The opiate troubles of newborns

Projectile vomiting, diarrhea, tremors, seizures, muscle contractions, excessive sweating and fever.

Welcome to the world of opiate withdrawal, and welcome to the Neonatal Intensive Care Unit at Eastern Maine Medical Center.

This is the place where this community’s smallest and most innocent victims of the opiate addiction epidemic are beginning their life.

Like the number of patients receiving treatment at methadone clinics and those dying of opiate overdoses, the number of drug-dependent babies being born here is growing substantially.

Just a few years ago, it was relatively rare to have a drug-dependent newborn in the unit. Today, those babies account for 27 percent of admissions to the neonatal ICU.

You can bet that figure will continue to grow.

“It’s normal to have three to five drug-dependent babies in here at once,” Sue Cullen, a registered nurse and educator at EMMC, said.

Here, where lights and voices are kept low, these babies spend about a month going through drug withdrawal.

They often cry excessively and contract their muscles so tightly that it sometimes takes two nurses to change a diaper.

The vast majority of these babies are born dependent on methadone, the drug that has become the lifeline for their mothers. As sad as it is, Cullen stresses that the babies born with a methadone dependency stand a far better chance in life than those born with addictions to other opiates.

“For one thing, if their moms are on methadone, it hopefully means they are off other illegal opiates and that they are working on their recovery,” Cullen said this week from her cramped office down the hall from the NICU.

While it may seem appalling to provide pregnant women with a potent opiate such as methadone, the alternatives are much worse, Cullen said.

“A pregnant opiate-addicted woman may very well miscarry or deliver a stillborn baby if she attempts to withdraw on her own. It’s extremely dangerous. You see, if Mom withdraws that way, so does the baby, and it’s simply too dangerous to that baby.”

That includes women already in the methadone clinic who become pregnant. The continuation of the methadone treatment is essential, she said.

For this reason, methadone clinic staff along with Cullen encourage pregnant addicts to come forward and get on the methadone program if they are not already.

“The highs and lows of heroin addiction, for example, are much more dangerous to the baby than a regulated dose of methadone,” Cullen said.

The good news is that, unlike teenage and adult addicts who permanently burn out certain brain receptors and will need lifelong drug therapy, these babies can be weaned. The receptors will repair themselves.

Long-term ramifications are still being studied, and there is evidence that babies born methadone-dependent may have a higher likelihood of attention deficit disorder, behavioral problems and learning disabilities.

Overall, however, these babies stand a good chance of having a normal life if their parents continue having success with their recovery.

“The social element, of course, is a big issue. If these babies end up being raised around the drug culture, then of course chances are pretty good that they will be using gateway drugs by the time they are 11 or 12 years old,” Cullen said.

Upon leaving the hospital, the families and the babies are monitored, but while it’s mandatory that the Department of Human Services be notified when opiate-addicted babies are born, unification of the family is still the goal, Cullen said.

“Some women still don’t want to come forward because they fear that the baby will be taken away from them. That’s not true. What we want to do is make sure that the infant is healthy and well cared for. That’s the number one priority,” she said.

I’ve been writing about this issue for five years now, and the numbers still stun me. As of last week, there were 584 patients enrolled in the local methadone clinic. It used to be that five to eight of those patients were pregnant. Now it’s as many as 20 to 30 at a time.

I admit that it is still difficult for me to wrap my brain around the idea of feeding a medicine cup of methadone to a pregnant woman.

Sadly, it’s apparently the safest option there is for those tiny little beings up on the eighth floor of Eastern Maine Medical Center.