Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Thursday, February 04, 2016

Welcoming Baby to This World

"Basically, they're in withdrawal."
"We do know Ontario has an increasing problem with opioid addiction. But we're also a little more aware of the problem. There's much more awareness of this, so we may also be picking this up a little bit more."
"They [addicted babies] certainly need to be under close care, and watched closely by nurses."
Dr. Astrid Guttman, chief science officer, Institute for Clinical Evaluative Sciences, Toronto

"Since 2000, prescription opioids have supplanted heroin addiction as the mean reason for starting methadone in Toronto."
Study on drug-addicted newborns in Ontario (February 2016)

"In the last 10 years the rates [prescription drug abuse among pregnant women] have doubled or tripled and it seems to be increasing,"
"They would have symptoms [in neonatal abstinence syndrome] of irritability, jitteriness, quick breathing and a high temperature,"
"The baby is craving that medication and until we can wean the baby off it gradually, we don't want the baby in pain or distress, so we do give that baby liquid morphine. Unfortunately we do have to do that with the baby and that would be under close observation in the neo-natal intensive care unit,"
"This has really snuck up on us, or I guess crept up on us in the last 10 years, just slowly increasing and increasing and many of us in our training didn't really have any expertise in dealing with this situation. And hopefully now we're gaining a lot of expertise, as well we're getting used to seeing moms in this situation."
"It's a harm reduction program obviously given a choice you wouldn't be on any opioid in the pregnancy but the methadone program gives the mom at least an opportunity to have a healthy pregnancy."
Dr. Anne Drover, pediatrician, Eastern Health, Newfoundland and Labrador (March 2015)

The scale of the current drug crisis is on par, if not beyond, that of the crack era. According to the Centers for Disease Control, sales of opioid painkillers such as oxycodone, hydrocodone and hydromorphone quadrupled between 1999 and 2010. From 2007 to 2013, according to the CDC, the number of heroin users increased 150 percent. Those new users, 75 percent of whom were introduced to opiates through prescription painkillers, were almost uniformly white, as were 90 percent of those who began using heroin over the last decade. More than 9 out of 10 people who used heroin between 2002 and 2013 did so while using at least one other drug, and the CDC estimates that 45 percent were also addicted to prescription opioids. The number of women who began using heroin during that period doubled.
Consequently, neonatal abstinence syndrome—essentially, postnatal withdrawal afflicting babies exposed to opiates in utero—has become an increasingly visible issue as the number of opiate-dependent infants has increased. A 2014 study found opiate abuse among pregnant women more than doubled between 1998 and 2011, based on case reviews of 57 million deliveries in American hospitals. The University of Michigan, in a 2012 study, noted that the incidence of NAS almost tripled between 2000 and 2009. Researchers wrote that symptoms of NAS “have been described in 60 to 80 percent” of infants born to mothers who used heroin or methadone while pregnant. Reuters, in an investigative story released in late 2015, determined an opioid-addicted baby is born every 19 minutes.
Kali Holloway / AlterNet, January 12, 2016

Neonatal withdrawal from narcotics and other medications or drugs of abuse was first described as neonatal abstinence syndrome (NAS) in 1975 by Dr Loretta Finnegan. She described a generalized disorder of hyperirritability of the central nervous system, gastrointestinal and respiratory dysfunction, and vague autonomic nervous system symptoms.1
In Australia the occurrence of NAS has increased dramatically from 0.97 per 10 000 live births to 42.4 per 10 000 live births in the past 25 years.2 In northern Ontario, narcotic abuse (in particular oxycodone in long-acting OxyContin or short-acting Percocet) has become an increasing problem.3 Remote First Nations communities with high rates of unemployment, poverty, and overcrowding bear the additional social and economic burden of narcotic abuse and addiction, with profound narcotic abuse in some of these communities.4 A 2008 survey carried out in the northern Ontario reserve of Constance Lake revealed that 46.3% of respondents abused prescription drugs and 39.6% abused illegal or street drugs.4
Narcotic abuse among First Nations populations affects the entire community, as well as the physical, mental, emotional, and spiritual well-being of the individuals.4 Self-identified risks for drug use in these communities include peer pressure, cultural loss, grief, lack of self-esteem, trauma, housing problems, domestic violence, and mental health issues.4
Female drug abusers are often of reproductive age—in the United States, 90% of female drug abusers are in that age group.5 The birth rate in First Nations communities is double that of the rest of Canada (23.0 per 1000 women vs 11.1 per 1000 women), and women who abuse oxycodone might well do so during pregnancy.6
Logo of canfamphys November 2011
Babies born addicted to opioids go through withdrawal then are weaned off the drugs with morphine.
Fotolia     Babies born addicted to opioids go through withdrawal then are weaned off the drugs with morphine

A new Canadian study concludes that society is in a great deal of trouble, and of course the current study's conclusion has been reached by other researchers viewing the catastrophic rise of drug use among young women of child-bearing age. It cannot come as a surprise to any woman of child-bearing age that what she does with her own body will be transferred through the placenta in pregnancy to the body of any child she carries. That exposure to drugs, chemicals, alcohol, tobacco, to a developing foetus guarantees a physically and mentally impaired baby.

Canada appears to have higher rates of newborns addicted to narcotic painkillers exposed in the womb than that of any of their Wetern counterparts; greater than Britain, Australia or the United States, according to new research on the steadily rising rates of neonatal drug withdrawal syndrome, affecting up to 80 percent of babies of women who use opioids. Oxycodone, hydromorphone and fentanyl are identified as the drugs behind a rise in deaths from overdose, as well. A death wish on the part of the mother, and imparted to her infant.

When birth occurs and the placenta no longer serves as a source of opioids crossing into the baby's bloodstream, the affected baby struggles with withdrawal symptoms, becoming irritable, jittery, experiencing problems simply breathing. They have a faster heart rate, cry continually, may have seizures and go into respiratory distress. Dr. Guttman, a pediatrician at the Hospital for Sick Children in Toronto was one of the authors of the recently released study.

The study, published in the journal Archives of Disease in Childhood Fetal & Neonatal Edition,  looked at statistics for Ontario only, but since the province accounts for an estimated 40 percent of the Canadian population, it is assumed that the numbers arrived at fairly well reflect other provinces as well. Doctors prescribe these addictive drugs for chronic pain or similar conditions; the exposure to their use most often represents the starting gate into addiction.  Doctors in Canada have been damned by regulators for their indiscriminate prescriptive drug habits.

Canadian doctors are recognized as being the second-highest opioid prescribers in the world; only doctors in the United States prescribe in greater numbers. Charges of inappropriate prescribing, too-high dosages, arbitrary prescriptions, all apply to prescription-happy doctors. The researchers for this new study measured the situation in  England, Western Australia, the U.S. and Canada, with Canada's figures associated directly with that of Ontario.

In 2011, 5.1 per 1,000 live births reflected addiction withdrawal babies. That number represented a value doubling the rates in  England and Western Australia; higher as well than those in the United States (2.7 per 1,000 births and 3.6 respectively). Mothers under 19 years of age appear to deliver the greatest number of babies with neonatal drug withdrawal. Communities in Northern Ontario have rates ten times higher than those in other parts of the province. And that would be because First Nations communities have a higher rate of affliction.

Born in drug withdrawal, babies have an increased risk of neglect, their mothers more likely to die during the childhood of their babies, leaving them orphans exposed to the same kind of living conditions that brought such despair to their mothers. Dr. Guttman is of the opinion -- and there would not be too many in society who would oppose that recommendation -- that public health policies targeting prevention and more effective treatment services are required for addicted women.

Which might work just fine, but not if the conditions that catapulted those young women into drug dependency in the first place aren't adequately addressed; a large order of neglected business that must at some point be remediated if society at large has a care about decent living conditions and equal opportunities for all those who live in the country that likes to think of itself as civilized and advantaged.

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