WASHINGTON COUNTY— After trying cocaine for the first time at age 18, Pam Riddle began to smoke crack with her husband and then became pregnant. By that time, they were smoking between a half-ounce to an ounce of crack a day.
“I fell in love with crack. We were out of control,” Riddle said. “When my son was born, he had cerebral palsy and slight mental retardation. He was deaf and I was too high at the time to figure it out and then his eardrum blew. It just goes on and on.”
Unfortunately, Riddle’s story is not an isolated case.
Babies born to mothers who ingested opiate prescriptions like oxycodone or street drugs such as methamphetamine and heroin during pregnancy have become an increasing concern in Washington County and across the United States.
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Within Dixie Regional Medical Center alone, at least a dozen babies are born each year who have been exposed to street drugs such as heroin, cocaine, methamphetamine or prescribed opiates while in utero, DRMC Neonatologist Dr. Erick Ridout said. Ridout serves as the medical director for neonatology for the southwest region which includes DRMC, Valley View Medical Center and Garfield Memorial Hospital.
A baby born in these conditions suffers from neonatal abstinence syndrome which is a drug withdrawal syndrome that occurs in newborns exposed to addictive prescription or illicit drugs while in utero.
In many cases, unless the birth is planned, the woman doesn’t know she is pregnant until she misses her second menstrual cycle and by that time the major organs of the baby have already developed.
When a pregnant woman uses drugs, the substances pass through the placenta to the fetus. After birth the baby is no longer receiving the drugs which results in a withdrawal period that can appear from one to 10 days after birth and include diarrhea, excessive crying, fever, hyperactive reflexes and sleeping problems, according to a Utah Health Status Update released in July 2013.
Other problems associated with neonatal abstinence syndrome are seizures, respiratory symptoms, feeding difficulties and low birth weight.
In the case of a mother using heroin during her pregnancy, the baby, at the time of birth, has immediate cessation of the continuous exposure. Because the baby has had to some degree or another continuous heroin affecting the brain and receptors, the baby will experience withdrawal and physiological needs similar to any addict that immediately stops the drug intake.
“They can have all types of physiological problems — heart rate, breathing, gastrointestinal distress – that can put them heading toward death, often putting them on the path where they have to get the drug back,” Ridout said. “We don’t use heroin, we use morphine in the hospital, where we address their need because they are truly addicted.”
Weaning babies from opiates and stimulants
Upon birth, the baby’s umbilical cord and feces are checked in order to determine what the baby has been exposed to from 20 weeks up to the time of delivery. The nurses then rate the babies on how severe the withdrawal in the baby is and whether they need to be put into the intensive care unit.
The opiates are the only ones that can be specifically treated to occupy the receptors, Ridout said. Other medications can be used to mask withdrawal from stimulants such as methamphetamine, nicotine and cocaine. In the case of a baby being addicted to opiates, if the opiate is not replaced, the baby can have physiological lapse and die.
Babies born to mothers who have been using methadone, a very long acting opiate, sometimes don’t manifest withdrawal until five-seven days after being born, Ridout said. In many cases it takes several weeks or months for babies to be weaned from methadone because it takes so long for it to get out of their system.
“They (babies exposed to methadone) can be very frustrating because you think you’ve gotten them squared away where they’re feeding and doing well and then they start having the need for more and eventually hit the end of that where we can start tapering them off,” Ridout said, “but that can be six to eight weeks in an intensive care unit so huge expense.”
According to Utah law, medical staff have a reporting requirement if one “has reason to believe that a child being subjected to conditions or circumstances which would reasonably result in abuse or neglect, that person shall immediately notify the nearest peace officer, law enforcement agency, or office of the division.”
In the case of a baby born to a mother who used drugs during her pregnancy, after delivery, the situation will be reported to law enforcement. In some cases, the moms that are using drugs are placed into the drug court system, through which they can receive treatment, Washington County Attorney Brock Belnap said.
“The whole idea is not to be punitive or tear families apart, it’s to get them help and recovery and to protect the child,” he said.
One of the underlying issues is the widespread use of opioid pain medications prescribed to women of childbearing age, 15-44, across the United States, Ridout said, and the most common medications prescribed to women of child-bearing age are hydrocodone, codeine, and oxycodone.
“This is a doctor problem that we have this much medication out there that is widely available, and that’s a big deal,” Ridout said. “That’s a problem.”
A report released in late January by the Centers for Disease Control and Prevention showed that “roughly one fourth of privately insured women aged 15 to 44 years and about one third of their counterparts insured by Medicaid filled a prescription for an opioid each year during 2008 to 2012.”
“From a prescription drug standpoint, we have a problem,” Ridout said. “It’s an epidemic; every state is struggling with it. Some might outcompete; but, even small places like St. George where you think we’re off the beaten path, heroin is here alive and well, methamphetamine is here alive and well, prescription drugs are everywhere because they are being prescribed in record numbers – and so they’re here.”
According to a Utah Health Status Update released in July 2013, between 2009 and 2012, 1,476 Utah mothers were reported to have used illicit drugs. As a result, 29.5 percent of babies born to these mothers tested positive for illicit drugs at birth — approximately 109 babies per year.
The American Medical Association estimated that in the U.S. approximately one infant, suffering from neonatal abstinence syndrome, was born every hour in 2009.
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