Medical authorities are witnessing explosive growth in the number of newborn babies hooked on prescription painkillers, innocent victims of their mothers' addictions.
The trend reflects how deeply rooted abuse of powerful narcotics, such as OxyContin and Vicodin, has become. Prescription drug abuse is the nation's fastest-growing drug problem, classified as an epidemic by the Centers for Disease Control and Prevention.
"I'm scared to death this will become the crack-baby epidemic," says Florida Attorney General Pam Bondi. Last month, she asked the state Legislature to establish a task force to compile data on drug-exposed babies and develop prevention strategies.
National statistics on the number of babies who go through withdrawal are not available, and states with the worst problems have only begun to collect data. Scattered reports show the number of addicted newborns has doubled, tripled or more over the past decade. In Florida, the epicenter of the illicit prescription drug trade, the number of babies with withdrawal syndrome soared from 354 in 2006 to 1,374 in 2010, according to the Florida Agency for Health Care Administration.
In response to the growing severity of the problem, the American Academy of Pediatrics convened a committee this year to revise its treatment guidelines for the babies. The new guidelines are set to be published next year.
Mark Hudak, who served on the committee, says the problem is not confined to Florida. The number of drug-exposed babies "has escalated across the country," says Hudak, a professor of pediatrics and division chief for neonatology at the University of Florida College of Medicine in Jacksonville.
• Maine Medical Center in Portland treated 121 babies dependent on prescription painkillers in 2010, up from 18 in 2001, says Geri Tamborelli, nursing director at the Family Birth Center and neonatal intensive care unit.
• East Tennessee Children's Hospital in Knoxville adopted a program to treat drug-exposed babies a year ago. Of the 579 babies admitted to the neonatal intensive care unit since then, 106 needed treatment for withdrawal from oxycodone and other painkillers — up from fewer than 40 in 2008. In September, painkiller-addicted babies filled nearly half the neonatal intensive care unit's 60 beds, the highest number ever.
"It has just exploded," says John Buchheit, director of neonatology at East Tennessee Children's Hospital. "Narcotic use is just rampant in our society, and our area is particularly bad. The babies are caught in the middle."
• At St. Joseph's Hospital in Tampa, 40 babies born in the first nine months of this year needed special care because of painkiller exposure — a 33% increase over all of 2010, says Ken Solomon, director of neonatology at three hospitals in the Tampa-St. Petersburg area.
Bondi first learned of the babies' plight on a visit to St. Joseph's. She says seeing the infants writhe in pain as they withdrew from the drugs broke her heart. "I had no idea there was this epidemic out there," she says.
"It's the newborn equivalent of an adult who goes off the drugs cold turkey. It's really horrible to see these kids. They look in so much pain," says Lewis Rubin, director of newborn services at Tampa General Hospital and chairman of neonatology at the University of South Florida.
To ease their pain and get the babies comfortable enough so they can eat and sleep, doctors give the babies narcotics and sedatives, which can include morphine, methadone and phenobarbital. "We have to readdict them," says Solomon, who uses intravenous morphine measured in micrograms. "Over a period of time, we withdraw the medicines. Sometimes it will take weeks."
Health professionals have dealt with addicted mothers and drug-exposed babies for decades.
"I've been in nursing for 26 years. There's been a problem with some drug or another for that entire time," Tamborelli says.
In the 1960s and 1970s, heroin emerged as a problem. That is when neonatologist Loretta Finnegan, who has studied substance abuse, developed a scoring system of symptoms to diagnose neonatal abstinance syndrome or drug withdrawal in the infants. By the 1980s, the problem had shifted to cocaine and crack. In the past five to 10 years, doctors say they have treated growing numbers of babies hooked on prescription opioid painkillers.
While abuse of many street drugs, such as cocaine and methamphetamine, is declining, painkiller abuse is growing. About 7 million people abuse prescription drugs, including painkillers, according to the 2010 National Survey on Drug Use and Health. Deaths from prescription painkiller overdoses have more than tripled in the past decade, the Centers for Disease Control and Prevention says.
"The epidemic of drug-addicted newborns really follows exactly from the spread of the pill mills, the ability to buy prescription drugs like OxyContin on the street, to get them on the Internet," Rubin says. "It's staggering to think of the financial, emotional and social costs of this problem."
Doctors want to intervene early to get pregnant addicts into rehabilitation. But some expectant mothers hide their addictions from their obstetricians because they fear government social workers will take the child, Solomon says.
A pregnant woman can't quit cold turkey because as she goes into withdrawal, the baby will, too, says Mary Newport, medical director of neonatal intensive care at Spring Hill Regional Hospital in Spring Hill, Fla. "The baby could have seizures in the womb. They can miscarry," she says.
One in 20 babies born in the semirural community north of Tampa is addicted to painkillers, Newport says. The number of babies treated in the neonatal intensive care unit for withdrawal from prescription painkillers has more than doubled from 37 in 2008 to 88 in 2010.
"There's a misconception that because these are prescription drugs, they aren't going to be harmful to the baby," she says.
"I didn't go to medical school to become a pain management doctor for a newborn. It's been thrust upon us. We feel very, very sorry for the babies, and it's very, very difficult for us to understand why these young women think it's OK. Most are addicted before they get pregnant."
The number of pregnant women with addictions to narcotic painkillers has grown so rapidly that Mercy Hospital Recovery Center in Portland, Maine, developed a specialized treatment program for them, says Mark Publicker, an addiction medicine specialist at Mercy.
The moms-to-be spend a month in a six-hours-a-day program before stepping down to three hours daily, Publicker says. About half the babies born don't have any withdrawal, he says. The other half have mild withdrawal.
"The experience of opiate withdrawal is the most painful and most difficult of any withdrawal syndrome," Publicker says. "It's hell. It's physical, emotional and spiritual hell."
At Eastern Maine Medical Center in Bangor, doctors screen every pregnant woman for opiate abuse. "We feel that the incidence is high enough that it's a reasonable screening test," says Jay Hagerty, a neonatologist at Eastern Maine Medical Center.
In the Tampa-St. Petersburg area, doctors and nurses are trained to look for signs of addiction in pregnant women, such as problems controlling pain with normal doses of medicine. "We've had to give some women five times the normal dose of narcotics," Solomon says.
Much of the prognosis for babies exposed to prescription painkillers is drawn from long experience with children exposed to heroin, an opiate that has many of the same characteristics as the narcotic painkillers. Most of those children, over time, catch up to their peers, although some have learning difficulties and attention deficit problems, doctors say.
Few long-term studies have followed children exposed to the prescription painkillers.
"We don't know as much as we need to know," Solomon says. "What also confounds it is the home situation. We don't know what happens when they leave the hospital."
Dear Drugs-Forum readers: We are a small non-profit that runs one of the most read drug information & addiction help websites in the world. We serve over 4 million readers per month, and have costs like all popular websites: servers, hosting, licenses and software. To protect our independence we do not run ads. We take no government funds. We run on donations which average $25. If everyone reading this would donate $5 then this fund raiser would be done in an hour. If Drugs-Forum is useful to you, take one minute to keep it online another year by donating whatever you can today. Donations are currently not sufficient to pay our bills and keep the site up. Your help is most welcome. Thank you.
Doctors see surge in newborns hooked on mothers' pain pills