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Drug-dependent babies challenge doctors, politicians

By ZenobiaSky, Jun 16, 2014 | | |
  1. ZenobiaSky
    NASHVILLE, Tenn. -- No one who hears it ever forgets the sound.

    When newborn babies begin to withdraw from powerful drugs, they shriek at a high, telltale pitch. Cut off from the substances they ingested through their mothers, they convulse, projectile vomit or writhe from skin-scorching diarrhea.

    Their tiny bodies shudder violently. They cannot be consoled.

    The urge to help is overwhelming. But the debate over how to help has consumed Tennessee doctors, researchers and politicians alike — and has led them to wildly different conclusions in their efforts to speak up for these infants.

    That's because drug-dependent babies are both heart-wrenching and expensive to care for. Meanwhile, state laws are divergent — and contradictory — in addressing the crisis.

    Beginning this summer, two laws will be in effect at the same time. One encourages treatment and protects parental rights; the other threatens jail time for addicted mothers. Together, they leave doctors unsure what to tell their patients.

    Babies born to addicted mothers are filling neonatal intensive care units in Tennessee faster than the health care system can figure out how to treat them. In the past decade, the number of babies in withdrawal has increased tenfold. Last year, 921 drug-dependent babies were born in the state.

    The average cost to deliver a drug-dependent baby is $62,000, compared with $4,700 for a healthy child. Taxpayers bear the brunt of this cost — most of these babies and their mothers are on TennCare, the state's health insurance program for the poor.

    The crisis has ballooned beyond Tennessee into a national issue. That's why Michael Botticelli, the White House's drug policy director, visited Monroe Carell Jr. Children's Hospital at Vanderbilt in April to learn about the faculty's urgent investigation into how best to treat drug-dependent babies.

    Flanked by an entourage of white-coated staff, Botticelli toured dark rooms where thin-chested infants breathed rapidly in clear plastic cribs snaked with tubes. He met a new mother recovering from addiction. He planned to take what he learned about newborn drug withdrawal, known as neonatal abstinence syndrome (NAS), back to D.C.

    "When you talk about forward-leaning states that are looking at NAS, you always hear Tennessee, Tennessee, Tennessee," Botticelli said.

    Treatment vs. criminalization

    The state has made its mark in trying to understand what triggers the painful symptoms in babies going through nicotine and opioid withdrawal. Researchers and insurers alike are looking for ways to reach out to and treat pregnant women with addictions.

    That also has helped make Middle Tennessee a crucible for a roiling controversy about how to cope with the epidemic of babies in drug withdrawal, with elected officials offering solutions of their own.

    But finding the right way to help is a dicey proposition. Women who know they are pregnant and addicted are often ashamed and fear that their babies could be taken away by the state. And the few doctors equipped to truly help them say they are baffled by the mixed signals being sent by lawmakers — to the point that they aren't sure what to tell patients.

    Last year, legislators passed a law designed to encourage mothers with addiction to seek treatment. Called the Safe Harbor Act, the law says that if addicted mothers seek help, the Department of Children's Services cannot take their children into state custody based on the addiction alone.

    But this year the legislature passed another law, one that tagged mothers with addiction as perpetrators of crimes against infants. As of July 1, police will be able to arrest a woman whose baby tests positive for drugs if she can't prove she's taking steps to get clean.

    "It would just seem to me that any society that puts value on life would agree that these defenseless children deserve some protection and these babies need a voice," said Republican state Rep. Terri Lynn Weaver, who sponsored the law that criminalizes addicted mothers.
    But civil rights activists and lawyers say they fear that the threat of criminalization will drive already-stigmatized pregnant addicts further underground, away from the care they need in the crucial period before babies are born.

    Weaver insists her law can single out bad actors.

    "These ladies are not those who would consider going to prenatal care. These are ladies who are strung out on heroin and cocaine and their only next decision is how to get their next fix," she said on the House floor. "These ladies are the worst of the worst. Again, I want to emphasize what they are thinking about, and that is just money for the next high."

    Doctors who work with women battling addiction tell a different story.

    Misunderstanding addiction

    Jessica Young treats pregnant women with substance abuse problems every day at her Vanderbilt clinic. She's the only Middle Tennessee obstetrician whose practice targets this patient population.

    Young cringed as she recalled the legislative debate.

    "When you don't have an understanding of addiction, treatment of addiction or the socioeconomic place these patients are coming from, then I don't think that you can make effective legislation," she said.

    Young understands the desperate need to reduce the number of babies in withdrawal. But those babies are a result of complicated systemic problems, she says. Few are simply the children of criminals.

    In fact, 42 percent of women who gave birth to drug-dependent babies in Tennessee last year were taking painkillers prescribed by doctors and no other drugs. While some of Young's patients first got hooked from recreational use, others took prescription painkillers after a cesarean section or injuries from a car crash and became addicted.

    Some are children of addicts themselves. Young said many of her patients suffer post-traumatic stress disorder from physical and sexual abuse. Some have undiagnosed depression, which opiates ease.

    Regardless of the jail threat, the medical community keeps searching for answers.

    Research has shown that quitting the drugs cold can endanger a baby. Even tapering off an addictive drug can lead to relapse and be especially dangerous during pregnancy.

    The gold standard in treatment is for a doctor to transfer the mother to a less harmful opioid, such as methadone or buprenorphine, and monitor its use.

    These medications can still cause a baby to withdraw, but at least the odds improve. Mothers on this kind of therapy have a 60 percent chance of delivering a healthy baby, compared with a 30 percent to 40 percent chance for women who receive no treatment.

    But women who need maintenance therapy drugs often struggle to get them.

    To get buprenorphine, they must go to one of the state's few doctors with a special license. To get methadone, they must go regularly to a clinic — in Middle Tennessee there's one in Nashville and one in Columbia. Women must often pay out of pocket.

    And many women of child-bearing age don't qualify for TennCare until they find themselves pregnant. That makes it difficult for an addict to access family planning or mental health preventive care before becoming pregnant.

    The state's three managed care companies — Amerigroup, UnitedHealthcare's Medicaid subsidiary and BlueCross BlueShield's BlueCare program — are trying to reach these women earlier to ensure that more babies are born healthy. All have flagged drug-dependent babies as a major cost issue. BlueCross, for example, covered 775 such babies in 2013.

    All three have launched efforts to help expectant mothers beat their addictions.

    Addiction is a legitimate disease, says William Wood, Amerigroup's chief medical officer. He compares it to diabetes and notes that doctors routinely treat diabetic women for their illness and their pregnancy simultaneously.

    But pregnant women with addiction face barriers of shame and fear.

    With that in mind, Tennessee lawmakers passed the Safe Harbor Act last year.

    The law "is something I could talk about with patients to help assuage their fears that they were doing the right thing by getting treatment, that if they continued to do what they were supposed to do, they wouldn't have to worry about losing custody," said Young, the Vanderbilt doctor.

    Unknowns remain

    While doctors and insurers struggle to bridge the disconnect between the impulse to help and the move by the legislature to punish, many women with addiction are left to fend for themselves.

    Managed care companies, fueled by compassion and their bottom lines, try to reach these women and to reward them for asking for help. Doctors labor to learn more about addiction, to standardize care for mothers, to ease the suffering of babies.

    All of this occurs against a backdrop filled with unknowns. Medical experts say they still don't know enough about drug-dependent newborns. They remain in the dark regarding the exact cause of withdrawal, the best therapeutic drug for addicted mothers and how dependency in an infant affects long-term childhood development.

    What they do know is that some form of treatment is better than none, for mothers and babies. If the new criminal penalty prevents addicted mothers from seeking help during pregnancies, they say, it will amplify the problem lawmakers set out to solve.

    And that, in turn, will further jeopardize the babies whose cries they claim to be hearing.

    Shelley DuBois and Tony Gonzalez
    The Tennessean
    7:23 a.m. EDT June 15, 2014

    The Newhawks Crew


  1. Once.up.on.a.time
    Those poor poor babies.

    It breaks my heart the hell their tiny new bodies must go through :(

    I'm a CP patient and have serious bladder problems, in which my bladder tears everytime it tries to fill up. When I discovered I was pregnant the first thing I asked was if my tablets would harm the baby. Or if she would be addicted when born.

    I was addicted both psychologically and physically to my pain medication. But I stopped it. No doubt in my mind that whilst she was an accident, the tiny life growing inside me was more important than my pain.

    I also stopped taking the medication to soften my bladder wall . They didn't know what effect, if any it would have on the baby, but still I wasn't willing to take the risk.

    So u spent my whole pregnancy in pure agony, as any expectant mother will know he toilet is where you spend a significant amount of time, my bladder has twice as much scar tissue as before due to the tearing in pregnancy.

    I understand people are addicted, pregnant women are addicted. But they are not the most important when pregnant. The baby can't speak for its self a mother should be a protector not put their baby at risk.

    These figures shock and appall me.

    Women need to take precautions for this not to happen or step up and kick the addiction in to check for their child
  2. Name goes here
    Personal story time.

    (My Buddies wife) is a heavy opiate user for legitimate, debilitating pain. She has had two children that went through her womb while she was taking oxycodone. This was done under her primary care doctors watch and extreme dislike from her obgyn. Without opiates, she would have spent the entire time bed ridden and in agony.

    At 7 months, She started to taper down so at 8 1/2 months there was no drugs in her and children's bodies. Both of her children were born without any complications. She suffered a lot to make sure her newborns did not have to detox.

    I understand addiction and the need for drugs while pregnant however it is unacceptable to have a drug addicted newborn. A mother knows what she puts into her system goes into the babies so having an addicted child should be punished.

    If a woman gets pregnant and tries to clean up/detox, I don't think their should be a legal action but I've seen heroin addicted babies born to women using right to the end. It's child endangerment.
  3. ZenobiaSky
    It is a truly sad situation. I watched my friend use meth during her whole pregnancy, I didn't say anything because I knew she would hide her use from me too, and I was her labor coach. I held me breath when her daughter was born, and thank god, no adverse effects.

    But on the other side, as a Respiratory Therapist, I have worked in the NICU and taken care of some of these babies, and it is heart wrenching, makes you want to wonder how can anyone do that to their child. I saw a case recently where mom and baby tested positive for cocaine, and charges weren't filed against the mother because they said child abuse can't happen in the womb, only afterl the baby is born... how ridiculous is that!!!!
  4. AKA_freckles
    I thought babies born addicted to opiates, especially methadone, are given drugs to taper off. Is this something I have misunderstood?
  5. Once.up.on.a.time

    If like to know the answer to this myself.

    Does anyone know or have experience of any medications given to babies born addicted?

    My little 18 month old angel is sat beside me snuggled up to her mummy, how anyone could hurt a child, especially a baby, in any way is beyond me.

    Babies are 100% dependant on their mum to look after them, primarily and most importantly in the womb. Once the baby is born others can assist with care, but in the womb it is 100% down to the mum.

    I'm pro choice, whilst I personally could never have an abortion, but once those cells are growing in my opinion it's a baby.

    I've read whilst doing my child and biological psychology modules of my degree, it's very early when the baby can feel pain in the womb.

    It shatters my heart these babies suffering inside what should be their protector. If you don't want to put the life inside you before yourself then et an abortion. Why isn't this simple?

    I'm off to show some more extra love to my little angel xx
  6. Diverboone
    This is a post I made in another thread concerning the new law to jail mothers for their drug use during pregnancy.

    Tennessee just became first state that will jail women for their pregnancy outcom Sometimes I wonder why I claim Tennessee as my home. Welcome to the State that you no longer confer with your medical provider/doctor concerning pregnancy related issues. Apparently our legislators believe they re more qualified.

    If you actually believe this is about the safety and health of newborns why does it fail to include the two drugs that are responsible for more negative pregnancy related issues, tobacco and alcohol. Tobacco and alcohol related pregnancy issues out number all the drugs this law covers. Is it not absurd that the 2 substances that are just as harmful if not more harmful than any illicit drug, and negatively affect more pregnancies and newborns than all other drug combined, is not mentioned? With this in mind, how could anyone in their right mind believe this law is about preventing harm?

    I believe we could start by removing the word "addiction" when referencing newborns. I hear this often, even during the debates over this law. By definition a child can not be born with an addiction.

    Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. A newborn is not capable of such behavior. A newborn may be born dependent. Neonatal Abstinence Syndrome is one of the two diagnosable medical conditions that is a direct result of drug use by the expecting mother. The other is Fetal Alcohol Syndrome.

    On the basis of popular literature, warning labels, and general confidence in the advances of modern medicine, many people wrongly believe that women have a high degree of control over their pregnancy outcomes. For example, the best selling pregnancy advice book What to Expect When You’re Expecting warns women to avoid contact with anyone who is smoking, changing a cat litter box, consuming unpasteurized cheese or undercooked meat, gardening without gloves, inhaling when handling household cleaning products, and ingesting caffeine, thereby creating the illusion that women who conform to all proscriptions can guarantee a healthy pregnancy outcome.

    The longstanding and constant medical reality, however, is that as many as 20-30 percent of all pregnancies will end in miscarriage or stillbirth. In fact, stillbirth is one of the most common adverse outcomes of pregnancy, and it occurs despite the best intentions and numerous precautions taken by individual women.

    No one would deny parents play a significant role in the health and well-being of their child, both before and after birth. But … every day in America women who did everything “right” during pregnancy that is, they got good prenatal care, they were married to the father of the child,
    their neither smoked nor drank nor abused drugs nevertheless give birth to babies with birth defects or low birth weight. … Scientific progress in understanding the causes of some birth defects inclines people to overestimate what is known, but the truth is that more than 60 percent of all birth defects are of unknown origin.

    This brings about the question. What will be the standard of proof that the mothers drug use was responsible for less than perfect outcomes? The mother's liberty is at risk, also the family unit, Along with the health of the newborn being in question, how could anyone in the medical field state with any degree of certainty that the mothers drug use was conclusively the cause of a factual medical issue with her newborn.

    My opinion is that this law is not backed by science. It's based upon opinion, with an ulterior motive aimed at gaining votes and public support. Also I highly question the Governments attempts to control the health decisions of expecting mothers. Those decisions are best discussed with and determined by someone with a medical degree.

    If we continue to allow laws such as this, we can expect to see legal actions taken against obese expecting mothers. Obesity and it's related issues are responsible for many more negative child births. Obesity is a choice, just as drug use is. But the risk, deaths and cost related to Obesity far succeed all illicit drug use combined. It's a slippery slope when the Government attempts to legislate populations health.

    We should not sit ideally by. The well being of expectant mothers and their newborns needs to be addressed. Criminal sanctions and incarceration is not how families are mended and prosper. The criminal justice system is a total failure within it's self. Nor has jurisprudence been effecting treating medical and often mental conditions. Doctors spend many years gaining their education in order to guide us with medical advice. So why would we allow legislators that did not take into consideration that most prominent medical associations were not in agreement with this law, A law that's very likely to cause more harm than help.
  7. Dr.Evil
    If people are interested in seeing the medical side of this debate, which most (sane) doctors falls along the lines of treatment/rehabilitation instead of criminalizing these mothers. I suggest you take a look at this thread.

    Drug Abuse Effects in Pregnancy
  8. Diverboone
    Dr.Evil I have had the chance to read that thread and found that I thought it to be well researched and written. I believe there is research existing to bolster most of the info made available in the thread.

    All the symptoms reported could be due the use of the named drug and research has show a link. But many of these symptoms can occur to newborns of non using mothers too. Which suggest that there may be other factors Besides drug use that play a roll in newborn's health. So it is very possible that a mother could be prosecuted for a medical issue that was not the results from her drug usage, but an underlying issue. An issue that will go untreated due to the assumption.

    Most major medical associations voiced their opposition to the passage of the latest law in Tennessee criminalizing mothers for suspected drug use. There just is not enough research for a medical expert to conclusively attribute less than perfect pregnancy outcomes upon a particular drug. Even your thread contains the disclaimer " ***almost all that report using one drug of abuse have used others during pregnancy***". More specific human research is indicated.
  9. Diverboone
    I can only assume that expecting mothers that don't avoid contact with anyone who is smoking, changing a cat litter box, consuming unpasteurized cheese or undercooked meat, gardening without gloves, inhaling when handling household cleaning products, and ingesting caffeine also cause their babies to suffer?

    There is an awful lot of assumption that illicit drug use is more harmful than non-illicit drug use and other activities. The risk posed to an unborn child is not determined by legalities. Just look at the suffering these little babies go through just because their mother is obese.

  10. Diverboone

    Despite the growing consensus that mass incarceration is not the way to cure all social ills, there seems to be a new trend toward prosecuting parents who fall short of prevailing ideals.
    You don’t have to be a parent, as I am, to understand the good intentions behind efforts to hold parents accountable for taking good care of their children. But we also have to ask what kind of care is best and whether the criminal justice system is always the best decider.

    Take for example the case of Debra Harrell, who was jailed and charged recently with “unlawful conduct toward a child” in North Augusta, South Carolina, according to news reports. Her crime: leaving her 9-year-old daughter alone to play with a few dozen other kids in a local park while Harrell went to work.
    Like a lot of parents, I wouldn’t have left my kid unsupervised at that age, no matter how safe the neighborhood may be. But, considering how many other parents were AWOL when I took my son to our neighborhood parks, that question is subject to endless debate.

    Freelance writer Kim Brooks found that to be true, as she recounted in a Salon article about her own arrest. She left her 4-year-old son in the car alone for a few minutes while she bought a pair of headphones. Although she didn’t deem that move to be unsafe or unusual, a “good Samaritan,” as she put it, videotaped her offense.

    “I’m glad we live in a world where people are watching out for kids,” she recalled her lawyer consoling her. “But in your case, what happened wasn’t malicious. It wasn’t neglectful. It was a temporary lapse in judgment. This is what we need to stress.”

    She eventually agreed to do 100 hours of community service and to take parenting classes.
    Her case also brought a lot of sympathy from Lenore Skenazy, a former New York Sun columnist who made a national splash with a 2008 column about her decision to let her 9-year-old son take the subway by himself. The resulting flood of praise and outrage (she embraced the title “World’s Worst Mom” for a syndicated TV series she hosted in 2012) moved her to found the Free Range Kids movement dedicated, in her words, to “fighting the belief that our kids are in constant danger.”

    Letting your kids roam free helps them learn and grow, Skenazy argues, unlike the “bubble-wrap kids” raised by us more paranoid parents.

    To me that view sounds more appropriate to the small-town world of a half-century ago in which I grew up. Today’s world is so immersed in horror stories about abducted children and kids dying in locked cars that merely leaving children unattended can be grounds for arrest.

    The “criminalization of parenting” is what libertarian-leaning Washington Post blogger Radley Balko calls these cases. Balko deplores the increasing use of the criminal justice system to address problems that used to be handled by families, friends, churches and other community institutions.
    I suspect that our society’s faith in those traditional institutions has declined with the rising, widely held suspicion that those institutions are under siege and breaking down.

    That fear helps to explain why Tennessee has taken the extreme and, I believe, dangerous step of passing the nation’s first state law that specifically criminalizes taking drugs while pregnant.
    Only a few days after the law went into effect on July 1, Monroe County police arrested Mallory Loyola, 26, after both she and her newborn infant tested positive for meth, according to police reports.
    There’s no question that the law is well intended. For some drug offenders, arrest may be the last-resort way to get them into the treatment they need. But a new danger to unborn children rises when the emphasis on prosecution deters women with drug and alcohol problems from seeking the prenatal care that they need.

    In recent years we have seen a broad spectrum of politicians and activists — from the libertarian right to the progressive left — push for alternative sentencing that reduces the expensive mass incarceration of nonviolent offenders, mostly in the government-sponsored war on drugs. We also need to look seriously for alternatives to prosecution that can avoid a new war on parents.

    Clarence Page is a columnist for the Chicago Tribune
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