The birth of a child, it's a time that should be joyous for families, but in Arkansas a record number of babies were born addicted to drugs. This, according to a new study released by the Arkansas Department of Health.
11 News Investigator, Winnie Wright, got to the bottom of the results, to find out what got us to this point, and what needs to be changed.
We've all seen the videos of babies born during the crack cocaine epidemic. Their tiny bodies withdrawing from drugs.
"Some of these babies, quite frankly, are going to come in dead,” said UAMS Neonatologist Dr. Whit Hall, as he reacted to a recent Arkansas Department of Health study. It found the number of babies born with Neonatal Abstinence Syndrome, or NAS, in Arkansas, increased more than ten fold between 2000 and 2014. The study, puts a lot of the blame on the growing opioid epidemic.
Dr. Hall treats those infants at UAMS, where, he says, the stats are much higher.
"Studies have shown that some form of substance use disorders are present in as much as 5% of babies, which is 10x 5 per 1,000,” the doctor explained.
Babies suffering from NAS have to stay in the hospital longer for assessment and treatment, which often means more exposure to opioids.
"Not only is it difficult on the babies, it's difficult on the the tax payer as well,” said Dr. Hall of the cost associated with the care.
NAS babies, he explained, are typically in the hospital for 2-3 weeks, as opposed to a couple of days. "The cost nationwide is anywhere from $1.5-2 billion annually. It's a huge expense. Mostly it's public insurance, that we the people have to pay. It's difficult on the baby, but it's difficult on the taxpayer as well."
A major concern for doctors: unlike with babies with drawling from methamphetamine or cocaine, in which symptoms will begin shortly after, birth, Dr. Hall said, opioid withdrawal symptoms may not surface for 5-7 days, meaning the babies are home, and not under a doctor's care.
"I can only imagine that a mother who is addicted to opiates, and has a baby that comes home and is irritable, and it is inadequately treated or has a severe case of Neonatal Abstinence syndrome and is very irritable, that baby is going to be at a very high risk for subsequent physical abuse,” Dr. Hall continued.
Unfortunately, many of the NAS mothers won't take their babies in for treatment, meaning the numbers could be much higher than we realize.
"There's still a lot of stigma in this state in using opiates or using substances during pregnancy," said Dr. Jessica Coker, a psychiatrist at UAMS that treats pregnant users.
"We also still have legal laws that make it a crime to use substances during pregnancy. So I think it's a lot of just fear that they have in getting treatment, because they feel like they're going to be judged, or that they're not going to be taken seriously or that they'll get in trouble, either with the legal system, or DHS,” said Coker. "Ideally getting them even before they're pregnant is the best scenario. The first few weeks of pregnancy is very important for brain development and spinal cord development."
Of course, that's not always the case.
"We know that around 5% of women continue to use elicit substances off the street while they're pregnant. In Arkansas that equates to about 1,500 pregnant women every year,” Dr. Coker said of the numbers they see in her department at UAMS.
There, they offer medication-assisted treatment during pregnancy. The women are provided with a drug like methadone to help ween themselves, as well as OBGYN care and a support system, they may not have gotten otherwise.
"The risk is less than the risk if they continue to use off the street and aren't taking care of their pregnancies and not seeing their OBGYN, and therefore usually delivering early,” she said of the risk associated with the treatment.
While the short-term effects are jarring, both doctors share concerns about the long-term effects for these infants.
"There's no question that exposure to these drugs can affect the long term neurodevelopmental outcome of these infants,” said Dr. Hall of the long term consequences.
It's the effects later in life that most concern Dr. Alan Mease, medical director of child and adolescent health at ADH.
"Toxic stress, early life adversity change the expression of the DNA, so then you get into the DNA aspect of this,” said Dr. Mease, adding drug-addicted mothers have a hard time attaching to babies, can be abusive, and neglectful. All causes, he said, of equally disturbing effects on development.
"A mother addicted to drugs isn't going to be able to establish a secure attachment to the baby. Babies need security for emotional development, without which, their brains can't develop. They'll wind up being the kid that gets thrown out of pre-school for aggressive behavior, a kid who won't do well in school, who will be likely to get in trouble for his own issues,” said Mease.
According to Mease, children exposed to toxic stress have higher chances of developing chronic disease. Their life expectancy is decreased.
"Arkansas is the highest state in early life adversity,” Mease explained, of why the odds are stacked against Arkansas kids.
All three doctors agree treatment works, and the sooner the better. So that's where focus should be.
"At the heart of it, moms want to be good moms,” Dr. Coker said. Her department is making a big push to work with OB-providers to let them know about services available for addicted mothers, and also telemedicine, so patients don't have drive to Little Rock for help.
"Generally speaking, mothers who agree to go to treatment, and admit to their drug use, and admit they have a problem, these mothers are much less likely to have any adverse effects at all,” Dr. Hall said of the unlikely consequences for mothers.
While it may seem counterproductive, Dr. Hall also said, it's extremely important these mothers breastfeed.
"The reason for that, the opiates get into the breast milk, and the babies can gradually with drawl themselves,” he explained, adding breastfeeding also helps babies and mothers bond.
Of course, if users think they may be pregnant, or if their babies are showing signs of NAS, the doctors say it is critical these women seek help.
Dr. Coker encourages women to call their office at 501-526-8201. They will typically get you scheduled the next day.
UAMS researchers are currently working on a project to study the effects of opioids on a fetus.
The goal: understanding which babies may be at a higher risk for negative outcomes like NAS.