Pubdate: Mon, 05 May 2014
Source: News-Press (Fort Myers, FL)
Copyright: 2014 The News-Press
Author: Frank Gluck


Southwest Florida hospitals have seen a sharp increase in the number 
of babies born with drug dependencies, dashing last year's hope such 
cases might finally be leveling off here.

The news comes as heroin and a powerful morphine derivative overtake 
pain pills such as oxycodone as opiates of choice among those 
receiving substance abuse treatment in Lee and Collier counties.

Lee Memorial Health System hospitals treated 92 newborns for neonatal 
abstinence syndrome in 2013, a condition best described as babies 
born in significant pain pill, heroin and/or methadone withdrawal 
because of their mothers' drug use.

The health system treated 75 such babies in 2012, and 74 in 2011. 
They were nearly non-existent a decade ago.

"Last time it looked like we were plateauing. So, I was optimistic 
that maybe we were seeing a change," said Dr. William Liu, medical 
director of the neonatal intensive care unit at the Golisano 
Children's Hospital of Southwest Florida. "But something is happening."

Rates in Collier also have steadily climbed, though not as quickly as 
Lee's. Its 2013 numbers will be reported to the state in about a month.

Though such cases make up only a small fraction of the number of 
births seen every year, these newborns are a potent reminder 
Florida's collective opiate addiction remains a problem.

Babies born physically addicted to opiates and opiate-like drugs can 
suffer a wide range of unpleasant symptoms, including tremors, 
vomiting, respiratory problems and difficulty eating. Unusually 
prolonged high-pitched crying is common.

They commonly must stay weeks in a hospital's neonatal intensive care 
unit while they are weaned from the drugs, usually by giving them 
diminishing amounts of morphine and phenobarbital.

One bright spot in the otherwise dismal numbers: The average length 
of stay for these babies at health system hospitals dropped to 19.5 
days from 30 days, records show.

A 2010 News-Press investigation revealed sharp increases in Florida's 
drug-dependent newborns since 2005. Records from all the state's 
hospital showed that such cases had, conservatively, tripled between 
2005 and 2009. They jumped more than 650 percent in Lee County over 
that period.

Shocked by the growing numbers, Lee Memorial Health System created a 
task force to educate Southwest Florida mothers about how drugs might 
affect their newborns. Attorney General Pam Bondi later formed her 
own task force, which resulted in better reporting of the problem in Florida.

Florida hospitals counted 1,630 such cases in 2012, compared to 694 
counted in 2008, according to the Florida Agency for Health Care 
Administration. Hospitals will report their 2013 numbers to the state 
in about a month.

It's unclear if the rates are tied to changing drug abuse habits, or 
just better reporting.

But treatment specialists in Lee and Collier say users are 
increasingly turning to less-expensive, but potentially more 
dangerous substances such as heroin and the morphine derivative known 
as Dilaudid.

Operation PAR, which operates a clinic in North Fort Myers, found 
nearly 60 percent of its patients were seeking treatment for heroin 
or Dilaudid use over the last 12 months. Use of oxycodone and similar 
opiates accounted for only 34 percent of its patients.

Three years ago, the clinic reported pain pills accounted for about 
85 percent of its clients. A law enforcement crackdown, and the 
resulting price hike in black market pills, is likely to blame, 
treatment specialists say.

"I know most of the patients have indicated what they'd prefer to use 
is still oxy, but don't "because they're so expensive -- I want to 
say $25, $30 a pill," said Jon Essenburg, a regional administrator 
for Operation PAR. It typically breaks down like this, he said: 
"Dilaudid is daily, heroin is if they can't find Dilaudid and oxy if 
they can afford it."

Many of these cases involve mothers undergoing methadone treatment to 
kick their pill and heroin habits. Methadone is considered safer than 
illicit drug use, and quitting cold turkey risks a miscarriage.

Operation PAR tells its pregnant patients to be upfront about their 
treatment with hospital staff.

That kind of increased reporting may be causing newborn dependency 
counts to increase, rather than a rash of new drug usage, Essenburg said.

On the other hand, Essenburg said the numbers likely under estimate 
the true extent of drug dependency in newborns. Sometimes symptoms of 
the withdrawal don't show up for days, after parents take their children home.

"We tell all our patients they need to let the hospital know they're 
on methadone, that this is a high-risk pregnancy," he said. "The one 
thing they're surprised by is how long it sometimes takes the baby to 
get weaned off (the drugs)."

Nancy Dauphinais, who works with drug-using pregnant women at The 
David Lawrence Center in Naples, said increased numbers of newborns 
showing signs of drug withdrawal might be a sign more women are 
getting needed drug treatment.

Babies born to women receiving methadone replacement therapy tend to 
show more obvious signs of withdrawal than babies born and are thus 
more likely to be counted.

"I think it's women coming forward for help," Dauphinais said. 
"Neonatal abstinence syndrome is actually preferable to a client 
going into withdrawal during pregnancy or using illicit drugs."
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MAP posted-by: Jay Bergstrom