DETROIT LAKES, Minn. -- As the nation’s opioid problem and related disorder continues to grow, there’s also been a significant rise in infants being affected by the drug at birth.
According to studies done by the Centers for Disease Control and Prevention, Opioid-Use Disorder (OUD) has quadrupled from 1999 to 2014.
“That’s really remarkable. That’s really serious,” said Julia Vasquez Lopez, an obstetrician at Essentia Health in Detroit Lakes.
While the number of adult opioid users continues to increase dramatically, Vasquez Lopez sees the opioid crisis from another perspective - in infants. She says Neonatal Abstinence Syndrome (NAS) cases, or infants experiencing drug withdrawal after birth, was five times higher in 2013 than in 2000. As the number of users goes up, so does the number of children affected - and the problem is even higher in rural counties.
“Maternal OUD and NAS disproportionately affect rural communities, where poverty levels are higher and where health care access is more limited … with the proportion of infants diagnosed with NAS from rural counties increasing from 12.9 (percent) in 2003-2004 to 21.2 (percent) in 2012-2013,” reads a University of Minnesota study headed up by Kay Kozhimannil, associate professor at the university.
At Essentia Health in Detroit Lakes, expectant moms testing positive for opiates has increased a percentage point from 2017 to 2018, roughly.
Using the time periods of the first eight months of 2017 compared to September 2017 to August 2018, the number of pregnant women who tested positive for drugs was up from 12 percent to 18 percent. Of those who tested positive, opiate detection increased from 8 to 9 percent.
The numbers of opioid-affected births in the area have stayed fairly consistent over the last three years, partially due to the connected resources Essentia Health, Becker County Human Services, and the Mom’s Program in White Earth offer expectant moms who are addicted to opiates.
There are treatments available to help women addicted to opioids have successful pregnancies. A big problem is that many women are ashamed to get help once they find out they’re pregnant. Often times, these pregnancies are unintended, says Vasquez Lopez. Then there is the stigma drug users face.
“A major problem is that these women feel fear and guilt and shame,” said Vasquez Lopez. “They’re also concerned about medical interventions.”
She says sometimes women will try to stop using opioids on their own, going cold turkey, which can be very dangerous for the mother and baby. Other times, they may not even come in for prenatal care, fearing they will get in trouble and, many times, if the women do come in, they find it hard to stick to a care plan.
“If they don’t come in for prenatal care, you don’t know anything about the case,” said Vasquez Lopez, stressing that those pregnancies, which are already high-risk, can quickly become emergency situations.
Babies born in these emergency or high-risk situations need to be monitored for days - even weeks - after they are born to treat withdrawal symptoms. Anywhere from 55 to 90 percent of babies born to a mother addicted to opioids will need therapy to come off the drugs that entered their system while they were in their mother’s womb.
A NAS score is used to determine the severity of the situation. Doctors watch for excessive crying, tremors, skin sores, convulsions, fever, sweating, high heart rate, excessive suckling, poor feeding, and a number of other symptoms. Basically, “anything that qualifies as an opioid withdrawal,” said Vasquez Lopez.
If NAS is suspected, the baby and mother are both drug tested, and the incident is reported to human services. The infant is taken from the mother in these cases and the mother is placed on a treatment plan, only able to get her child back once she complies.
Pregnant women who get treatment before their child is born, however, can avoid having their child taken away.
“If the mom is in the methadone program, then she is evaluated by the social worker. If they see she has been compliant with her care, then, I think, the baby goes home with the mom,” said Vasquez Lopez, adding that it’s up to the social worker to determine.
The goal, of course, is to decrease an infant’s exposure to opioids as much and as soon as possible. The sooner expectant mothers who are addicted get care, the better the outcome. Opioids are an increasing problem, but a new generation born addicted only makes it worse.
“In babies with NAS, for long-term, they can have all kinds of problems. They can have a lower IQ and increased risk of illicit drug dependence as well. The don’t grow normally. Sometimes, they have problems gaining weight,” Vasquez Lopez said.
And that’s just the beginning. Studies haven’t yet captured the totality of the long-term effects children born addicted to opioids face, but one thing is certain: they can face significant disadvantages.
“The associations between maternal OUD and mental illness, chronic pain, tobacco use, and other substance use call for clinical attention to the multifaceted nature of OUD,” reads the University of Minnesota study.
With early treatment, there’s no reason baby and mother can’t overcome these obstacles, though. Vasquez Lopez says many mothers, if they begin a treatment program early enough and follow it, are even able to breastfeed their children, flying in the face of another disadvantage these cases often lead do: separation of mother and baby that can hamper bonding and attachment.