WSJournal. Pain Pills' Littlest Victims

Mothers on Oxycodone Give Birth to Drug-Dependent Babies; 'It's Heartbreaking'

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VIDEO: CLick on Hospitals in Florida and elsewhere are grappling with the latest fallout from the epidemic of prescription-drug abuse: babies born addicted to painkillers. The newborns present new challenges for hospitals. Photo: Jason Henry/The Wall Street Journal

SARASOTA, Fla.—Hospitals around the country are confronting an unsettling consequence of the prescription-pain-pill epidemic: a surge in the number of babies born dependent on drugs such as oxycodone.

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One recent morning a 12-day-old girl lay writhing in the neonatal intensive-care unit at Sarasota Memorial Hospital. Erin Weatherwax, a nurse, tried to console the newborn by holding her against her chest and patting the baby's back. She placed the girl in a motorized swing that made cricket sounds. But the infant continued to squirm, unable to sleep more than a few minutes at a time.

The baby suffered withdrawal from methadone, a drug used to treat painkiller addiction that her mother took during pregnancy. The hospital sated the baby's physical cravings by giving her morphine as well as phenobarbital, a barbiturate used to treat seizures. Now she had to be weaned off those drugs.

Born Dependent on Opioids

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Jason Henry for The Wall Street Journal

Eight hours after Gabriel was born, he exhibited a variety of withdrawal symptoms, including stiffened muscles and excessive sucking.

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"It's heartbreaking," Ms. Weatherwax said.

Between 2000 and 2009, the number of newborns showing symptoms of withdrawal from drugs called opioids—including painkillers like oxycodone and antiaddiction drugs such as methadone—tripled in the U.S., according to a study published earlier this year in the Journal of the American Medical Association.

In 2009, more than 13,000 babies in the U.S. were diagnosed with the condition, formally known as neonatal abstinence syndrome, the study said.

The newborns—reminiscent of the "crack babies" of the 1980s and 1990s born to women addicted to cocaine—present a host of challenges to hospitals. There is no standard way to treat their withdrawal, so doctors and nurses are improvising to figure out the most effective combination of drugs and dosages.

The babies require constant attention, and their stays in a neonatal intensive care unit, or NICU, can stretch for weeks, tying up hospital resources. Their treatment is costly—a mean of $53,400—according to the JAMA study, and Medicaid covers the tab for 78% of the babies. Hospital charges to care for such infants jumped to an estimated $720 million in 2009 from $190 million in 2000, the study said.

Hospitals in states such as Kentucky and West Virginia have reported a sharp rise in the number of opioid-dependent babies. In Florida, long the nation's epicenter of illegal prescription-drug sales, the problem is acute, especially in a cluster of counties near Tampa Bay, including Sarasota. Hospitals such as Spring Hill Regional Hospital, north of Tampa, said that as many as 30% of the babies in their NICUs suffer from opioid withdrawal.

Hospitals were ill-prepared for the drug-dependent infants. "This isn't a problem I learned about in training," said Terri Ashmeade, medical director of the NICU and chief of pediatrics at Tampa General Hospital. Her unit, like others, relied at first on protocols for heroin withdrawal in babies, mainly using phenobarbital, she said. But the staff quickly found that withdrawal symptoms for today's painkillers, which are powerful and long-acting, were much more severe.

The newborns cry incessantly, jerk their limbs and vomit. They can have such severe diarrhea that it burns the skin off their bottoms. Though treating them with the very opioids they are withdrawing from may seem jarring, doctors say the alternative could be worse: seizures and even death.

After years of trying different treatments, Tampa General settled on a uniform approach three months ago. Like many hospitals, it relies on a system that assigns points for different symptoms, and it initiates drug treatment if the numbers cross a certain threshold. (There is no blood test or other diagnostic to determine whether a baby is drug-dependent.)

Eight hours after he was born, Gabriel, a baby undergoing treatment recently at Tampa General's NICU, exhibited a variety of symptoms, including stiffened muscles and excessive sucking. So the hospital gave him methadone and, when the symptoms persisted, increased the doses until he reached the maximum. Two days later, he was still scoring high, so the hospital gave him clonidine, a drug used to treat withdrawal in adults.

At eight days, Gabriel was still taking the maximum dosage of methadone and close to the maximum of clonidine. He appeared mostly calm, but startled and trembled at times. It would likely take weeks more to wean him off the drugs, nurses said.

Sixty miles to the south, Sarasota Memorial is following a different protocol. While using the same scoring system, it starts babies on morphine, and if necessary, adds phenobarbital.

Hospitals have no choice but to experiment, given the paucity of research on what treatments are most effective. The American Academy of Pediatrics in February published new guidelines for neonatal abstinence syndrome—its first update since 1998. Though the paper cited a range of potential treatments, it didn't recommend one particular protocol.

To try to come up with a standard regimen, a collaborative of Florida hospitals, including Sarasota Memorial, plans to compare various approaches. Each NICU will rely on morphine and clonidine, but at different dosages, increased and decreased at different rates, said Mark Hudak, a neonatologist at Wolfson Children's Hospital in Jacksonville, which is part of the group. The group hopes to assemble its findings some time next year.

One objective is to cut down the amount of time babies are spending in intensive care and assess whether they are being overmedicated, Mr. Hudak said.

Hospitals are grappling with another concern: They worry they aren't catching all the affected babies. Not every mother is forthcoming about using prescription painkillers, which leaves it up to medical staff to look out for symptoms. Most newborns are discharged within 48 to 72 hours, yet babies exposed to long-acting opioids like methadone can take five or more days to show signs of withdrawal.

"Some are going home and withdrawing," said Tony Napolitano, medical director at Sarasota Memorial. And a mother with dependency issues may not be equipped to handle a highly irritable and sensitive newborn, he said.

Organizations like the Healthy Start Coalition of Hillsborough County, a nonprofit, are urging obstetricians to broach the subject of opioid use with their patients. Many don't, often because they are unaware how widespread the problem is, said Executive Director Jane Murphy.

Because the phenomenon of opioid-exposed babies is so new, little is known about any long-term effects. Some studies suggest they are at greater risk of attention deficit hyperactivity disorder, but the findings aren't conclusive.

Fears that the "crack babies" of decades past would develop severe physical, mental and emotional disabilities proved to be unfounded, research showed. But prescription-drug exposure "seems to be affecting babies' physiologies more than cocaine," said Ms. Ashmeade, the Tampa General neonatologist.

Write to Arian Campo-Flores at arian.campo-flores@wsj.com