeep Merchant, chief of the division of neonatology at hospital’s Civic campus.
He said the phenomenon is occurring among women of all socioeconomic groups, and not just the socially marginalized. “A lot of child- bearing moms are on those medications,” he said. A decade ago, “we would see one [ NAS baby] every three or four months,” Merchant said. The hospital now sees “one, two or three a month,” he said.
In Vancouver, where the street drugs of choice have long been heroin, cocaine and crystal meth, “we are starting to see more young women on prescription opioids that are impacting their pregnancies,” said Dr. Ron Abrahams, medical director of perinatal addictions at B. C. Women’s Hospital in Vancouver.
Across Canada, doctors are being urged to screen for mothers who are using, or at risk of using, narcotics during pregnancy.
Funding to screening
An expert panel of the Ontario Provincial Council for Maternal and Child Health is also calling for a co- ordinated strategy that would include formalized funding for toxicology screening to test all known and suspected cases of NAS in newborns, as well as more resources for addiction treatment and other support services, especially in northern and first nations communities. At this week’s pediatricians’ meeting, Koren will discuss how NAS can be detected in a baby’s hair and meconium.
“If the mother hasn’t done her drugs for a while — a day or two, or more — the baby’s urine and blood may not show it,” he said. Depending on the drug, signs of withdrawal can start as early as 24 hours after birth, or as late as a week or longer. If a baby is sent home undetected, the situation could be life threatening. “He may not feed, he may end up dehydrated and having seizures,” Koren said.
Some are calling for a major social marketing movement to raise awareness about the risks of narcotic use in pregnancy, similar to campaigns around drinking in pregnancy and fetal alcohol syndrome.
“The level of awareness must be much higher,” Koren says. “It’s a national emergency.”
Canadians today are among the highest users of prescription opioids in the world: in the past decade alone, our opioid consumption has more than doubled. Among the provinces in 2010, Alberta had the overall highest opioid use rate in the country, Quebec the lowest, but nowhere are the rates falling.
Among pregnant women two things are happening: their use of narcotics is growing, and the treatment used to get them off their drug of choice itself increases the risk of neonatal drug withdrawal.
High prescription rates
Between 1991 and 2009, the number of prescriptions for oxycodone in Ontario rose by 900 per cent, says Dr. Kimberly Dow, a professor of pediatrics at Queen’s University in Kingston and co- chair of the Provincial Council for Maternal and Child Health task force on neonatal abstinence syndrome.
“Physicians are prescribing these [ drugs], legitimately in many cases, but sometimes over- prescribing,” Dow said. Along with the higher prescribing has come higher rates of abuse and dependence.
A study published last month in the Journal of the American Medical Association found that the number of mothers in the U. S. using opiate drugs increased five- fold over the last decade.
Methadone is the drug of choice for a narcotic- addicted mother in pregnancy.
“It’s safer for the mom, it reduces risk and it provides a better pregnancy outcome,” Dow says. But methadone is long acting, meaning it stays in the baby’s system longer. About 85 per cent of babies exposed to methadone in the womb develop at least one sign of drug withdrawal.
Painful withdrawal
Opioids cross the placenta. The concentration in the baby’s blood is the same as it is in the mother’s, Dow says. At birth, the placenta is cut off, and, with it, the baby’s drug supply.
Babies can experience the same symptoms of withdrawal as an adult coming off heroin.
They suffer central nervous system irritability — an extremely high pitched cry, increased muscle tone, frantic feeding, tremors and seizures — as well as fever, vomiting and diarrhea.
Says Dow, of Queen’s: “They look like they’re in pain.”
“We have an NICU [ neonatal intensive care unit] of 22 beds. I’ve had up to four at one time in there,” she said.
The standard treatment for the babies is morphine, the drug slowly tapered off as signs of withdrawal diminish.
In Vancouver, babies are roomed in with mothers immediately after birth, instead of separated.
“We try and normalize the birth process,” says Abrahams. “As long as the moms are cuddling and holding the baby” and babies are getting proper nutrition from breastfeeding or formula, “the babies tend to do very well and mostly don’t need treatment from withdrawal.”