The youngest victimsHaywood Regional delivers babies to addicted mothers three times as often as the rest of the country
The youngest victims of drug abuse haven’t even been born yet.
As drug problems in Haywood County continue to grow, so, too, does the number of infants who exhibit withdrawal symptoms due to being exposed to intoxicating substances in the womb.
Back in 2004, in North Carolina, there were 104, about .1 percent, hospitalizations associated with drug withdrawal in infants — also known as Neonatal Abstinence Syndrome, or NAS — per 100,000 live births, and in 2014, there were 971, or about 1 percent. However, in Haywood County, the number of babies born to mothers with substance abuse issues was 6 percent in 2014, and has since risen to 7 percent in the last couple years.
“Unfortunately we see infants affected by maternal drug use far more often than we would like. Among the most common in our area, and in Western North Carolina, are THC (marijuana), methamphetamine, opiates and suboxone,” said Dr. James Guerriere, a pediatrician at Mountain Medical Group. “Nicotine, while not an illicit drug, also is heavily prevalent.”
While withdrawal from any substance isn’t pleasant, Tonya Chitwood, director of Women’s Care Services at Haywood Regional Medical Center, said nicotine withdrawal can be particularly tough on a newborn.
“The best way to empathize with a newborn going through nicotine withdrawal is expect for them to exhibit the same physical and mental difficulties as adults trying to quit,” she said. “We would encourage anyone with a nicotine addiction to reach out to the national help hotline for counseling and free medication.”
Dr. Don Teater, who treats addiction in Haywood County, said that although most people consider these babies addicted, this is a common misconception.
“They’ve been born dependent, but they aren’t addicted,” he said, adding that a person can’t be born addicted to a substance because they aren’t making the conscious decision to use.
But that doesn’t mean that they can’t suffer through their mother’s addiction while still in the womb.
“If the mother starts going through a withdrawal while pregnant, her unborn infant will also to through withdrawal, which can be extremely dangerous,” Guerriere said. “Prenatal care is extremely important when drug use is involved, not only for the mother, but for the health of the baby.”
He added that there can also be further complications down the road.
“Once out of the newborn period, infants are not ‘safe’ from the effects of maternal drug use,” he said. “Exposure to illicit drugs increase the risk for sudden infant death syndrome, as well as an increased risk of infant abuse, behavioral problems such as anxiety and ADHD, among a myriad of other potential risks.”
Dr. Teater said he prefers to keep addicted mothers on Methadone or a similar substance to keep their cravings at bay. Even though two out of every three babies born to women on Methadone and one of every three born to women on Buprenorphine (which is slightly less addictive) go through withdrawals, he said the complications that can arise from expectant mothers quitting anything cold turkey are much worse. A mother going through withdrawals carries a higher risk of miscarriage or premature birth.
If a baby is born with an existing dependence to a substance, severity of withdrawals is determined by the Finnegan Score, which measures things such as crying, irritability and startle reflex. For babies who are born with a severe dependence problem, both Teater and Guerriere said the course of treatment is either Methadone or a similar substance, which the baby will be weened off of over a few weeks.
“If Methadone isn’t enough, then the infant would need to be sent to a NICU where they can start Phenobarbital and be monitored even closer,” Guerriere said.
Although it may seem that giving a baby these substance could be dangerous, Teater noted that studies have found no connection between babies being treated this way and developmental issues or likelihood of future addiction.
He added that although there are multiple angles of the issue that need to be addressed, he also went back to the one point that dominates just about any of his arguments: doctors need to stop over-prescribing opioids.
“There are a lot of drugs we don’t give to women of child bearing age,” he said. “But opioids, because it’s thought of as so benign, is not one of them.”
Dr. David Kirk, an OB/GYN practicing at Haywood Women’s Medical Center who is certified through the American Society of Addiction Medicine for care and treatment of patients struggling with addiction, said that it is vital for women who are concerned about the health of their baby to get help right away.
“If you have a substance addiction, please seek prenatal care as quickly as possible for an assessment for treatment options,” he said. “Our treatment options and care plans remove the judgement of addiction and offer a healthier way to approach care and healing. That is exactly what we want to offer to the women in our care.”