That Start In Life

"A lot of child-bearing moms are on those medications.  We would see one (NAS baby) every three or four months.  The hospital now sees, one, two or three a month."  Dr. Pradeep Merchant, chief of neonatology, The Ottawa Hospital

Canadians at the present day represent some of the highest users of prescription opioids in the world.  Opioid consumption in the country has doubled over the last ten years.  Despite that knowledge and the complications that arise from that fact, there is nowhere in Canada among the provinces where the rates of opioid use is declining.


"Physicians are prescribing these (drugs), legitimately in many cases, but sometimes over-prescribing" said Dr. Kimberley Dow, professor of pediatrics at Queen's University in Kingston, co-chair of the Provincial Council for Maternal and Child Health task force on neonatal abstinence syndrome.


And this is important.  Both that women who are pregnant feel they should be taking drugs, and that doctors are willing to accede to their patients' requests for prescriptions.  No one among the public, let alone the medical community seems to recall the lesson that the use of Thalidomide during pregnancy to combat morning sickness should have taught us.


There are universal campaigns undertaken to convince pregnant women not to drink and not to smoke, both practices which are harmful to the developing foetus, let alone the woman carrying a child.  Rates of neonatal abstinence syndrome (NAS), have doubled in Canada, the result of a rise in legitimate and illicit use of prescription opioids, from sea to sea.


In 2010-11, 654 newborns were diagnosed with NAS, quite an increase from 171 in 2003-04.  "The numbers are very, very significant - you hear it from all over the province, and all over the country.  The burden is huge.  These kids stay in hospital sometimes months to get them off the drug", according to Dr. Gideon Koren, director of Motherisk Program at Toronto's Hospital for Sick Children.


A study published in the Journey of the American Medical Association a month ago revealed that the number of women in the U.S. using opiate drugs has also increased five-fold over the last ten years.  Now that's utterly astounding.  It doesn't take the mind of a genius to understand that everything crosses the placenta.


Narcotic-addicted mothers make a deliberate choice to use methadone during pregnancy.  "It's safer for the mom, it reduces risk and it provides a better pregnancy outcome."  But it is also long-acting, staying longer in the baby's system.  Some 85% of babies exposed to methadone in the womb develop one sign at least of drug withdrawal.


The concentration of drug in the baby's blood equals that of the mother.  When the placenta transference is cut off at birth the baby's drug supply vanishes and they experience the same withdrawal symptoms as an adult coming off heroin.  Central nervous system irritability characterized by high-pitched crying, frantic feeding, tremors and seizures.


What responsible woman would know this and still continue to take drugs while pregnant?  What intelligent woman would choose to become pregnant and carry a pregnancy through to delivery, while a prisoner of drugs?  And then watch her baby vomiting, feverish, diarrhetic.


Standard treatment for such babies is the administration of morphine, slowly reducing it as signs of withdrawal diminish.  But then, the long-term consequences of NAS are unknown.  "We're just beginning to look at this phenomenon."