June 19, 2014
WASHINGTON (Boston Globe) — New research shows that the number of babies born in Massachusetts with opiates in their system is more than triple the national rate — and far higher than the number tallied by state officials.
Hospital diagnoses data reported to the federal government and obtained by the Globe also show that the toll of opiate addiction is affecting babies not only in Massachusetts, but in New England as a whole, at far greater rates than the rest of the nation.
“If you don’t know the scope of the problem, how can you begin to address it?” said Dr. Elisha Wachman, a neonatologist at Boston Medical Center who specializes in treating these babies and is involved in an effort by 42 Massachusetts hospitals to determine the prevalence of drug-exposed babies and improve their care.
Based on the hospitalization figures, Wachman and other researchers estimated that more than 1,300 Massachusetts babies — or about 17.5 per 1,000 hospital births— were born with narcotics in their system in 2013. Nationally, the figure is five babies out of every 1,000 births, based on hospitalization figures from 2012, the most recent available from the Federal Agency for Healthcare Research and Quality.
The state’s tally is dramatically smaller — just 128 babies born with drug dependence in 2013 — raising questions about Massachusetts’ method of counting.
“There has to be some lapse there. We see that many at Boston Medical Center alone,” Wachman said.
The state’s figures are based on cases reported to the Department of Children and Families. State law mandates hospital staff to report instances of addicted newborns to the child protection agency, but some experts say the numbers are underreported because of the stigma and fear that mothers will lose their children. A department spokeswoman says the number only includes addicted babies who show withdrawal symptoms.
Asked why the state does not instead analyze and publicize the hospital statistics that it submits annually to the federal government, a spokesman for the Massachusetts agency that collects the data said it does not have the manpower to sort through the thousands of hospital procedure codes in its database.
Researchers say that hospitalization statistics are a more reliable indicator of drug-dependent babies.
Newborns who have been exposed to drugs in utero can experience painful withdrawal symptoms that can include difficult feeding and breathing, diarrhea, vomiting, and seizures that can last for weeks, even months. The long-term effects of the condition, known as neonatal abstinence syndrome, are unknown because few studies have looked at these children beyond the first years of life, when some cognitive or movement impairment could be detected.
A new task force is working to improve how the state quantifies the problem, following Governor Deval Patrick’s recent declaration of opiate abuse as a public health emergency.
“This is something that we are looking at enhancing as part of the governor’s task force recommendations,”Anne Roach, spokeswoman for the Massachusetts Department of Public Health, said in an e-mail. Over the next year, Roach said, the department will “analyze the available data to measure the impact of neonatal abstinence syndrome.”
Statistics from the federal database show the trend of drug-dependent babies has been growing at an alarming rate across New England, particularly in Maine and Vermont, where the numbers of drug-exposed newborns increased tenfold over the last decade.
Reasons for the high rates of opiate abuse in New England range from overprescribing by doctors and drug dealers in major urban areas recognizing untapped markets, to a lack of detox beds and treatment programs. Also, as oxycodone abuse has dropped, suppliers have increased the availability of low-cost heroin.
Dr. Alan Picarillo, chief of neonatology at UMass Memorial Healthcare and coleader of the state hospital collaborative to improve care for drug-exposed babies, said the number of pregnant women in the region using prescription opiates is much higher than the rest of the country.
He helped launch the statewide focus on these babies in 2012 after nearly every hospital voiced concerns about an increasing number of addicted newborns.
“People saw this as a hot-button topic, but no one knew exactly how to handle these babies because there was no cookbook as to how to treat them,” Picarillo said.
In Maine, an estimated 26.5 babies out of 1,000 hospital births in 2011 had been exposed to drugs in utero. In Vermont, the number is 34.4 babies out of every 1,000 births in 2012, according to estimates by the federal health care research agency.
Vermont last year issued a comprehensive report of its hospitalization records on the prevalence of drug-addicted newborns, said Barbara Cimaglio, the state’s deputy commissioner for alcohol and drug abuse programs. The majority of the mothers were on medication-assisted therapy for opiate dependency so their babies endured a period of planned withdrawal.
Vermont also funds a program at Fletcher Allen Healthcare in Burlington, the state’s largest hospital system, to track drug-addicted newborns and their mothers over time in an effort to improve care.
Ohio, Indiana, Florida, and Tennessee are also on the vanguard of collecting detailed statistics and establishing a coordinated treatment program, experts say. Tennessee in 2013 began requiring doctors and nurses to report incidents of drug-exposed newborns through an online portal, and the Tennessee Department of Health updates the numbers every week on its website. Kentucky, too, recently passed a bill mandating the reporting of all cases of neonatal abstinence syndrome to its state health department.
But many other states do not require drug-dependent babies be recorded at birth. The discrepancy in how drug-dependent newborns are counted underscores a national problem: Each state uses a different approach — if it keeps track at all.
That lack of coordination has raised concerns in Washington about whether knowledge is being shared among states and hospitals about the best way to respond to the increase in drug-exposed newborns.
“Right now we have a patchwork of data collection, and trying to assess the best way to treat these babies is difficult,” said US Representative Katherine Clark, a Massachusetts Democrat. “Some states are doing a lot. Some are doing nothing.”
Clark filed legislation Wednesday that would direct the US Department of Health and Human Services to conduct a comprehensive one-year study to help states collect accurate data and improve treatment.
There are also no recent studies that compare the effectiveness of different treatments, leaving different hospitals to adopt different protocols, said Dr. Robert Sege, a pediatrician and medical director of the Child Protection Team at Boston Medical Center.
At BMC, which has a prenatal clinic that specializes in the care of mothers struggling with substance abuse, about 150 babies born each year are exposed to prenatal opiates — the highest among Massachusetts hospitals.
Infants there remain in the hospital, typically with their mothers, for an average of 19 days as doctors and nurses administer varying doses of morphine while assessing their withdrawal symptoms.
At other hospitals in the country, infants are sent home sooner and are prescribed an oral methadone to be taken over two or three months, Sege said.
“I don’t know which is right,” Sege said.
There are also non-pharmalogical ways to treat these babies and keep them comfortable, Wachman said, such as tight swaddling, allowing babies to rest in a dark corner undisturbed for several hours at a time between feedings and medications, and encouraging skin-to-skin contact with their mothers as well as breast-feeding, if possible.
“A lot of hospitals don’t have guidelines for these things, which should be standard in how we treat these babies,” Wachman said.