The national crisis in opiate addiction affects Americans young and old, women and men, and now even newborns.
According to U.S. News & World Report, the national rate of babies born with neonatal abstinence syndrome (NAS), which can result from the use of opiates by the mother during her pregnancy, increased fivefold from 2000 to 2012.
Twenty-seven in every 1,000 babies were admitted to neonatal intensive care units suffering from NAS in 2013, compared with seven in every 1,000 in 2004, according to a study published in the New England Journal of Medicine.
Opioids are not always villains.
“Opioids are used to treat pain, but are best used for short duration to avoid addiction,” said Dr. James J. Steigerwald, a member of the OB Hospitalist Group at Memorial Hospital in Colorado Springs.
Opioids include various prescription medications, such as Vicodin, Percocet, Norco, Lortab, Codeine, Oxycodone, Hydrocodone and Dilaudid, but also heroin, he added. All have their dangers.
“They can depress breathing effort and could potentially lead to respiratory arrest and death with an overdose,” Steigerwald said. “Heroin can be used as an injection, which increases the risk for infections, including hepatitis and HIV.”
Short-term use during pregnancy is considered generally safe, but longer use can increase the risk for preterm labor, fetal distress, and fetal demise, he said.
“There are studies that show an increased risk of congenital heart defects in babies exposed to codeine in the first trimester, but in general the chronic use of opioids in pregnancy increase the risk for fetal growth restriction, placental abruption [the separation of the placenta from the uterine wall], preterm delivery, and fetal death,” he said.
“Babies are also at risk for neonatal abstinence syndrome [addressed in the U.S. News article], which occurs as they withdraw from the opioid exposure after birth. Long-term studies have not found significant differences in cognitive development for children up to 5 years of age.”
The problem is fairly extensive.
“A survey in 2010 estimated that 4.4 percent of pregnant women abuse opioids,” he said.
Opioid addiction is a growing problem that has received a lot of media attention in the past year, and it’s not a situation that is easy to resolve.
“Opioid addiction is very difficult to overcome, Dr. Steigerwald said. “It is associated with physical dependence and tolerance that leads to the need for ever higher doses. Once the physical dependence develops, a withdrawal syndrome occurs if the opioid is stopped. This may last for several weeks.”
If a woman is using opioids, she ideally needs to address the issue if planning a pregnancy.
“Stopping all opioids prior to getting pregnant would be best,” he said. “I recommend that women who are thinking about getting pregnant or are currently pregnant talk to their Ob/Gyn about what is best for them.”
There are ways to manage the situation.
“If a woman is pregnant and using heroin, the recommended treatment is to switch her to methadone,” he said. “This is a form of opioid-assisted therapy to reduce the risks associated with heroin use, to prevent narcotic withdrawal, and encourage prenatal care.”
Methadone therapy is prescribed and dispensed daily through a registered substance abuse treatment program.
“We usually do not try to wean off the medication during the pregnancy, but recommend a medically supervised withdrawal after the pregnancy,” he said.
And if a baby is born addicted?
“Treatment for the newborn usually consists of giving them opiates and gradually weaning down the dose.”
The issue isn’t going away, either.
“The problem is increasing, so there are more babies that need to be treated,” he said.