Opioid abuse in America has reached epic proportions. Public health authorities estimated in 2017 that two million people were addicted. In the same year, more than 47,000 Americans died from opioid overdoses, far more than from car crashes or guns, making drug overdoses the leading cause of death for Americans under 50.
But experts say that, even as more attention is gradually being paid to the crisis, one particularly vulnerable group – pregnant mothers who are addicted and their newborns – are being overlooked.
“We have drugs that could treat people who are addicted,” said Stephen Patrick, a paediatrician at Monroe Carell Jr. Children’s Hospital at Vanderbilt University in Tennessee. “But the vast majority of pregnant women get no treatment.”
Babies born to opioid-addicted mothers typically suffer from extreme irritability and tremors. They frequently are unable to feed, a situation that can be life-threatening.
Yet a growing number of specialists say that due to outmoded thinking and a lack of funding, evidence-based treatments as not being administered and addicted mothers and their babies are often left to suffer needlessly.
The number of babies with symptoms of withdrawal has grown seven-fold over the last 15 years to about 32,000 per year today, Patrick said.
Drugs like methadone and buprenorphine, especially in combination with counselling, are increasingly being shown to be the most effective way to treat opioid addiction. Yet only about one in ten addicted pregnant women gets any type of treatment for her addiction, he added, about the same proportion as for all people addicted to opioids.
Part of the reason is the serious lack of treatment programs.
According to the Substance Abuse and Mental Health Services Administration website, although this approach “has proved to be clinically effective. … Unfortunately, MAT [medication-assisted treatment] is greatly underused.” The site says this is due in part “to misconceptions about substituting one drug for another … [and a] lack of training for physicians.”
But another driver is the fear of losing one’s baby. “Women are sometimes scared to seek treatment,” said Hendree Jones, a professor of psychology and executive director of UNC Horizons, a leading drug treatment program for pregnant mothers and their newborns at the University of North Carolina, Chapel Hill teaching hospital.
Mothers sometimes try to hide their addiction, thereby avoiding treatment for themselves and their baby and hindering healthcare access. “They are afraid child welfare services will take their children,” said Jones.
Indeed, traditionally, a mother’s addiction has been a reason for child welfare authorities to remove an infant. “This is a big problem,” said Alison V. Holmes, a professor of Pediatrics at Children’s Hospital at Dartmouth-Hitchcock, in New Hampshire, “viewing addiction as a crime instead of a health problem.”
According to Patrick, treatment reduces the risk that a pregnant woman will suffer an overdose or give birth prematurely, both big dangers to the health of the newborn. “When a mother receives drug treatment during pregnancy, the baby still has withdrawal symptoms,” he said. “But the babies still often do better since the mother tends to use less” of the opioid.
Experts say more recently, child health services are beginning to recognise the benefits of keeping infants with their mothers, where possible. The trend is supported by 2016 federal legislation that requires states to develop “plans of safe care” that take into account both infant safety and the goal of keeping a family together.
But the crisis is crying out for more uniform practices and standards of care. “We have pretty good evidence that [US] states are pretty confused about how to implement plans of safe care,” said Patrick.
There is a similar lack of uniform standards for the treatment babies of addicted mothers receive in hospital right after birth. Traditionally, newborns suffering from opioid withdrawal, a condition known officially as neonatal abstinence syndrome (NAS), are sent straight to the intensive care unit.
“They are very hard to care for,” said Holmes. “You can’t get them to stop crying; they have shakes and tremors and they don’t sleep much. It’s very exhausting for the care giver.” One of the biggest risks for the health of such newborns is that they are often very difficult to feed and may lose weight.
Yet more recently, some hospitals have changed to a “rooming in” approach – placing the newborn with their mother, reducing stimulation to a minimum, and monitoring them closely.
Dr. Holmes’ hospital, in New Hampshire, is one of them. In a meta-study published in the child health journal, JAMA Pediatrics, in 2018, she and her colleagues found that when infants are kept in the room with their mother, they need less medication and hospital stays are shorter. “These were very significant results,” she said.
Dr. Patrick adds that when Children’s Hospital at Vanderbilt adopted a similar policy, the number of infants in withdrawal who needed morphine to calm them dropped significantly to 20 percent, from a larger portion.
Meanwhile, UNC Horizons, the drug treatment program for expecting mothers and infants in North Carolina, is widely seen as a leader in the field.
The program takes a holistic approach, providing addiction treatment, medical and mental health care, parenting support, legal assistance and job placement. “It’s so much better for patients to be able to get all their care under one roof,” said Dr. Holmes, who said her program in New Hampshire tries to model itself on Horizons.
Experts say such comprehensive care is more effective than prison, or removing newborns, in getting mothers to kick their addiction. Horizons said its approach is “trauma-informed,” since it takes into account the stigma and rejection that such women have typically already gone through. Its goal, it said, is “to heal the whole family.” — Burton Bollag
(Picture credit: ep_jhu/Flickr)