When a woman confirms that she is pregnant, she will often stop consuming anything that could potentially harm her fetus, including alcohol, over-the-counter medications, and caffeine. However, the decision to give up harmful substances is not an easy one if a woman suffers from addiction. The number of babies born addicted to powerful opiates like OxyContin and Oxycodone increased fivefold between 2000 and 2009–the equivalent of one baby every hour, or close to 13,500 babies every year. Prescription painkiller use by pregnant women has become a public health crisis—one that costs an estimated $720 million annually (Journal of American Medical Association). The health outcomes for the babies who are exposed are not yet fully known, although we do know that in general children born to drug addicted mothers tend to be born earlier, have lower APGAR scores, and suffer from withdrawal symptoms after birth. These babies often require extensive initial treatment, which results in longer hospital stays. Children born to mothers who abuse drugs, no matter what those drugs are, are also more likely to be neglected or abused. While many recent studies have not clearly determined whether women are taking painkillers that have been prescribed to them for chronic conditions, or whether they are abusing these medications, the bottom line is that more children are being exposed to dangerous drugs in utero, indicating a health crisis that needs to be addressed.
Children born with neonatal abstinence syndrome (NAS) often cry inconsolably. They sweat profusely, have difficulty breathing, suffer from diarrhea, and in more serious cases, experience seizures (American Medical News). Because babies do not show any signs of withdrawal until 2-3 days after birth, doctors often miss the opportunity to diagnose the syndrome because mother and child have already been released from the hospital. This can create a dangerous situation for both the mother and baby, as parents likely will not know what to do once their child begins showing symptoms of withdrawal: “When a baby is diagnosed with neonatal abstinence syndrome, the newborn is kept in an area with low light and little noise, and is held and rocked by nurses and volunteers. The length of the hospital stay can vary from a week to two months” (American Medical News).
Some women continue to take prescription painkillers after they become pregnant because they believe that prescription medications are safe: “Contributing to the abuse of pain relievers is the belief among some patients that prescription drugs are safe because they are administered by physicians and manufactured in legitimate factories…. There also are some well-meaning doctors who are misinformed about the benefits and downsides of opioid pain relievers and thus overprescribe the drugs (American Medical News).
So what can be done to address this growing problem? Some physicians are calling for mandatory urine toxicology screens for pregnant women. Others oppose this measure as too extreme. If a screen comes back positive, it is likely that social services will become involved in the situation. Another approach involves providing key information to women at risk. According to Mark L. Hudak, a neonatologist at the University of Florida College of Medicine-Jacksonville, “before prescribing an opioid to women of childbearing age, physicians should discuss the potential negative health effects the drug could have on a fetus if the patient becomes pregnant” (American Medical News). If chronic pain is the issue, physicians should consider recommending alternative approaches to pain control, such as biofeedback, prenatal massage, acupuncture, meditation, and yoga. If addiction is the underlying problem, referrals to a specialized treatment facility should be made early in pregnancy. One of the biggest challenges facing physicians is the scope of this problem: “It is a diverse group of mothers who are addicted to opiates. Some of them are abusing street drugs. Some are being treated for chronic pain and others are in methadone treatment programs. Because of that [diversity], this is a complex issue that is going to require answers that are not simple” (American Medical News). Yet we have to start somewhere. We must do something. We have a right to ask why pharmaceutical companies are pushing the sales of highly addictive drugs. We have a right to ask why so many doctors are prescribing them. And we have a duty to examine why we have such a need to self-medicate. If we don’t, we only have ourselves to blame for the next generation of broken children.