The neonatal intensive care unit (NICU) in the East Tennessee Children’s Hospital in Knoxville is busy this year. Every day, there are more than a dozen babies born who are hooked on painkillers and other drugs. It’s an alarming trend that has health officials worried. They’re calling it an “epidemic” that could become commonplace across the U.S. As many as three dozen infants at the Knoxville hospital are born addicted to drugs every day. As of October, Tennessee had already seen more infants born addicted to opiates than in all of 2011. “At the current rate,” said Dr. John Dreyzehner, Tennessee Department of Health commissioner, “we are projecting more than 800 drug-dependent newborns by the end of this year.” In response to the crisis, Tennessee has become the first U.S. state to require reporting of all neonatal abstinence syndrome cases.
Neonatal Abstinence Syndrome
The condition of being born addicted to any drug, whether from illegal substances like heroin or legal prescription painkillers, is known as neonatal abstinence syndrome (NAS). The term refers to any type of drug addiction, but recently refers to opiates more than any other substance. NAS occurs when a pregnant woman becomes addicted to a drug, such as a prescription painkiller to treat chronic pain, making her unborn infant addicted as well. Once born, the infant no longer has access to the substance and goes into withdrawal. The symptoms of opiate withdrawal are just as difficult for infants as adults, and are the same for babies born addicted to heroin as babies born addicted to OxyContin. After the opiate’s effects wear off, the babies become “inconsolable,” according to neonatal nurse practitioner Carla Saunders, writhing in pain, trembling and cringing at the slightest sound or touch. They also have difficulty eating and suffer from flu-like digestive symptoms. The effects of withdrawal, which last for days, can be so difficult for some infants that they require doses of methadone or morphine to make the process of easing off opiates easier. Besides being put on morphine, babies with NAS are often treated in special rooms that are darker and quieter than the main NICU wing. These babies are also comforted and calmed by specially-trained hospital volunteers called “cuddlers,” who help the nurses and doctors simply by holding the stressed infants. It is a very labor-intensive process to help a newborn get through opiate addiction, and takes, on average, about 24 days before the baby is deemed stable enough to be discharged to outpatient care.
- According to a study published in the Journal of the American Medical Association (JAMA), an estimated 13,539 infants were born with NAS in the U.S. in 2009 (about one every hour)
- The number of infants born with NAS has more than tripled since 2000
- The number of pregnant women who use opiates has increased by 500 percent since 2000
- The cost of treating a newborn with NAS in Tennessee is about $67,000
- The majority of mothers of NAS babies (42 percent) took prescription meds for legitimate medical conditions
Tip of the Iceberg
The rise of infants with NAS is just a part of a larger opiate problem in the U.S. Since the start of the millennium, the number of opiate drug overdoses has skyrocketed. What was once a rare event associated with heroin use in the inner cities has now spread widely, with opiate overdose rates quadrupling in the span of a decade. This year, an estimated 17,000 people will die from opiate overdose, including more than 6,000 women. Of all drug overdose deaths in the U.S., nearly half are due to prescription painkillers -more than cocaine and heroin combined. Unfortunately, the rate of opiate addiction is rising in pregnant women as well, who often start using the substances for legitimate medical reasons.
Prevention Is Key
Fortunately, NAS is preventable. And while the numbers of babies diagnosed with NAS continue to rise, health officials are hoping that the trend can be reversed through better education of healthcare providers and expectant mothers. Stricter labeling laws on prescription pills, for example, are now being called for. The requirement for NAS reporting by other states, which allows for more effective reporting, is also in the works. For now, the initial outlook for NAS babies appears to be positive, though also uncertain in some areas. This huge influx of NAS is so recent that doctors aren’t sure how it will affect physical and mental development later on. Addiction is a lifelong condition, and many experts agree that NAS will likely lead to a greater potential for behavior problems later in life. When taken into account along with the health risks of prenatal exposure to opiates and other drugs, these problems make the need to prevent NAS more important than ever.