Treating the tiny victims of Canada’s fastest-growing addiction

ANNA MEHLER PAPERNY

HAMILTON

From Saturday’s Globe and Mail

Last updated Monday, Feb. 20, 2012 10:06PM EST

Laura was on methadone, recovering from an OxyContin addiction, when she got pregnant with Carter, her third child. Recently brought Carter, now a month old, home from the hospital. He was born with the shakes, the sweats, stiff limbs and sneezing fits connected with his withdrawal. He was on morphine for three weeks. He is healthy now. Mom and baby spend some quality time in their Hamilton home on December 6, 2011. Mom says, she hasn’t been this happy in years. (Glenn Lowson)

Hours after his birth, stiff-limbed and trembling, Carter was whisked away to a bassinet in a neonatal intensive care unit and fed morphine through a dropper.

He broke out in sweats, a fine sheen clinging to his neck and scalp, when, weeks later, nurses started to wean him off. His mother, Laura, who asked to be identified by her first name only, knew exactly what he was going through: She’d experienced withdrawal before.

 “That was the worst part. Knowing what it feels like, and knowing a little baby … it’s the worst feeling in the world, you know? You don’t want your child to go through that.”

Carter is one of a growing number of Canadian babies born with neonatal abstinence syndrome, an addiction to drugs their mothers took while pregnant. These aren’t the “crack babies” that made headlines in the 1980s. Doctors attribute this rise to the use and abuse of prescription opioids: the painkillers fuelling Canada’s fastest-growing addiction – and the methadone used to treat it.

Last year, at least 1,057 babies were born in Canada with NAS, an 18-per-cent increase over the year before, according to the Canadian Institute for Health Information. In Ontario, that number increased by a third in a year; in Manitoba, it more than doubled. As the incidents go up, so does the cost: The national average hospital stay for NAS infants last year was 15 days.

“There’s a sense of urgency, for sure,” said Gideon Koren, a pediatrician at the Hospital for Sick Children in Toronto. “The numbers have increased staggeringly.”

Canadians pop more prescription opioids than almost any country in the world, behind only the United States and Belgium. The number of opioid-related deaths in Ontario equals the number of drivers killed in motor-vehicle accidents annually. Spurred by the spiralling human and financial cost of opioid addiction, some provinces are trying to better track these drugs and their use.

Last fall Ontario became one of the first jurisdictions in North America to design modernized guidelines setting out a standard of care for NAS. The recommendations include testing women of childbearing age for substance use and diagnosing babies with neonatal abstinence using the same updated scoring system.

In Vancouver a deceptively simple, previously unheard-of approach that keeps addicted babies with their moms while in hospital is proving successful. Facilities in Edmonton and Winnipeg are following suit.

Despite these steps, doctors worry that increasing incidence of NAS is outpacing the health-care system’s ability to treat it.

“A number of clinicians mentioned the fact that they were seeing these babies – more, it seemed, every year … for quite a long period of time,” said Marilyn Booth, executive director of Ontario’s Provincial Council on Maternal and Child Health, which wrote the new guidelines. “It’s not just an Ontario problem. It’s across the country.”

Diagnosed, the condition is treatable. Babies are swaddled and given tiny doses of morphine to ease their withdrawal and monitored for weeks or months in a bassinet in a neonatal ICU before they’re slowly weaned off.

But that diagnosis depends on a woman telling her obstetrician she’s an addict, or a doctor recognizing symptoms once the baby is born. Those can be difficult to spot – as common as excessive crying or sneezing, or as severe as vomiting, rapid breathing and seizures. Some GPs may not realize painkillers prescribed before the woman conceived could affect her pregnancy.

If NAS goes undiagnosed, it can prove serious or fatal.

In her 17 years as a social worker at St. Joseph’s Healthcare in Hamilton, Jodi Pereira has become accustomed to seeing babies hooked on their mother’s meds. “It’s right across the board,” she said. “We used to assume it was always young moms – absolutely not any more.” St. Joe’s neonatal ICU gets about 40 newborn opioid addicts a year. The number and severity of cases are on the rise.

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