Pubdate: Sun, 15 Jun 2014
Source: Blade, The (Toledo, OH)
Copyright: 2014 The Blade
Author: Marlene Harris-Taylor


The opioid and heroin epidemic has eclipsed the crack cocaine problem
of the 1980s as a public health crisis and, as a result, the number of
babies being born to opiate-addicted mothers is increasing at an
alarming rate, including in the Toledo area.

Government and health-care officials are struggling with how to manage
the care of the drug-dependent babies. Their numbers are increasing
each year and the costs of care are skyrocketing and straining the
resources of hospitals in some Ohio counties, health officials say.

In northwest Ohio, several hospitals are working together to share
ways they've been treating the addicted babies - in some cases
differently than what'‍s done at other hospitals - in hopes of
effecting change across the nation.

"I think the opiate epidemic overall is a lot different than a lot of
other drug epidemics because it's more difficult to recover from
treatment and it is spreading at a rate we haven't seen before," said
Rick Massatti, research administrator for the Ohio Department of
Mental Health and Addiction Services.

Unlike the crack epidemic that was concentrated in major urban centers
in Ohio, the opioid crisis is centered in rural and suburban
communities, with some parts of southern Ohio suffering the worst in
terms of deaths, overdoses of users, and babies being born with
neonatal abstinence syndrome, or NAS, Mr. Massatti said.

NAS is a condition that some babies experience when withdrawing from
certain drugs that a mother has taken during pregnancy, such as
prescription painkillers including OxyContin, Percocet, and morphine,
but can also be caused if the mother uses street drugs such as heroin,
crack, and speed while pregnant.

Health officials said, however, that the overwhelming majority of new
NAS cases in Ohio are related to the use of prescription pills and
heroin. The high risk group for having NAS babies is white women
between the ages of 25 to 34 from rural areas, Mr. Massatti said.

In 2001, a small percentage of Lucas County residents, 5.6 percent,
were diagnosed with opiate abuse and dependence, but that number
increased dramatically by 2013. Last year, one out of four people in
treatment had a primary diagnosis of opiate abuse, Mr. Massatti said.
He added that the number does not include people treated in private
facilities or who do not seek treatment at all.

An addict's story

"I started on pills and worked my way up," said a 21-year-old
Toledo-area woman - a new mother - who asked that her name not be
used. She recently moved into her sister's home in Holland but she has
moved around a lot, living most recently in Sylvania, where she
discovered she was pregnant last September.

She started using pain pills to get high when she was 16, primarily
because her friends were using them too.

"I went from Percocet to Opana. At that time I could get the Opana
before I could get the Percs, so that's why I switched. They would
cost about $40 for one pill. They are very expensive."

She also discovered that the drugs helped her feel better, be more
energetic, and happier while she was completing her shift as a greeter
at a restaurant.

"When I first started doing Opana, I could probably split one pill
into like five pieces and do five lines that would probably last two

"It hits you faster when you snort it," she said.

Her boyfriend at the time brought heroin into the picture when she was
about 18.

"I asked him what it was and he wouldn't tell me, so you know me being
stupid I just snorted it and I absolutely fell in love. It's a feeling
of euphoria like you are on cloud nine. It's really hard to explain,"
she said.

After years of using drugs, and losing multiple jobs, a car, and her
apartment, she had enough. Last fall, she decided to check herself
into Arrowhead Behavioral Health, a private drug rehabilitation and
psychiatric hospital in Maumee.

"It was weird on Sept. 29, I took a nap and woke up and I was bawling
my eyes out. I was sick of using. I just wanted to get clean," she

A routine screening for all incoming patients at Arrowhead revealed
that she was nine-weeks pregnant. She immediately went into a
methadone treatment program to manage her addiction and keep her off
heroin for the remainder of her pregnancy. Despite her efforts, her
baby boy was born drug-dependent on May 1 at ProMedica Toledo Hospital.

"The babies have a craving for opiates, and if you don't give it to
them, they withdraw," said Dr. Howard Stein, director of neonatology
at ProMedica Toledo Children's Hospital.

"He would sneeze and yawn and he sweated a lot. A lot of crying and he
was really fussy. He wouldn't sleep like he was supposed to, and you
know a newborn baby is supposed to sleep a lot," the mom said.

ProMedica Toledo Children's Hospital and Mercy Children's Hospital use
similar treatments for the infants, which first begins with just
trying to keep them in a quiet place without a lot of stimulation,
swaddling them, and cuddling them.

"If the nonpharmacological methods do not work, then we will start
medication," said Dr. Gagandeep Brar, associate medical director of
neonatology at Mercy Children's Hospital.

The medication is methadone, an opiate, that is given to the babies to
stabilize them and stop the withdrawal. Then they are slowly weaned
from the drugs for a number of days or weeks depending on the severity
of the NAS, Dr. Brar said.

"I prayed and prayed that he wasn't going to have to be on methadone
like this, but I was wrong," said the Holland mother.

Dr. Stein said the drug-addicted mothers are very ashamed and
remorseful. "They are not bad people - addiction is a bad disease," he

Rising numbers

Statewide, the number of drug-addicted women having babies increased
nearly 143 percent over a nine-year period from 1,553 in 2004 to 3,772
in 2013, Mr. Massatti said.

Not every baby born to a mother using drugs will develop NAS. "I would
say about 80 to 85 percent of them will end up getting the withdrawal
symptoms," Dr. Brar said.

>From 2000 to 2004, Lucas County had some of the lowest rates in the
state of babies born drug-dependent. There were 1.4 NAS babies per
1,000 births. Between 2007 and 2012, that number grew to a rate of 4.2
per babies out of every 1,000 births. Though a substantial increase,
that number is still much lower than the state average during that
time period, which is 6.9.

"Just to put things in perspective, I have been here nine years.
Initially when I started, we would have maybe one or two babies a
year. I think the shift happened in 2009 when we had seven babies that
year, and the numbers have been increasing every year. Last year, we
had more than 35 babies, so it has increased five fold, and that
basically is what is reflected in the rest of the country as well,"
Dr. Brar said.

Scioto County in southern Ohio has seen the most dramatic increase in
drug-dependent babies in the state. The number of babies exploded
between 2004 and 2012 from six NAS babies per 1,000 births to 52.6
babies per 1,000 births.

"We don't take the moms off drugs during pregnancy because we worry
about in-utero withdrawal and we can't monitor the fetus," Dr. Stein
said. He said the majority of the mothers are in a treatment program
during pregnancy and use methadone or Subutex to manage withdrawal
symptoms. The minority, about 25 to 30 percent, are still taking
street drugs such as heroin, he said.

When the NAS babies begin the methadone treatment, many stay in the
hospital for weeks and are slowly taken off the drugs.

A different approach

The lengthy hospital stays required for these infants, who are cared
for in neonatal intensive care units, or NICUs, has government and
medical officials grappling with how to manage the costs. About 84
percent of NAS inpatient hospitalizations are paid for with public
dollars through the Medicaid system.

The average hospital's inpatient charges for NAS infants are typically
many times higher than charges for all other infants. In 2013, there
were 1,687 inpatient hospitalizations for NAS babies in Ohio and the
cost for their care was nearly $100 million, Mr. Massatti said.

"Usually what happens with a well infant that is born healthy and
discharged after three days, we usually spend $7,000 to $9,000, versus
a baby who has drug withdrawal the number is anywhere from $56,000 to
$80,000 for the entire hospital stay. So much money, so much of our
health-care dollars, are being spent on taking care of these babies.
It is a huge burden on society and on health care," Dr. Brar said.

There are a number of initiatives on the national, state, and local
level right now focused on the problem and aimed at helping the
government and physicians get a handle on the issue, said Dr. Jeffrey
Blumer, chairman of the department of pediatrics at the University of
Toledo Medical Center, the former Medical College of Ohio.

"The approach to taking care of the babies after they are born is
really nonstandard. It's all over the map," he said.

ProMedica and Mercy children's hospitals have for years used a
different approach than most other hospitals in the state and in the
country, Dr. Blumer said. They have developed a system for treating
NAS babies that begins with them using methadone in the hospital, but
then once the babies are stable they are sent home to complete their
treatment. Most other hospitals keep the baby in NICU until they are
completely weaned from the drug.

In Toledo, the babies are sent home with either their mom, dad,
another family member, or foster parents. The hospital social workers
and the Lucas County Children Services Board assess the families to
determine who should care for the babies when they leave the hospital,
said Dean Sparks, executive director of Lucas County Children Services.

Dr. Blumer, along with Dr. Stein at ProMedica Toledo Hospital and Dr.
Brar at Mercy St. Vincent Medical Center, are leading the local effort
to document what Toledo hospitals are doing, so that the process could
possibly be adopted by other hospitals around the state and the
country. This would save millions of dollars per year, Dr. Blumer said.

"When we started this project in 2012 and all the [Ohio] children's
hospitals submitted data and we showed how our babies go home on
methadone, we were shocked to see we were the only ones doing this,"
Dr. Stein said.

Many professionals have questioned the process used in Toledo, and
they have wondered if the addicted parent might use the drugs intended
for the baby. Dr. Blumer said Toledo hospitals already have years of
evidence showing this process works well; parents don't abuse their
babies'‍ drugs, and the drug-addicted mothers overall do a great
job caring for the babies at home.

"Our babies do not get readmitted. Our babies don'‍t have any
kind of complications and they do very well when they are discharged
home with methadone," Dr. Brar said.
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