Editor's Note: This story corrects the average cost of an addicted baby‘s hospital stay.
Government and health-care officials are struggling with how to manage the care of an increasing number of babies being born to opiate-addicted mothers.
The opioid and heroin epidemic has eclipsed the crack cocaine problem of the 1980s as a public health crisis and, as a result, the number of babies being born to opiate-addicted mothers is increasing at an alarming rate, including in the Toledo area.
Government and health-care officials are struggling with how to manage the care of the drug-dependent babies. Their numbers are increasing each year and the costs of care are skyrocketing and straining the resources of hospitals in some Ohio counties, health officials say.
In northwest Ohio, several hospitals are working together to share ways they’ve been treating the addicted babies — in some cases differently than what’s done at other hospitals — in hopes of effecting change across the nation.
“I think the opiate epidemic overall is a lot different than a lot of other drug epidemics because it’s more difficult to recover from treatment and it is spreading at a rate we haven’t seen before,” said Rick Massatti, research administrator for the Ohio Department of Mental Health and Addiction Services.
Unlike the crack epidemic that was concentrated in major urban centers in Ohio, the opioid crisis is centered in rural and suburban communities, with some parts of southern Ohio suffering the worst in terms of deaths, overdoses of users, and babies being born with neonatal abstinence syndrome, or NAS, Mr. Massatti said.
NAS is a condition that some babies experience when withdrawing from certain drugs that a mother has taken during pregnancy, such as prescription painkillers including OxyContin, Percocet, and morphine, but can also be caused if the mother uses street drugs such as heroin, crack, and speed while pregnant.
Health officials said, however, that the overwhelming majority of new NAS cases in Ohio are related to the use of prescription pills and heroin. The high risk group for having NAS babies is white women between the ages of 25 to 34 from rural areas, Mr. Massatti said.
In 2001, a small percentage of Lucas County residents, 5.6 percent, were diagnosed with opiate abuse and dependence, but that number increased dramatically by 2013. Last year, one out of four people in treatment had a primary diagnosis of opiate abuse, Mr. Massatti said. He added that the number does not include people treated in private facilities or who do not seek treatment at all.
An addict’s story
“I started on pills and worked my way up,” said a 21-year-old Toledo-area woman — a new mother — who asked that her name not be used. She recently moved into her sister’s home in Holland but she has moved around a lot, living most recently in Sylvania, where she discovered she was pregnant last September.
She started using pain pills to get high when she was 16, primarily because her friends were using them too.
“I went from Percocet to Opana. At that time I could get the Opana before I could get the Percs, so that’s why I switched. They would cost about $40 for one pill. They are very expensive.”
She also discovered that the drugs helped her feel better, be more energetic, and happier while she was completing her shift as a greeter at a restaurant.
“When I first started doing Opana, I could probably split one pill into like five pieces and do five lines that would probably last two days.
“It hits you faster when you snort it,” she said.
Her boyfriend at the time brought heroin into the picture when she was about 18.
“I asked him what it was and he wouldn’t tell me, so you know me being stupid I just snorted it and I absolutely fell in love. It’s a feeling of euphoria like you are on cloud nine. It’s really hard to explain,” she said.
After years of using drugs, and losing multiple jobs, a car, and her apartment, she had enough. Last fall, she decided to check herself into Arrowhead Behavioral Health, a private drug rehabilitation and psychiatric hospital in Maumee.
“It was weird on Sept. 29, I took a nap and woke up and I was bawling my eyes out. I was sick of using. I just wanted to get clean,” she said.
A routine screening for all incoming patients at Arrowhead revealed that she was nine-weeks pregnant. She immediately went into a methadone treatment program to manage her addiction and keep her off heroin for the remainder of her pregnancy. Despite her efforts, her baby boy was born drug-dependent on May 1 at ProMedica Toledo Hospital.
“The babies have a craving for opiates, and if you don’t give it to them, they withdraw,” said Dr. Howard Stein, director of neonatology at ProMedica Toledo Children’s Hospital.
“He would sneeze and yawn and he sweated a lot. A lot of crying and he was really fussy. He wouldn’t sleep like he was supposed to, and you know a newborn baby is supposed to sleep a lot,” the mom said.
ProMedica Toledo Children’s Hospital and Mercy Children’s Hospital use similar treatments for the infants, which first begins with just trying to keep them in a quiet place without a lot of stimulation, swaddling them, and cuddling them.
Dr. Gagandeep Brar of Mercy Children’s Hospital examines a baby in the neonatal intensive care unit. Some opiate-addicted babies are given methadone to stabilize them and stop withdrawal symptoms.
“If the nonpharmacological methods do not work, then we will start medication,” said Dr. Gagandeep Brar, associate medical director of neonatology at Mercy Children’s Hospital.
The medication is methadone, an opiate, that is given to the babies to stabilize them and stop the withdrawal. Then they are slowly weaned from the drugs for a number of days or weeks depending on the severity of the NAS, Dr. Brar said.
“I prayed and prayed that he wasn’t going to have to be on methadone like this, but I was wrong,” said the Holland mother.
Dr. Stein said the drug-addicted mothers are very ashamed and remorseful. “They are not bad people — addiction is a bad disease,” he said.
Statewide, the number of drug-addicted women having babies increased nearly 143 percent over a nine-year period from 1,553 in 2004 to 3,772 in 2013, Mr. Massatti said.
Not every baby born to a mother using drugs will develop NAS. “I would say about 80 to 85 percent of them will end up getting the withdrawal symptoms,” Dr. Brar said.
From 2000 to 2004, Lucas County had some of the lowest rates in the state of babies born drug-dependent. There were 1.4 NAS babies per 1,000 births. Between 2007 and 2012, that number grew to a rate of 4.2 per babies out of every 1,000 births. Though a substantial increase, that number is still much lower than the state average during that time period, which is 6.9.
“Just to put things in perspective, I have been here nine years. Initially when I started, we would have maybe one or two babies a year. I think the shift happened in 2009 when we had seven babies that year, and the numbers have been increasing every year. Last year, we had more than 35 babies, so it has increased five fold, and that basically is what is reflected in the rest of the country as well,” Dr. Brar said.
Scioto County in southern Ohio has seen the most dramatic increase in drug-dependent babies in the state. The number of babies exploded between 2004 and 2012 from six NAS babies per 1,000 births to 52.6 babies per 1,000 births.
“We don’t take the moms off drugs during pregnancy because we worry about in-utero withdrawal and we can’t monitor the fetus,” Dr. Stein said. He said the majority of the mothers are in a treatment program during pregnancy and use methadone or Subutex to manage withdrawal symptoms. The minority, about 25 to 30 percent, are still taking street drugs such as heroin, he said.
When the NAS babies begin the methadone treatment, many stay in the hospital for weeks and are slowly taken off the drugs.
A different approach
The lengthy hospital stays required for these infants, who are cared for in neonatal intensive care units, or NICUs, has government and medical officials grappling with how to manage the costs. About 84 percent of NAS inpatient hospitalizations are paid for with public dollars through the Medicaid system.
The average hospital’s inpatient charges for NAS infants are typically many times higher than charges for all other infants. In 2013, there were 1,687 inpatient hospitalizations for NAS babies in Ohio and the cost for their care was nearly $100 million, Mr. Massatti said.
“Usually what happens with a well infant that is born healthy and discharged after three days, we usually spend $7,000 to $9,000, versus a baby who has drug withdrawal the number is anywhere from $56,000 to $80,000 for the entire hospital stay. So much money, so much of our health-care dollars, are being spent on taking care of these babies. It is a huge burden on society and on health care,” Dr. Brar said.
There are a number of initiatives on the national, state, and local level right now focused on the problem and aimed at helping the government and physicians get a handle on the issue, said Dr. Jeffrey Blumer, chairman of the department of pediatrics at the University of Toledo Medical Center, the former Medical College of Ohio.
“The approach to taking care of the babies after they are born is really nonstandard. It’s all over the map,” he said.
ProMedica and Mercy children’s hospitals have for years used a different approach than most other hospitals in the state and in the country, Dr. Blumer said. They have developed a system for treating NAS babies that begins with them using methadone in the hospital, but then once the babies are stable they are sent home to complete their treatment. Most other hospitals keep the baby in NICU until they are completely weaned from the drug.
In Toledo, the babies are sent home with either their mom, dad, another family member, or foster parents. The hospital social workers and the Lucas County Children Services Board assess the families to determine who should care for the babies when they leave the hospital, said Dean Sparks, executive director of Lucas County Children Services.
Dr. Blumer, along with Dr. Stein at ProMedica Toledo Hospital and Dr. Brar at Mercy St. Vincent Medical Center, are leading the local effort to document what Toledo hospitals are doing, so that the process could possibly be adopted by other hospitals around the state and the country. This would save millions of dollars per year, Dr. Blumer said.
“When we started this project in 2012 and all the [Ohio] children’s hospitals submitted data and we showed how our babies go home on methadone, we were shocked to see we were the only ones doing this,” Dr. Stein said.
Many professionals have questioned the process used in Toledo, and they have wondered if the addicted parent might use the drugs intended for the baby. Dr. Blumer said Toledo hospitals already have years of evidence showing this process works well; parents don’t abuse their babies’ drugs, and the drug-addicted mothers overall do a great job caring for the babies at home.
“Our babies do not get readmitted. Our babies don’t have any kind of complications and they do very well when they are discharged home with methadone,” Dr. Brar said.
Contact Marlene Harris-Taylor at firstname.lastname@example.org or 419-724-6091.