By the numbers
5.63: Number of new mothers using opiates per 1,000 hospital births in 2009, up from 1.19 in 200
3.39: Number of newborns suffering neonatal abstinence syndrome per 1,000 hospital births in 2009, up from 1.20 in 2000
$720 million: Total hospital charges related to NAS in 2009, up from $190 million in 2000
Source: Journal of the American Medical Association, based on study of hospitals in 44 states
The consequences of drug addiction can carry a heavy toll for the tiniest people: newborn babies who suffer from withdrawal.
In the neonatal intensive care unit, health professionals see firsthand a product of alarming increases in prescription opioid abuse — community health advocates cite a 666 percent increase in the dispensing of oxycodone from 2009 to 2011 in Hall County.
“We’ve definitely felt that in the neonatal world,” said Janessa Canals-Alonso, nurse manager at Northeast Georgia Medical Center’s NICU. “Where before we were impacted more by premature deliveries, or just a very sick infant, all of sudden we’re constantly having babies that are in withdrawal in our units.”
In the Northeast Georgia NICU, about two babies per month are treated for neonatal abstinence syndrome, the medical terminology for addiction withdrawal. Those incidences have doubled in only five years, Canals-Alonso said.
Studies show the syndrome is most commonly associated with opiate use — from prescription painkillers like Oxycodone to illegal drugs such as heroin — prior to and during pregnancy. Other types of drugs, like barbiturates, cocaine and smoking, also can cause withdrawal symptoms in newborns.
The effects of NAS are in addition to the impact of the drug on the infant’s development. The severity and duration of withdrawal depends on the drug involved. Symptoms include seizures, tremors, excessive high-pitched crying, hyperactivity and vomiting.
The infant is not considered “addicted” to the drug, which speaks to a physical and behavioral state of mind, but experiences withdrawal when the dependency-inducing supply of the drug is cut off outside the womb.
A baby suffering from the syndrome for opiate use has to be administered medications such as methadone, an opiate used to treat heroin addiction, and then slowly weaned off of the drug. Such treatment is not cheap.
“This hits health care costs dramatically,” Canals-Alonso said. “Just one NICU day itself, without anything, could be $1,200. When you start adding medications, any other treatment that goes on — it could be thousands and thousands of dollars.”
The average stay in the NICU is about 15 days for an infant with withdrawal, she said.
“This has been a very difficult topic for many NICUs throughout the nation,” Canals-Alonso added.
Indeed, research has shown that like the proliferation of opioid pain prescriptions, the increase locally in infant withdrawals mirrors national trends.
A 2012 study published in the Journal of the American Medical Association looked at information on millions of discharges from thousands of hospitals in 44 states to measure trends and costs associated with NAS over the past decade, revealing almost a fivefold increase from 2000 to 2009 in the number of mothers using opiates — from 1.19 to 5.63 per 1,000 hospital births per year. The rate of newborns diagnosed with the syndrome increased from 1.20 to 3.39 per 1,000 hospital births per year.
Factoring inflation, total hospital charges for NAS were estimated to have increased from $190 to $720 million over the same period of the study, with the majority of costs shouldered by Medicaid, researchers said.
In October, the Food and Drug Administration recommended tighter controls on hydrocodone, signaling an increasing sense of urgency to combat prescription, illegal sales and improper diversion — such as teens raiding the bathroom cupboard — of prescription opioids.
Men are more affected, but women are catching up in the prescription drug problem, which the Center for Disease Control has labeled an epidemic. The number of women dying due to prescription drug abuse rose 400 percent between 1999 and 2010, the CDC reported, compared to 250 percent for men.
One of the biggest problems for pregnant women dependent on a prescription drug is that it may be too late to take the cessation measures necessary to prevent infant withdrawal.
“That can effect the infant. They can have seizures in utero if you went cold turkey,” Canals-Alonso said. “So a lot of the time, to play it safe, the physician will keep that mom on medication or wean her off very slowly. But they can’t take her off completely; that mom can’t take herself off completely.”
The seeming paradox of such a situation, and a severe consequence, was prominent in an Oct. 9 wreck in South Hall County, where a pregnant woman was arrested for DUI of drugs, serious injury by vehicle, endangering a child while driving under the influence, driving while license suspended and failure to maintain lane.
Sugar Hill resident Amber Nicole Taylor, 22, said she was on drugs prescribed to her when she crossed the center lane and hit two vehicles before overturning her own, seriously injuring her father, according to the Georgia State Patrol. Taylor pleaded guilty and will participate in Hall County’s drug court program.
Canals-Alonso said doctors should have frank, informed discussions with patients on the consequences of delivering a baby in withdrawal.
“I think there needs to be more education on the back end as to what are the symptoms the baby can have once delivered,” she said. “Unfortunately when we get these moms, they’re very upset because they weren’t informed that their baby was going to go through up to a six-week withdrawal.”
The onset of symptoms of neonatal withdrawal can begin as early as 24 hours of birth or can be delayed until five to seven days of age, dependent on type of drug or substance used. A baby with NAS symptoms sometimes never sees a NICU.
“That’s an entire other concern,” Canals-Alonso said. “These babies are very difficult to manage. They cry uncontrollably; you can’t console them. They’re very jittery and they are difficult feeders. A mom is already having to deal with so many new life changes in addition to a baby who is inconsolable. That just adds so much stress.”
She paused, a nurse’s concern coloring her voice.
“You know, you worry about those babies, and those moms as well,” she said.