'Just flooding us': Tenn. spike in drug-dependent newborns is warning to nation
On an average day, neonatal nurse practitioner Carla Saunders faces two dozen babies born hooked on drugs, infants so sick with the pain of withdrawal that they cry nonstop, claw their faces and writhe in agony at the sound of a voice or the touch of hand. But that's just the average.
"Today, it may be even higher," says Saunders, who staffs the 60-bed intensive care unit at East Tennessee Children's Hospital in Knoxville, Tenn. "It's been as high as 37."
The babies are part of a grim trend in Tennessee, where a new report shows that the number of newborns dependent on drugs their mothers took during pregnancy is higher than ever — and experts say it should be a warning to the rest of the nation.
"At the current rate this epidemic is progressing, we are projecting more than 800 drug-dependent newborns by the end of this year," said Dr. John Dreyzehner, the commissioner for the Tennessee Department of Health.
Already this year, the Volunteer state has counted more babies born with symptoms of withdrawal from opiates — a condition known as neonatal abstinence syndrome, or NAS — than they saw in all of 2011.
Because Tennessee is the first state to require reporting of NAS, experts say it's a harbinger of a worsening national problem of pregnant women addicted to prescription painkillers and other opiate drugs — and a reminder of the toll substance abuse takes on the tiniest citizens.
"At best it represents a significant amount of human suffering and at worse, we're concerned about what might follow the child throughout life," Dreyzehner told NBC News.
Stopping pregnant women from using drugs — and drug users from becoming pregnant – is the key to easing one of the worst consequences of America's ongoing prescription drug crisis, he said.
'They were just flooding us'
Overall, an estimated 13,539 babies were born with NAS in the U.S. in 2009 -- or about one every hour-- according to a 2012 study published in the Journal of the American Medical Association. That's nearly triple the number in 2000, researchers said.
(No government agency tracks NAS cases, although Tennessee is a start and Florida is considering requiring reporting, experts say.)
America's prescription drug abuse problem is no secret. Drug overdoses have exceeded motor vehicle crashes as the leading cause of accidental death in the U.S. since 2009. Some 17,000 people die each year from opiate overdoses, more than quadruple the number a decade ago, according to the Centers for Disease Control and Prevention.
This year, CDC officials warned that the problem was growing worse among women, with painkiller deaths spiking five-fold between 1999 and 2010.
Pregnant women are no exception, according to the 2012 study, which found that maternal opiate use also jumped five-fold between 2000 and 2009.
In places where the prescription drug problem has been particularly bad – New England, Florida and the hills of Appalachia — there's been a parallel rise in drug-dependent babies, experts say.
Saunders, the Tennessee nurse practitioner, first noticed the problem in 2008, when her hospital saw 35 drug-dependent babies. By 2010, that number was up to 115 and by last year, the hospital hit 287.
"They were just flooding us," she said. "I thought, oh my god, this is the tip of the iceberg. We're going to have to take on the number one problem in the country."
Babies born to mothers addicted to drugs arrive with the same substances in their systems, typically prescription painkillers such as Oxycontin. When the effects start to wear off, the infants go into withdrawal, with all of the symptoms and distress of any adult user.
"In general, they are crying 24/7. They are inconsolable," Saunders said. They claw at their faces, they have tremors, they go rigid with pain and stress. The babies have trouble eating and suffer from frequent diarrhea, which leaves their bottoms bleeding and raw.
Caregivers try to ease the babies through withdrawal, which can take about a week, with soothing care, including swaddling and rocking in dark, quiet rooms. But many infants have to be dosed with morphine or methadone, also opiates, and then slowly weaned off the drugs.
"It is extremely labor-intensive. These kids can be as labor-intensive as our most critically ill newborns," Saunders said.
The issue has been recognized for years, but it's getting worse, not better, said Dr. Mark Hudak, a professor of pediatrics at the University of Florida College of Medicine-Jacksonville, and lead author of American Academy of Pediatric guidelines on NAS.
"I think that the problem is continuous and relatively little progress has been made as far as babies affected," he said.
'An entirely preventable situation'
The costs of treating such babies is rising, too. The charge for treating a healthy newborn through TennCare, the state's Medicaid program, is about $4,200, while the cost to treat a baby diagnosed with NAS is nearly $67,000. State Medicaid programs bear more than 77 percent of the burden for NAS charges nationwide, the 2012 study found.
One reason the issue is so intractable may be that many addicted women don't realize they're at risk, experts say. New data from Tennessee show that 42 percent of mothers of drug-dependent newborns used only substances prescribed for legitimate treatment. Another 30 percent used illegal drugs and about 20 percent used a mix of both.
Anger is the natural reaction of many who encounter drug-affected babies writhing in pain, but Saunders and other health experts said that reaction doesn't help anyone. Even a short course of opiates can lead to dependence and many pregnant women can't stop ‘cold turkey,' she said.
"Any one of us is an accident away from being an addict," she said.
State and federal regulators have cracked down on prescription drug use, adding stiffer warnings to labels and making it harder to get and abuse the drugs.
But the key, Dreyzehner said, is not only to target drug prescribing and availability, but also to make sure that doctors and patients – including would-be mothers – recognize the risks well before pregnancy.
"What's critical is that this is an entirely preventable situation."