Number of drug-dependent babies keeps rising

Shortly after he was born, tremors wracked Leopoldo Bautista's tiny body as he suffered through the pain of drug withdrawal — pain his mother understands.

Samantha Adams is being treated with methadone for heroin addiction and passed the methadone into Leopoldo's system. Sitting vigil with him at Norton Hospital, she teared up about watching the 10-day-old she loves "going through what I'd been through."

Leopoldo is part of a heartbreaking trend as the state struggles with pain-pill and now heroin epidemics. Kentucky hospitalizations for drug-dependent newborns soared 48 percent in a year, from 955 in 2013 to 1,409 in 2014. And the latest numbers represent a 50-fold increase from only 28 hospitalizations in 2000.

"The seemingly never-ending increase every year is so frustrating to see," said Van Ingram, executive director of the Kentucky Office of Drug Control Policy. "It's a horrible thing to spend the first days of your life in agony."

And it's growing more common across the nation.

Admissions of drug-dependent babies to U.S. neonatal intensive care units nearly quadrupled from 2004 through 2013, a recent study in the New England Journal of Medicine found.

Meanwhile the overall incidence nearly doubled in four years nationally, with one affected baby born every 25 minutes by 2012, accounting for $1.5 billion in annual health care charges. That's according to Vanderbilt University researchers publishing in the Journal of Perinatology, who say rates are highest in a region encompassing Tennessee, Mississippi, Alabama and Kentucky.

These infants are born into suffering.

They cry piercingly and often. They suffer vomiting, diarrhea, feeding difficulties, low-grade fevers, seizures — and even respiratory distress if they're born prematurely. They're extra-sensitive to noise and light, so NICUs must be kept dark and quiet. Treatment includes declining doses of morphine, intravenous fluids if they become dehydrated, and comfort measures like swaddling and rocking to calm them.

For these babies, the slow withdrawal from drugs is their first experience of the world.

Why the increase?

Some doctors say growing awareness of the problem — known technically as neonatal abstinence syndrome, or NAS — pushes up the numbers, although others argue this is a small factor if it contributes at all.

Dr. Veeral Tolia, a MEDNAX neonatologist at Baylor University Medical Center in Dallas and lead author on the New England Journal article, said the surge mainly reflects "the current epidemic of opioid drug use and abuse."

Researchers point to steep increases in painkiller prescribing to all Americans — including pregnant women. According to the U.S. Centers for Disease Control and Prevention, health care providers wrote 259 million prescriptions for painkillers in 2012, enough to give every American adult a bottle of pills. Ten of the highest-prescribing states were in the region with the most drug-dependent babies: the South.

Research led by Dr. Stephen Patrick, an assistant professor of pediatrics and health policy who also led the Perinatology study, found 28 percent of pregnant Medicaid recipients studied in Tennessee filled at least one opioid prescription. He suspects the same is true in other high-prescribing states such as Kentucky.

Legitimate use not only raises the risk of having a drug-dependent baby, it can sometimes lead to abuse and addiction.

Shannon Stout of Louisville became addicted to painkillers after a doctor prescribed Percocet for back pain from a car wreck in 2007. She abused Opana and Valium throughout her pregnancy with her son, Brennen Sayles, who was born three years ago withdrawing from the drugs. The baby spent six weeks in the NICU, suffering from shaking and diarrhea. "I'm still struggling with what I did, with self-forgiveness," Stout said. " I hate what I did to him."

Area doctors say they're now starting to see more pregnant moms struggling with heroin addiction. Federal statistics showdrug-poisoning deaths involving heroin nearly quadrupled from 2000 to 2013 nationally. In Kentucky, Ingram said preliminary numbers from 2014 show there were about 230 heroin deaths out of more than 1,000 drug overdose deaths overall.

Some treatment professionals say addicts are turning to heroin because it's cheaper and easier to get after government crackdowns on prescription drug abuse. Kentucky passed a law in 2012 to increase oversight of pain management clinics, stop pill-pushing doctors and require prescribers to use an electronic prescription drug monitoring system. Some addicts and doctors blame the law for the rise in heroin, although state officials say it's only one factor.

Whatever the reason, "heroin is definitely on its way back," said Dr. Lori Devlin-Phinney, a neonatologist with University of Louisville Physicians, adding that at U of L Hospital, it's "the No. 1 drug that moms are taking."

Adams, 27, of Sellersburg, Ind., said she began using heroin about 3 ½ years ago after a bad breakup. Thirteen months ago, she sought help at a methadone clinic. But as she got clean, she became pregnant with Leopoldo, her fifth child.

The clinic reduced her dosage of methadone, an opioid, from 110 to 70 milligrams, but she knew from treatment center videos that her unborn baby still faced a risk of being born dependent on the drug — and she worried. Though many doctors consider medication-assisted treatment the best option for pregnant addicts, it can cause NAS and some suspect it's contributing to the rising rates.

Adams' mother, Elizabeth Ashby, said she was relieved that her daughter was seeking treatment, but she worried for her grandchild and couldn't believe how many other families were facing the same battle. "Whenever I gave her a ride to the methadone clinic," Ashby said, "I'd see all the pregnant girls getting in line."

Not enough treatment

Despite rising opioid abuse, drug treatment for pregnant women is sorely lacking. Less than 2,000 of the 11,000 treatment facilities listed by the U.S. Substance Abuse and Mental Health Services Administration offer services to pregnant women. In Kentucky, only 71 of 286 facilities do, and all but 10 are outpatient facilities.

"I don't really expect (NAS numbers) to go down until we get more treatment for pregnant women," said Dr. Ruth Ann Shepherd, director of the Division of Maternal and Child Health in the Kentucky Department for Public Health.

There have been recent steps in that direction. Volunteers of America is renovating and doubling the capacity of its Freedom House recovery center in Louisville with a new 12-bed unit for pregnant women and six apartments for postpartum women and their children. And Attorney General Jack Conway's office last year announced a total of $1 million in pharmaceutical settlement funding for two other programs serving pregnant addicts, the Independence House in Corbin and the Chrysalis House in Lexington.

State officials also point to the growing ranks of behavioral health providers offering substance abuse treatment and accepting Medicaid.

Still, doctors and treatment professionals say the demand far outstrips the supply of treatment — and this can mean delays. Even when treatment centers give pregnant women top priority, just a few days' wait can cause them to turn away, endangering the babies in their wombs, said Dr. Dawn Forbes, neonatologist at Kosair Children's Hospital. "When people hit rock bottom," she said, "there's a small window to get them into treatment."

Stout said she was lucky to get into The Healing Place in Louisville last December and hopes to become a drug counselor someday. She's relieved that her son, who is in the custody of her mom, doesn't seem to have any long-term problems related to NAS. Possible problems include growth, behavior and cognitive issues, but doctors say these are influenced greatly by whether or not a child grows up in a supportive environment.

Adams said she's hopeful for Leopoldo's future. Doctors are slowly weaning him off morphine, and he's doing better than some babies because he was born a healthy 6 pounds and 6 ounces at term. Doctors say they expect babies to go home sooner than they did in the past; the average stay at Norton is three weeks or less. Like the majority of mothers with NAS babies, Adams has Medicaid to pay the bills.

On a recent afternoon, Adams cuddled Leopoldo in her arms, kissing his cheek and caressing his dark hair as his hands reached out from under his blanket.

"Here I am loving myself again, and I've got a new life to care for. I feel like I've got a second chance," she said, looking into his scrunched-up face. "The world is so full of surprises and beautiful things. … It's never too late to change."

Reporter Laura Ungar, who also covers public health for USA Today, can be reached at (502)582-7190 or on Twitter @laura_ungar.

Hospitalizations for Drug-Dependent Babies in Kentucky

2000: 28

2001: 67

2002: 99

2003: 143

2004: 176

2005: 182

2006: 241

2007: 285

2008: 361

2009: 470

2010: 524

2011: 730

2012: 889

2013: 955

2014: 1,409

Sources: Kentucky Injury Prevention and Research Center, Kentucky Office of Drug Control Policy

Drug-dependent babies -- by the numbers

Every 25 minutes: How often a baby was born with neonatal abstinence syndrome (withdrawing from drugs) in the United States in 2012

27: Cases of NAS per 1,000 NICU admissions nationally in 2013, up from 7 per 1,000 in 2004

48 percent: Percentage increase in Kentucky hospitalizations for NAS between 2013 and 2014

440: Number of babies diagnosed with NAS at Norton Healthcare hospitals in 2014, up from 365 in 2013

31,354: Number of pregnant Medicaid recipients studied in Tennessee, out of 112,029, who filled at least one opioid prescription.

$1.5 billion: Annual health care charges nationally due to NAS

80%: Portion of NAS infants enrolled in state Medicaid programs

Sources: New England Journal of Medicine, Journal of Perinatology, Pediatrics, Kentucky Office of Drug Control Policy