Thousands of babies are being born addicted to opioids and suffering withdrawal after birth, known as neonatal abstinence syndrome (NAS).
By 2014, one infant was born almost every 15 minutes with signs of drug withdrawal, according to Dr. Stephen Patrick, pediatrician and neonatologist at the Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tennessee.
He has too many tragic stories to count.
“Recently I was caring for a sick infant at Vanderbilt who had been transferred to our neonatal intensive care unit from the newborn nursery,” Patrick said at a Senate hearing on Feb. 8. “The infant had trouble feeding, was jittery, and had a rapid weight loss—more than 10 percent of his body weight in a few days. Something was wrong.”
He said the infant was exhibiting classic signs of NAS, but it can be difficult to diagnose in a newborn.
“Over the next few days, the infant was increasingly irritable, continued to have difficulty feeding, increased muscle tone and muscle jerking. We suspected opioid withdrawal, but the mother denied using any drugs. Despite this, we started treating the infant as we would any infant with the syndrome,” Patrick said.
After a week, the umbilical cord drug screen came back positive for an opioid.
“As I walked into the infant’s room to talk to his mother, I could sense her guilt and anxiety,” Patrick said. “She cried as I talked to her about the drug test, and wondered aloud if she would lose custody of her infant. She had been afraid of my response and the response from child welfare.”
Patrick said the mother had become addicted to opioids after an accident, was not able to get treatment for her opioid use disorder while pregnant, and was too scared and ashamed to ask for help.
This dangerous combination of circumstances is a daily tale around hospitals in the United States.
“If a woman is fearful of criminal punishment, she may avoid prenatal care, go to another state to deliver, or even deliver at home, potentially resulting in adverse outcomes for mother and baby,” Patrick said.
He said infants are usually discharged from hospital 24 to 48 hours after being born, but signs of drug withdrawal may not develop until 72 hours or later.
“If women are unwilling to disclose substance use, their infants are at risk of experiencing withdrawal at home with potentially dire health consequences, including death,” he said.
Once rare, the NAS diagnosis has become increasingly common. Patrick’s team’s research found that the number of infants diagnosed with neonatal abstinence syndrome has grown nearly seven-fold from 2000 to 2014.
In 2015, Americans were prescribed three times as many opioids as they were in 1999, Patrick said. Eighty percent of new heroin users start their addiction through prescription pills.