Fellowship Story Showcase
Prescription for Tragedy | Many more Kentucky babies being born addicted
Laura Ungar wrote these stories for The Courier-Journal as a 2012 National Health Journalism Fellow. Other stories in this series include:
More than half the babies in University Hospital’s neonatal intensive care unit one day this month were suffering from drug withdrawal — one sucking licorice-flavored morphine to ease his tremors and near-constant crying, another so sensitive to light and sound that he slept in a dark isolation room.
They are the tiniest victims of Kentucky’s prescription pill epidemic, and their numbers are soaring.
Kentucky has seen its hospitalizations for addicted newborns climb from 29 in 2000 to 730 last year. The state’s 2,400 percent increase dwarfs by comparison a disturbing national rise of 330 percent found in a study that examined hospitalizations from 2000-09.
“It’s a silent epidemic that’s going on out there,” said Audrey Tayse Haynes, secretary of the Kentucky Cabinet for Health and Family Services. “You need to say: ‘Stop the madness. This is too much.’ ”
The skyrocketing numbers reflect the enormity of Kentucky’s prescription drug abuse problem, which is among the nation’s worst. It kills about 1,000 Kentuckians a year and wrecks thousands more lives in a state plagued by doctor shortages, high levels of chronic pain and illness, and too little drug abuse treatment.
Van Ingram, executive director of the state Office of Drug Control Policy, requested statistics on Kentucky infant hospitalizations — collected for the first time — after hearing that the state’s pain pill explosion was fueling a dramatic rise in addicted newborns. He soon realized the state’s epidemic is threatening to claim a second generation.
“I was blown away,” he said. “We need to slow the tide.”
While state officials and doctors say the hospitalization statistics reflect newborns suffering withdrawal from all types of drugs, they blame prescription pills for the dramatic increase. And even as growing awareness and better diagnoses play a role in the rising numbers, they say rampant abuse is driving the rise.
Melissa Lueloff, 28, of Louisville, who gave birth to an addicted girl two years ago, said her cravings at the time for OxyContin, Opana and cocaine ruled her life even during pregnancy — “I just couldn’t stop.”
Neveah was born a month premature and spent five days in a neonatal intensive care unit struggling with withdrawal, constantly clenching her tiny fists and whining in pain.
A silent epidemic
Nurse Tonya Anderson, an infant development/touch therapist for neonatal nurseries at Kosair Children’s Hospital, said there are times when as many as 14 of 26 babies in the special-care nursery where she works suffer from withdrawal.
“They are just agitated. They are screaming. They have tremors. Their faces — you have the grimace. They’re in pain. … Sometimes, the babies have seizures,” she said. “We hate it. … It breaks my heart to see these babies go through withdrawal.”
On a recent morning, Anderson cuddled and caressed a crying infant whose tiny foot peeked from beneath a blanket. The newborn, surrounded by beeping monitors, quieted and melted into her chest.
As nurses and doctors care for the newborns, state and hospital officials are trying to cope with the larger problem — convening experts, seeking grants to educate the public and creating special infant-withdrawal units in hospitals.
But there’s not enough drug treatment for pregnant addicts, they say, and more needs to be done to protect the lives the addicts carry.
Carla Saunders, a neonatal nurse practitioner at East Tennessee Children’s Hospital in Knoxville, a pioneer in the treatment of babies withdrawing from drugs, said the public simply cannot afford to ignore this national epidemic.
A team of researchers writing in the Journal of the American Medical Association in May found that overall health care costs for addicted newborns are soaring — from $190 million in 2000 to $720 million in 2009.
Addicted babies stayed an average of 16.4 days in the hospital at a cost of $53,400 per infant, with government-funded Medicaid paying the bill in 80 percent of cases.
And while little is known about long-term outcomes, evidence suggests that addicted babies may have higher rates of behavioral issues and attention deficit and hyperactivity disorder that could burden schools and the health care system for years to come, Saunders said.
“People think it’s easy to ignore the substance-abuse problem,” she said. “But it’s your problem. You better take notice.”
According to the May study in the Journal of the American Medical Association, the rate of newborns suffering withdrawal in the United States rose from 1.2 hospitalizations per 1,000 hospital births in 2000 to 3.4 per 1,000 in 2009. Doctors call the condition “neonatal abstinence syndrome.”
Based on their findings, researchers estimated that 13,539 newborns were born addicted in 2009 — more than one baby every hour.
“We knew that it was common, but we would not expect this problem would have tripled in the last decade,” said Dr. Matthew Davis, an associate professor at the University of Michigan and one of the study’s authors. “There are not many medical problems that have tripled in a decade — not obesity, not heart disease, not diabetes.”
Davis and his colleagues did not examine regional data, but he said he was not surprised about Kentucky’s numbers, given the overall trend. There’s regional evidence that rapid increases have occurred after the national study period ended in 2009.
In Kentucky, the number of hospitalizations for addicted newborns rose from 470 in 2009 to 730 in 2011. Saunders said the number of addicted babies at her Tennessee hospital has more than tripled in the past three years.
University of Kentucky biostatisticians who calculated Kentucky’s hospitalization numbers didn’t break them down by county or region, but Kentucky doctors said addiction affects babies in every corner of the state.
Dr. Lori Ann Devlin-Phinney, a neonatologist who sees patients at University Hospital, Kosair Children’s and Baptist Hospital East, said she’s counted 132 newborns treated for addiction to opiates or narcotics at University’s NICU in the past seven years.
She’s seen similar numbers at Kosair Children’s — including 65 in 2011 — and about 50 during the seven-year period at Baptist East.
Devlin-Phinney also tracked a steep recent rise at University Hospital, from nine in 2006 to 44 in 2011. The hospital had particularly high numbers of addicted babies in its NICU earlier this month — with eight of its 15 babies suffering withdrawal in the 24-bed unit.
Neonatologists at UK Medical Center in Lexington, where many patients come from Eastern Kentucky, report seeing 90 to 100 addicted babies a year — or about one in eight babies there.
“Every hospital where there are newborns sees it,” said Anderson.
According to the JAMA study, 60 percent to 80 percent of infants exposed to opiates in the womb develop neonatal abstinence syndrome.
While babies do not show signs of psychological addiction, they experience the physical effects of withdrawal.
UK screens every mother and baby for drugs, but some hospitals instead assess a mother’s drug use history and look for symptoms in the newborn. Those symptoms may show up one to three days after birth, potentially meaning a baby would have to return to the hospital after going home.
By that time, the mother’s drugs are out of the newborn’s system, and “they’re basically looking for their fix, so they have this withdrawal,” said Dr. Henrietta Bada of UK.
Many cry constantly. Some suffer diarrhea, vomiting, low-grade fevers, sweating and seizures. They’re extra-sensitive to noise and light and often console themselves by sucking.
At Kosair Children’s recently, one newborn girl sucked frantically on an orange pacifier and squeezed her eyes tightly closed, opening them only when nurses dimmed the lights.
Bada said some born prematurely experience respiratory distress and have to be placed on ventilators. They “can get into critical condition,” she said.
Devlin-Phinney said doctors often use a combination of oral morphine and phenobarbitol to treat addicted babies, escalating doses based on symptoms and then weaning the infants from them.
Babies with milder cases don’t need medicating, doctors said, but all require comfort measures. Anderson swaddles the babies in blankets to make them feel secure, massages them gently, and rocks and cuddles them.
“Sometimes,” she said, “all we can do is hold them.”
Janiece French of Louisville, a 68-year-old grandmother, helps the nurses provide this tender care as a volunteer at Kosair Children’s. In her three years volunteering, she’s witnessed the cycle of addiction, caring for siblings of drug-addicted babies born in the same condition.
Earlier this month, she settled into a rocking chair with a newborn girl, gently rubbing her back to soothe the baby through withdrawal.
“Mostly it’s just rocking, cuddling — whatever it takes,” French said. “But all you can do is get them off on the right track. You do what you can while they’re here and then, like your own children, you have to let them go, give them their wings, and hope for the best.”
Dr. Lori Shook, a UK neonatologist, said caring for such babies can be frustrating because the condition “is avoidable.”
“At the same time,” she said, “the substance-abuse problems suffered by their mothers are very real.”
Dr. Jonathan Weeks, an obstetrician and associate professor of maternal/fetal medicine at the University of Louisville, treats the mothers, trying to help.
He said pregnant addicts going cold turkey risk miscarriage or preterm birth, so the treatment of choice is methadone, a pain reliever that also prevents withdrawal symptoms. But some women on methadone give birth to babies who go through withdrawal from that drug.
Weeks said many of the pregnant addicts he sees are strongly motivated to get clean. And while kicking their habits in the first trimester is better for the fetus, he said that often doesn’t happen.
“The vast majority of mothers are concerned about their babies,” he said. But “opiate addiction is a chronic problem with lots of relapses.”
Kentucky has a handful of long-term residential programs that target pregnant and post-partum addicts, including Volunteers of America’s Freedom House in Louisville and Cumberland River Comprehensive Care Center’s Independence House in Corbin. Both provide therapy, life-skills education and support.
Recovering pill addict Valerie Hall of Pikeville, a 26-year-old mother of three, was five months pregnant with her youngest child when she came to Independence House after serving jail time for drug trafficking. With counseling and support, she gave birth to a healthy, drug-free son, Easton, more than four months ago.
“I know he would’ve been born addicted if I had not come here,” she said, cradling Easton as he sucked on a bottle. “I love him so much, and I’m grateful nothing happened to him.”
Rickitta Smith, a recovering pain pill addict and former Freedom House client, said that program helped her give birth to a healthy baby as well.
“I was just tired of living that life,” said Smith, who stopped taking the drugs when she was five months pregnant with her son. “I could feel my baby being hurt. It scared me.”
But there are often waiting lists for such programs, and a similar location recently closed in Louisville for lack of funding.
When a woman gives birth to an addicted baby, she can face serious consequences.
Criminal charges, however, are unlikely. Although women have been charged over the years with taking drugs while pregnant, a 1993 Kentucky Supreme Court ruling found that criminal child abuse doesn’t extend to a woman’s use of drugs while pregnant, Assistant Commonwealth’s Attorney Leland Hulbert said.
But giving birth to a drug-affected baby can bring in child-protective services. Doctors and advocates said some women then go through treatment and keep their babies, but others lose custody. UK doctors said about four in 10 drug-affected babies can’t go home with their mothers.
“A lot of these moms are very loving moms,” Shook said. “They’re just not at a point in their lives when they can take care of a baby.”
Doctors and nurses said they try to educate parents in the hospital about caring for their infants and getting help for their addictions. “Our place is not to judge,” Saunders said.“Our place is to help.”
Tara Glover, a family advocate for Volunteers of America whose own son was born withdrawing from drugs nearly two decades ago, said many people see addiction as a moral failing instead of a disease. “But addicts aren’t bad people,” she said. “They’re sick people.”
Lueloff said she was at one of the lowest points in her life when she gave birth to Neveah, who was placed with a foster family and then an aunt.
But after becoming pregnant again, Lueloff sought help at a house run by Volunteers of America’s substance-abuse services. She wiped away tears as she recalled getting sober and giving birth to a healthy son less than a year ago, her fifth child.
“This place has changed my life,” she said.
Lueloff has regained custody of Neveah, is living on her own with her children, and beginning management training for McDonald’s. She said she’s bonding with her daughter, who used to consider caregivers her parents.
“Now,” Lueloff said, twirling her hands through her daughter’s black ponytail, “she’s calling me Mommy.”
This article was originally published in http://www.courier-journal.com