Dope sick. That is the term that opioid addicts often use to describe the symptoms of their drug withdrawal. Imagine having the flu, the stomach bug and a migraine, all at the same time, for days: exhausted but unable to sleep, hungry but nauseous with vomiting and diarrhea, aching all over while shaking uncontrollably and sweating profusely, anxious and depressed. Watching an adult suffer through opioid withdrawal is painful, but seeing a newborn baby with the same symptoms is heart-wrenching.
Babies get dope sick, too. I fear that, in our nation’s perpetual discourse on the opioid epidemic, we are overlooking the tiniest victims of this crisis: the babies who become addicted in the womb to their mothers’ drugs and ultimately suffer from drug withdrawal after birth, called Neonatal Abstinence Syndrome (NAS). Unfortunately, for Neonatal Intensive Care Units (NICU’s) across the country — and particularly here in Tennessee — the year-over-year rise in the rates of Neonatal Abstinence Syndrome cannot be ignored. Since the early 2000s, the incidence of NAS in Tennessee has increased tenfold, far exceeding the national increase of threefold in the same time period. For the most part, NAS babies are otherwise healthy, term newborns who require an average of
20 days of ICU-level treatment — with IV morphine, tube feedings, oxygen, physical therapy and continuous monitoring — for their drug withdrawal; costing patients, health systems, insurance companies and Medicaid programs as much as 15 times more than
a typical newborn.
As you would expect, many babies born with NAS became physiologically dependent upon pain medications, morphine or heroin that the mother abused during pregnancy. However, increasingly, cases of neonatal abstinence are the result of mothers participating in medication-assisted treatment (MAT) programs for opioid addiction, using prescribed drugs like buprenorphine (known commercially as Subutex or Suboxone) or sometimes methadone. Medication-assisted treatment can be an effective approach to treating opioid dependence, when combined with behavioral therapy, social support and after-care services; however, while most agree that MAT drugs do reduce withdrawal symptoms and cravings, controversy exists in the medical community related to substituting one addictive substance for another, as well as ideal duration of therapy.
Are pregnant women in physician-supervised MAT programs better off than using street drugs or illicit prescription narcotics? Of course. Are these treatments completely risk-free for moms and babies? Absolutely not. Medication-assisted treatment programs do help women start their recovery from opioid addiction, but the risks and side effects — to both mother and baby — should be clearly and frequently communicated to women of childbearing age who seek these treatments. Likewise, MAT must be treated as only one tool in the recovery process, instead of relying upon it as the primary or sole approach to breaking an opioid addiction.
Thankfully, there is a new treatment facility in the area that focuses exclusively on the recovery of pregnant women addicted to opioids. Located in the former Humboldt General Hospital, “A Mother’s Love” offers residential medication-assisted treatment, as well as an abstinence-based approach, through a partnership between Aspell Recovery Center, Pathways Behavioral Health, and the Ayers Children’s Medical Center. Women can enter treatment at any time during their pregnancies and then can return to the facility with their babies, for up to three months after delivery. Perhaps more important than the medication-assisted treatment itself are the wraparound services that help moms and babies ultimately transition into long-term sober living, including housing, employment, mental health services, and childcare. This unique collaboration has garnered attention from across the state and is accredited by the Tennessee Department of Mental Health and Substance Abuse Services; the program’s services are operated by licensed, master’s-level therapists, board-certified physicians (psychiatry, OB/GYN, and neonatologists), and nurses and staff specializing in recovery. “A Mother’s Love” plans to take its first clients this week, and more information is available by contacting Mary Russell or Rachel Hill at (731) 784-0370.
What is even better than treatment? Prevention. Changing prescriber behavior and limiting narcotic access are necessary and well-recognized primary prevention strategies to address our nation’s crisis. But how about even further upstream, particularly for this special population? Currently, 86 percent of pregnancies in opioid-addicted women are unintended, so let’s advocate for accessible and affordable long-term contraception to prevent unintended pregnancies in women with opioid addiction. For women who do become pregnant while addicted to opioids, let’s mobilize the resources for safe and effective comprehensive treatment programs, including vital recovery support services, to minimize or eliminate the risk of Neonatal Abstinence Syndrome for the tiniest victims of this epidemic.
Lisa Piercey, MD, MBA, is a pediatrician and the Executive Vice President for West Tennessee Healthcare, and is a proud board member for Aspell Recovery Center.