Prescription drug epidemic spreads to babies

Dr. Terri Ashmeade of Tampa General Hospital says more babies are being treated for prescription drug withdrawal. The hospital has treated about 25 so far in 2010, compared with 17 in all of 2009.

SCOTT MCINTYRE | Times

Dr. Terri Ashmeade of Tampa General Hospital says more babies are being treated for prescription drug withdrawal. The hospital has treated about 25 so far in 2010, compared with 17 in all of 2009.

Dr. Mary Newport sees the symptoms more and more in the babies she treats: oddly stiff limbs, severe tremors, vomiting, diarrhea, insomnia, crying that never stops.

The common denominator: Their mothers were taking prescription drugs, mostly painkillers like OxyContin and Vicodin, and antianxiety drugs like Xanax during pregnancy.

Some of the moms had no idea these medications would hurt their developing babies — after all, it's not like it's heroin or cocaine, many think.

"They are seriously misinformed," said Newport, medical director of Spring Hill Regional Hospital's neonatal intensive care unit.

The prescription drug epidemic, well documented among teens and adults, now is claiming victims before they are even born. Tampa Bay area doctors and addiction specialists are reporting a dramatic increase in the number of pregnant addicts and infants needing treatment for withdrawal from prescription drugs.

The trend is reminiscent of the "crack baby" epidemic of the 1980s, when mothers used crack cocaine during their pregnancies.

But area neonatologists say that in some ways, the current trend is worse. Some women don't understand that prescription drugs can be dangerous during pregnancy. Others decide to stop the drugs as soon as they learn they are pregnant, causing sudden withdrawal that can lead to miscarriage.

And doctors say that treating a baby with drugs like oxycodone, methadone or Xanax in the system takes longer, and involves more medication, than treatment for heroin or cocaine.

"Babies are suffering more," said Dr. Terri Ashmeade, medical director of Tampa General Hospital's neonatal intensive care unit. "Withdrawal patterns seem to be worse (with prescription drugs) than what we were seeing with heroin."

• • •

Between 550,000 and 750,000 children nationally are born each year after prenatal exposure to drugs or alcohol, though it's not known how many of the babies are exposed to prescription drugs.

Here's what we do know: Many more people are abusing prescription drugs, about half of them are women, and they're getting younger, according to a study released Thursday by the federal Substance Abuse and Mental Health Services Administration. It found the rate of treatment admissions for prescription drug abuse has more than quadrupled in the last decade.

In 1998, the largest group of women admitted for prescription drug abuse treatment in Florida was age 26 to 45. A decade later, the predominant age was 21 to 30.

The National Institute on Drug Abuse considers prescription drug abuse during pregnancy an "understudied" research area that needs attention.

• • •

Neonatologists and others on the front lines say they don't need a federal survey to know there are more newborns hooked on prescription painkillers.

Newport said she has seen more babies treated for prescription drug withdrawal in the past two years at Spring Hill Regional than in the previous 25 years combined. Ashmeade said that at Tampa General, about 25 babies have been treated so far this year for prescription drug withdrawal, compared with 17 in all of 2009.

The trend is also evident in area treatment centers such as Operation PAR. Dr. Michael Sheehan, medical director of the nonprofit group, says that at any given time, 40 to 50 pregnant women are receiving treatment for prescription drug abuse at one of its four clinics in Clearwater, New Port Richey, Bradenton and Fort Myers.

Sheehan added that the pregnant women seeking treatment are getting younger. Years ago, they were in their late 20s and early 30s. And now? "Late teens and early 20s," he said.

Newport agrees, often referring to the mothers she sees as "girls." She said they usually obtain the drugs illegally, and often take multiple kinds.

"We're seeing oxycodone, Vicodin, methadone, a lot of Xanax," Newport said. "I'm amazed at the number of girls on antidepressants, antianxiety drugs, even during pregnancy."

• • •

Just about anything consumed by a pregnant woman passes to the fetus through the placenta.

Consuming alcohol can lead to fetal alcohol syndrome, putting the baby at risk of heart defects, poor growth and delayed mental and emotional development. Babies born to mothers who smoke cigarettes during pregnancy are more likely to be born too soon and too small.

Babies with prescription drugs in their system often suffer from neurological symptoms such as hypertonia, or stiff limbs. If the drugs are opioid painkillers (such as oxycodone and methadone), the babies can also have gastrointestinal symptoms like vomiting and diarrhea, Ashmeade said. If they're withdrawing from antianxiety medications like Xanax, the babies can have tremors and cry constantly.

Put it all together, and you have a baby in misery for weeks and even months.

"Some of the worst withdrawals I have seen were babies whose mothers were taking Xanax and methadone," Newport said.

Babies can suffer withdrawal even in cases where the mother was taking the drugs in amounts prescribed by a doctor.

Opioids such as oxycodone and Vicodin are considered Pregnancy Level C drugs, which means that they have not been studied in pregnant women, but in animal studies are linked to birth defects. But they can be prescribed during pregnancy if the doctor believes the benefit to the mother outweighs possible risk to the fetus.

• • •

Newborns are often weaned off their addiction with another opioid painkiller, morphine. Typically, the baby receives doses that decrease over time, until the withdrawal symptoms go away. Newport says that can take anywhere from three weeks to two months, depending on the severity of the symptoms and the type of drugs in the system. In some cases, symptoms can persist for months after the baby has left the hospital, she said.

Ashmeade added that doctors often don't know exactly what drugs the mother was taking until they test the baby's blood or urine. "Some moms will not admit, some will," she said.

When drugs are found in a newborn, doctors call the hospital social worker, who may summon the Florida Department of Children and Families, but not always, doctors say.

In some cases, the mothers have already been dealing with social workers or state officials during pregnancy, Ashmeade said.

"But oftentimes, these moms are legitimately taking medications, taking them for chronic pain," she said. "It doesn't necessarily mean the mom was abusing the drugs."

• • •

Treatment for prescription drug abuse begins for some women during pregnancy, at centers like Operation PAR, created about 40 years ago to help parents deal with drug addiction.

Sheehan, the medical director, says that pregnancy is often a wakeup call for women. They arrive at Operation PAR at different stages of pregnancy, though Sheehan says that the earlier women seek treatment, the better.

The most common treatment is with methadone, which gradually reduces or eliminates craving for other opioid drugs and can help save the baby's life. The Centers for Disease Control and Prevention says methadone is particularly effective because it blocks the euphoric and sedating effects of other opioids. The treatment does not cause birth defects, but the Substance Abuse and Mental Health Services Administration acknowledges, "some infants may go through withdrawal after birth."

Sheehan adds that it helps mothers beat addiction while delivering babies that will most likely survive.

But doctors say babies don't have an easy time of it. Newport says treating a baby with methadone withdrawal usually takes longer than if the mother continued on her original drug. But Newport agrees methadone is the best medical option to get mothers off drugs so they can care for their children.

The worst idea is quitting cold turkey, a sudden withdrawal that is agonizing and possibly fatal.

"The baby could have seizures and die," Newport said.

• • •

Federal health agencies say the prescription drug epidemic is too new to know what the long-term impacts could be on babies born hooked.

But doctors like Ashmeade say that no matter what kind of addiction a mother suffers from, her children run a much greater risk of being neglected or abused if she can't stay clean and sober.

Ashmeade said the key to helping ensure these babies' welfare is to provide more treatment opportunities for their mothers. At centers like Operation PAR, pregnant women receive top priority, but there are waiting lists for others.

"We need to increase the number of treatment programs, or make it easier for people to get into treatment," she said. "People are going to find a way to get the drugs."

Times researcher Caryn Baird contributed to this report. Richard Martin can be reached at rmartin@sptimes.com or (727) 893-8330. For the latest in health news, visit tampabay.com/health.

Prescription drug epidemic spreads to babies 07/16/10 [Last modified: Saturday, July 17, 2010 10:26pm]

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