A growing trend: Opiate abuse during pregnancy, suffering newborns

Editor's note: This is the first of two parts about opiate abuse and its potential consequences during pregnancy.

More newborns are experiencing Neonatal Abstinence Syndrome, a drug withdrawal syndrome as a result of opiate abuse during pregnancy. In 2000, there were just over 4 million births in the U.S. and 8,000 infants were exposed to opiates and opiate-like drugs (such as heroin, morphine, opium, methadone and) in the womb. Of these, 4,000 needed treatment for NAS.

The numbers only go up from there. In 2015, about 50,000 babies were exposed to opiates and at least 23,000 suffered from opiate-based withdrawal. (About 50,000 fewer babies were born in 2015 than in 2000, too.) It's also not just an urban problem anymore. At rural Dartmouth-Hitchcock Hospital in New Hampshire, almost 10 percent of mothers are now positive for opiates when they come in to deliver.

Before I talk about how we got to his point, here is some history of opiate use that dates back to the 1850s and crucial work done by Philadelphia's Loretta Finnegan, MD to help mothers and newborns dependent on opiates starting in the 1970s.

Withdrawal in newborns is an old problem

Newborn withdrawal was recognized beginning in the 1850s when opiates were legal and could be found in many home remedies such as paregoric "baby soothing drops." Most19th century patent medicines for "woman's problems" were either alcohol (Lydia Pinkham's) or laudanum (an opiate) based. Mary Todd Lincoln was addicted to laudanum containing patent medicine. Paregoric (a form of opium) was available over the counter for "teething" until the 1960s.  One third of babies born to opiate addicted mothers died in withdrawal until about 60 years ago, when doctors began to treat the newborns with paregoric when they withdrew.

A Philadelphia doctor's research to help newborns

In 1970, Finnegan was a young doctor treating sick newborns at the old Philadelphia General Hospital when she noticed many babies withdrawing. Most of these newborns had mothers using multiple street drugs primarily heroin. Heroin is rapidly processed in the body and newborns starting shaking and then having seizures soon after birth when their body level of opiates rapidly fall.

There was almost no scientific knowledge about what to do for these children, but she made it her life's work to figure out which babies needed treatment, what to treat them with and how long to watch for withdrawal.  She also figured out that you had to treat the addicted mothers with methadone during their pregnancy to minimize the harm to the babies (many substance abusing patients have up to 10 drugs in their system at any one time). She started the Family Center Program at Thomas Jefferson University Hospital and it has become the Maternal Addiction Treatment Education and Research Program supervised by Diane Abatemarco, PhD, MSW, with about 230 families and growing.

Finnegan, who was one of my teachers, pioneered using methadone during pregnancy to minimize fetal harm, figured out the scoring system to determine when the newborns needed to be treated, and most importantly started a complete care system for these mothers and babies during pregnancy and after birth. Doctors, nurses, and social workers all made sure that these babies were given the best care. Eventually, she became assistant head of the National Institute of Health, Office of Substance Abuse Protection.

Her scoring system is still used today to determine when infants need to be given opiates and then when to wean them off of the drugs. In my next post, I will discuss how opiate abuse became a growing problem in recent times and what's being done about it.

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