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State wants to help newborns withdrawing from moms' pain pill addiction

Published Feb. 10, 2013

TAMPA — Roxies and oxys, as they're called on the street, were among the powerful prescription painkillers Sarah Ryan was abusing when she found out she was pregnant.

Her battle with drug addictions during earlier pregnancies eventually cost her custody of her three sons. This time, she wanted things to be different, but needed help.

"I just couldn't stop. And the more I hated myself, the more I wanted to drown my sorrows," the 29-year-old Valrico resident said. "I was petrified to actually tell a physician that I was addicted, because I didn't want to lose my child. I was so scared they'd judge me."

Ryan felt trapped in a cycle increasingly common in Florida, where prescription drug abuse has fueled a three-fold increase in the number of babies born into agonizing withdrawal symptoms.

For the first time, a statewide task force of doctors, social workers and public health experts have evaluated the scope of the problem and possible remedies. They issued a report last week with these key findings:

• More than 1,560 Florida newborns in 2011 were diagnosed with the symptoms of Neonatal Abstinence Syndrome — withdrawal conditions believed to be even more common than data suggest.

• The babies typically spend three weeks in neonatal intensive care, resulting in hospital charges as high as $53,400 per baby, compared with $9,500 for a healthy newborn.

• In 2011-12, state taxpayers spent more than $32 million on their care through the Medicaid program, which covers about three-fourths of these babies.

Attorney General Pam Bondi, who chairs the group, visited St. Joseph's Hospital in Tampa to see babies in withdrawal.

"Once you see a baby, it changes your life,'' she said, recounting the shrill cries of newborns in agony, lying in incubators covered to block out irritating noise and light.

"Then we started looking at the numbers. It's a tremendous cost for the hospitals and the taxpayers."

One of the first task force recommendations is requiring hospitals to report cases of babies born into drug withdrawal, just as they report infectious diseases such as tuberculosis and measles.

Another is to see that more pregnant women receive the kind of care Ryan found at Tampa's Drug Abuse Comprehensive Coordinating Office (DACCO).

"The first healthy decision I made for me and my child," is how she describes the help she received early in her second trimester.

Ryan quit the pills, but rather than going cold turkey she was given supervised doses of methadone, a prescription narcotic commonly used to ease withdrawal symptoms. That's the protocol widely considered best for both the fetus' survival and the mother's ability to stay sober.

"If you had diabetes, you would take insulin and you would get on the right dose and remain on the insulin to treat that disease. Opiate dependence is also a disease," said Dr. Jason Fields, DACCO's medical services manager. "Methadone is an effective medication that helps them to become healthy."

Ryan also improved her nutrition with the help of regular prenatal care. Six months ago, she delivered 5-pound, 4-ounce Samuel Quinn. He seemed healthy, but on his third day began to show signs of withdrawal. He was placed on methadone, and then weaned off the drug over 31/2 weeks in neonatal intensive care.

But she is now caring for her healthy baby while continuing her treatment at DACCO.

More research is needed to identify the best way to treat newborns in withdrawal, said task force member Dr. Ken Solomon, a neonatologist. Some hospitals administer methadone, others use morphine. St. Joseph's recently purchased equipment that soothes the babies by simulating the movement of the womb. Tampa General is exploring an infant massage program.

"In the early stages of this treatment, they are just utterly miserable," said Solomon, who treats newborns at St. Joseph's and Morton Plant Hospital in Clearwater. "They act like somebody is pounding a nail into their head."

The long-term effects are especially concerning to neonatologist Dr. Mary Newport at Spring Hill Regional Hospital, where 30 percent of NICU admissions last year involved drug exposure.

"We've had this rash of all of these children who had this very intense drug exposure, and then withdrawal and treatment for that. They are about to hit the school system," said Newport.

In the medical literature, these babies don't appear to suffer lasting harm. But Newport notes that synthetic painkillers like oxycodone are relatively new.

Because these medications are often prescribed by doctors for pain, many pregnant women falsely assume they're safe.

The Zero Exposure Project by the Healthy Start Coalition of Hillsborough County aims to change that perception. The task force called its advertising campaign a model for the state, highlighting the images it used of a belly bump paired with the slogan "a pregnant woman never takes pills alone."

Yet there's no money to continue advertising the campaign, which was featured on three-dozen bus benches in fall 2011 at a cost of $4,500.

Bondi said the state is seeking federal funds for awareness campaigns. The task force also wants to help treatment facilities reach more women. And it recommended exploring new laws to offer pregnant women immunity for seeking substance abuse treatment.

"Our goal is not to arrest mothers and take babies away from mothers," Bondi said. "It's to prevent this from happening."

Letitia Stein can be reached at lstein@tampabay.com or (727) 893-8330.

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