The increasing numbers of women who abuse prescription painkillers while pregnant are delivering the crack babies of the 21st century, specialists say.
As drug abuse in this country has shifted from street drugs toward the medicine cabinet, more children enter the world dependent on their mothers' prescription painkillers, like OxyContin, Vicodin and Percocet. Baby nurses who once monitored rows of cribs with cooing newborns today are on alert for irritable newborns who may cry excessively, or develop tremors, diarrhea, sweating and vomiting in their first hours to days of life -- all signs of withdrawal from drugs they absorbed from their mother's bodies.
"You walk into the nursery, and you can hear these kids screaming. This is a high-pitched, angry, sort of pained cry," said Dr. Jonathan R. Wispe, a neonatologist at Nationwide Children's Hospital in Columbus, Ohio, who estimated that at any given moment, there were probably three to four such children in a unit that's kept quiet, dark and calm just for them. "They're rigid and tense. They look like miserable things."
Wispe belongs to a coalition of Columbus-area hospitals that track these births. "We've probably seen a tripling or quadrupling of opiate-addicted babies," from 2005 to 2010, the last year for which they have statistics, he said. In 2010, 56 babies at his hospital and more than 200 in Columbus were born hooked on their mothers' prescription narcotics.
"Two-thirds of the time at least," the mothers don't reveal their drug-using history, he estimated.
As a result, doctors must be vigilant about possible in-utero drug exposure, which may begin to cause symptoms within hours to days of delivery, depending on the mother's patterns of usage, several doctors said. Generally, it crops up within two to three days, Wispe said. "They get very jittery and very cranky. Initially, feeding them helps."
"When the kid withdraws depends on when Mom takes her last dose, and how used to it she is," Wispe said. "If Mom is a chronic user, then babies are badly addicted."
Treatment generally consists of a hair-of-the-dog approach. To relieve pain and agitation, doctors administer small doses of morphine or methadone, sometimes adding clonidine, a blood pressure drug, to lower the heart rate. Once they have the babies stabilized, they can begin the painstaking process of gradually tapering the drugs until they're pain-free and able to function again. Babies born hooked can spend up to six weeks in the hospital before they're ready to go home.
"The tried-and-true at this point is morphine," said Dr. Walter Kraft, director of the Clinical Research Unit at Thomas Jefferson University in Philadelphia. He explained that because morphine is a short-acting drug, it's easier to control the dosage for a tiny baby. But he and several colleagues wondered if buprenorphine, a longer-acting drug that has eased withdrawal for adult opiate addicts without being tied to daily visits to a methadone clinic, could be used in newborns soon after delivery.
Because the drug is a pill placed under the tongue, "the challenge was: Are they going to swallow it, spit it out?" he recalled. Doctors created a liquid version, put it under the newborns' tongues "and immediately put in a pacifier. At the end of the day, it ended up working."
Buprenorphine Promising in Early Trials for Reducing Babies' Dependence
Their preliminary study of 50 newborns between 1995 and 2009 suggested the drug reduced treatment time by 30 percent. Babies given buprenorphine were treated for 23 days and released after 28, compared with 34 treatment days and a 39-day stay for newborns given morphine, he said. But that study wasn't a rigorous, randomized, double-blind study in which doctors and patients have no idea who is getting which drug. Kraft and his colleagues have just begun recruiting for an 80-patient study, funded by the National Institute of Drug Abuse, of buprenorphine treatment among newborns.
At Johns Hopkins in Baltimore, psychologist Hendree E. Jones, who specializes in pregnancy and addiction, led an international multi-center study to see if giving buprenorphine to women who were anywhere from six to 30 weeks into their pregnancies, could not only treat their addictions, but also improve the health of their newborn babies. The average hospital stay for babies whose mothers got buprenorphine was 10 days, compared with 17.5 for babies whose mothers got methadone, according to findings published Dec. 9, 2010, in the New England Journal of Medicine, she said. Another positive indication that buprenorphine can help reduce the numbers of babies born dependent on painkillers is that at the time of delivery, only 9 percent of the mothers taking buprenorphine and 15 percent of mothers taking methadone screened positive for use of opiates.
"I've been doing this job for 30 years. I can look back and see the different waves of drugs," said Wispe. "When I first started in the mid-'70s, it was mostly heroin. Then we went through ... cocaine in the '80s and '90s, then we went through methamphetamines, and now back to the prescription opiates in the last four to five years, but heroin is coming back quickly."
At the Mayo Clinic in Rochester, Minn., neonatologist Dr. Robert V. Johnson said he saw one way in which pregnant women's use of prescription painkilling pills was slightly less risky to their babies than abuse of injectable street drugs like heroin. "Street drugs posed an increased risk of infections, HIV and other blood-borne diseases. At least with prescription medications, they're safer and you may have a better sense of dosages that the baby has been exposed to." But, he said, "you still have to individualize treatment based on the symptoms of the babies. "