The epidemic of opiate addictions that has cost hundreds of lives is taking another toll, newborn babies, and the epicenter for New York State is here.
The rate of babies born addicted to opiates in Western New York is the highest in the state.
In Erie County alone, as many as 554 babies were born addicted to opiates in a recent three-year period, with the numbers rising in each of those years.
For every 10,000 births in Erie County, 189 newborns test positive for drugs in their systems, according to the state Health Department.
In Niagara County, the rate of newborn addiction was even higher: 217.
And in Chautauqua County, it was 223 per 10,000 births.
The suffering of newborns exposed to opiates while fetuses is a direct result of the opiate epidemic, said Erie County Health Commissioner Gale R. Burstein.
“We’re seeing the other effects of the opiate epidemic, moms giving birth to addicted newborns, increased deaths, and the onset of opiate addiction trending toward younger ages,” Burstein said. “It is very sad how many people are beginning their life with such discomfort, and we still have to learn the long-term effects of individuals born with neonatal abstinence syndrome.”
Within their first 24 hours of life, the addicted newborns go through painful withdrawal.
This includes frantic shaking of their arms and legs, inconsolable crying and seizures in the most severe cases.
Sometimes, doctors insert a feeding tube to ensure the infant receives adequate nourishment.
One mother who gave birth to an addicted baby is Amber, a 27-year-old mother of two, who was willing to talk provided she be given anonymity. She shared her story, in the company of her counselor at a University at Buffalo clinic, in the hopes it would encourage other addicted pregnant women to find help.
Amber said she never intended to become addicted to prescription painkillers and certainly not while pregnant. But, she said, she became addicted to opiates after going to Dr. Pravin V. Mehta’s Niagara Falls office in 2008 for gallstones. She said she had no idea that he was known on the streets as “Dr. Feel Good” because of his reputation for writing painkiller prescriptions without medical justification.
“I thought I had gallstones, but he sent me for an MRI and said I had herniated discs, which I later learned was not true. By the end of the day, he had prescribed 20 milligrams of Opana that I took three times a day, and 10 milligrams of Lortab that I took twice a day. He also gave me a weight reduction prescription. I was so messed up. Within a month, I was addicted,” Amber said.
When Mehta was arrested in 2011 and accused of illegally prescribing opiates, Amber turned to the streets to buy prescription painkillers from drug dealers. She was pregnant with her first child.
But the agony of withdrawal from the medications was unbearable.
When her daughter was born and started shaking uncontrollably in the throes of withdrawal, Amber said she watched in disbelief, knowing firsthand the pain of withdrawal.
“I was in tears. I was in shock. She was shaking, having tremors. They thought she was going to have seizures. I decided I needed help,” Amber said.
Her baby, born in August 2012, spent three months at Women & Children’s Hospital receiving tens of thousands of dollars in medical treatment to wean her from the addictive substances.
Her addicted newborn was not alone. Across the state, nearly 6,000 babies were born with a “drug-related diagnosis” from 2010 through 2012, according to state health records.
And millions of dollars was spent treating those newborns.
The youngest victims
The first impulse of a medical professional witnessing a newborn go through withdrawal is to ease the baby’s pain, said Dr. Thomas Riley, a neonatologist at Sisters of Charity Hospital in Buffalo.
“Every year, we are seeing more and more babies with drugs in their systems,” he said. “Sometimes detox of the newborns can take up to a month or longer depending on the symptoms.”
The most recent state figures are for 2012, but indications point to an increasing pace of infants born addicted to opiates and other substances.
The Catholic Health System, which includes Sisters Hospital, last year handled about 200 newborns who tested positive for drugs in their system, Riley said.
As the drug levels in an addicted baby’s body drop, neonatal abstinence syndrome takes hold. That is when the babies start shaking, cry uncontrollably and develop diarrhea so severe that diaper rash may resemble second-degree burns. To try to soothe these newborns, volunteer “cuddlers” rock and hold the babies.
The detoxification of newborns is a gradual process. It is also expensive.
“Newborns are given 1.1 milligrams of morphine per kilogram of their weight with every feeding,” Riley said. “It can take up to a month with an average detox of three weeks, but it depends on the drug the mother was taking or if the mother was on multiple substances. Anything you take into your body when you’re pregnant – cigarettes, alcohol – has some effect on your fetus.”
A three-week hospital stay for a newborn being weaned from opiates can add up to about $16,000, health officials said.
And after the baby leaves the hospital, there is a great unknown: Are these infants more susceptible to becoming addicts later in life?
“We don’t know a lot yet, but there are studies being done as these babies are now starting to reach teenage and young adult years to see if they are more prone to addiction because the receptors in their brains may have been altered,” Riley said.
Studies on fetal alcohol syndrome have already determined that there is a greater association with alcoholism later in life.
Expectant mothers who are addicts should enter a substance abuse treatment program and avoid abruptly stopping drugs on their own, Riley said.
“Some mothers have stopped cold turkey, and they are at risk of a miscarriage,” he said.
After her daughter was born, Amber said she entered an outpatient drug treatment program in Niagara County and was placed on Suboxone to help her gradually overcome the cravings for prescription painkillers.
“I was in the program for about 18 months and became pregnant again. I switched from Suboxone to a milder medication in my second pregnancy, and my son was born without any withdrawal symptoms and is doing great. So is my daughter,” Amber said.
She said she became pregnant a third time six months ago and has continued on a prescription for Buprenorphine, which, like Suboxone, is used to wean addicts from opiates. The medication helps her avoid relapsing, she said.
Amber is currently a patient at the University at Buffalo MD Family Medicine Special Services Clinic, where she participates in monthly group meetings to discuss addiction and how best to help other pregnant women addicted to opiates.
“If the woman can remain totally abstinent during the entire time of pregnancy, that is ideal,” said Dr. Richard D. Blondell, a professor at UB’s Department of Family Medicine.
“Usually that happens in a halfway house or group home. But maybe only about 10 percent of women who have addictions can do that,” said Blondell, a specialist in addiction medicine.
Over the last several years, more than 60 pregnant mothers have been assisted at the Amherst clinic Blondell oversees, and each year, the number of mothers arriving for help increases, he said.
If a women is unable to detox, he said, the next best thing is to regulate the addiction by prescribing a drug that a doctor can monitor, as opposed to the expectant mother continuing to self-medicate with illegally obtained prescription painkillers or street drugs.
“Most people who do heroin cycle in and out of withdrawal, and that is bad for babies in-utero,” Blondell said. “It is much better to have them on a steady dose of a prescription medication like Buprenorphine.”
And while society may look down upon pregnant women who continue to take drugs during pregnancy, condemnation serves no useful purpose, according to Blondell and his staff.
“A lot of the women who come in are beat down and look horrible," he said, “but we try to be warm and supportive and treat them with dignity and respect. You know, if they get treated well, they do better. If you kick them when they’re down, they just get worse.”
Addicted mothers are already likely to belittle themselves, especially after their babies are born and they watch the infant go through withdrawal, Blondell said.
That was Amber’s experience. She said she was filled with remorse at seeing what her baby was experiencing.
“My lifestyle completely changed after I became addicted. I went from someone who wouldn’t take an aspirin to someone who couldn’t drive a car when I was on the painkillers,” she said. “When Dr. Mehta got arrested, I was on the streets buying what had been prescribed for me. Everyone in Niagara Falls who had been his patient was on the streets.”
In time, Amber said she became a patient of North Tonawanda Dr. Matthew A. Bennett, who reviewed her medical charts and determined she did not have herniated discs. But by this time, the damage was done. She was an addict and could not stop taking the pills.
She said she was stunned when Bennett, in 2012, was arrested for improperly writing prescriptions for addictive painkillers. Both Bennett and Mehta have separately pleaded guilty in federal court to conspiracy to distribute oxycodone, have or will surrender their medical licenses, and face the possibility of several years in prison when they are sentenced.
Addicted mothers seeking help cannot change the past, Blondell said.
“But (they) have a choice of what they do in the future,” he added.
As for Amber, she said that once her third child is born, she intends to wean herself from Buprenorphine and be completely drug-free.
The biggest obstacle stopping women from getting help is shame, said Kyla Fallin, a social worker at the UB-sponsored clinic on Sweet Home Road adjacent to UB’s North Campus.
“The stigma in general with addiction is a problem, but when you add on the layer of addiction in pregnancy, there is even more negativity,” Fallin said. “People need to feel safe and that they are not being judged.”
Many pregnant women who ended up in addiction have been abused, she said.
“A high number of women in this treatment population have experienced trauma, sexual abuse, childhood maltreatment, parental loss, domestic violence, things like that, which can help to explain how someone becomes addicted. It can definitely be a factor,” Fallin said. “The mothers who come here want their babies born healthy. The common thread is the women seeking treatment and trying to turn their lives around.”
Fallin is developing a program for health care professionals assisting addicted pregnant mothers in rural areas where resources are limited.
But the opiate epidemic cuts across geographical and demographic boundaries, Blondell said.
“A lot of my patients have jobs and families,” he said. “My waiting room looks like a pediatrician’s office. We even have a toy box, and at the end of the day there are toys scattered all over the floor.”
Addiction, he adds, “is an affirmative-action, equal-opportunity disease.”
To that end, Burstein says the consequences of the opiate epidemic continue to worsen.
“Other side effects include increases in hepatitis C in younger age groups and, in a rural Indiana community, we’re seeing this huge outbreak of HIV from the sharing of needles. That could happen anywhere,” the health commissioner said. “It could happen here.”