PRESCRIPTION DRUG EPIDEMIC SPREADS TO BABIES

Dr. Mary Newport sees the symptoms more and more in the babies she
treats: oddly stiff limbs, severe tremors, vomiting, diarrhea,
insomnia, crying that never stops.

The common denominator: Their mothers were taking prescription drugs,
mostly painkillers like OxyContin and Vicodin, and antianxiety drugs
like Xanax during pregnancy.

Some of the moms had no idea these medications would hurt their
developing babies "" after all, it's not like it's heroin or cocaine,
many think.

"They are seriously misinformed," said Newport, medical director of
Spring Hill Regional Hospital's neonatal intensive care unit.

The prescription drug epidemic, well documented among teens and
adults, now is claiming victims before they are even born. Tampa Bay
area doctors and addiction specialists are reporting a dramatic
increase in the number of pregnant addicts and infants needing
treatment for withdrawal from prescription drugs.

The trend is reminiscent of the "crack baby" epidemic of the 1980s,
when mothers used crack cocaine during their pregnancies.

But area neonatologists say that in some ways, the current trend is
worse. Some women don't understand that prescription drugs can be
dangerous during pregnancy. Others decide to stop the drugs as soon as
they learn they are pregnant, causing sudden withdrawal that can lead
to miscarriage.

And doctors say that treating a baby with drugs like oxycodone,
methadone or Xanax in the system takes longer, and involves more
medication, than treatment for heroin or cocaine.

"Babies are suffering more," said Dr. Terri Ashmeade, medical director
of Tampa General Hospital's neonatal intensive care unit. "Withdrawal
patterns seem to be worse (with prescription drugs) than what we were
seeing with heroin."

Between 550,000 and 750,000 children nationally are born each year
after prenatal exposure to drugs or alcohol, though it's not known how
many of the babies are exposed to prescription drugs.

Here's what we do know: Many more people are abusing prescription
drugs, about half of them are women, and they're getting younger,
according to a study released Thursday by the federal Substance Abuse
and Mental Health Services Administration. It found the rate of
treatment admissions for prescription drug abuse has more than
quadrupled in the last decade.

In 1998, the largest group of women admitted for prescription drug
abuse treatment in Florida was age 26 to 45. A decade later, the
predominant age was 21 to 30.

The National Institute on Drug Abuse considers prescription drug abuse
during pregnancy an "understudied" research area that needs attention.

Neonatologists and others on the front lines say they don't need a
federal survey to know there are more newborns hooked on prescription
painkillers.

Newport said she has seen more babies treated for prescription drug
withdrawal in the past two years at Spring Hill Regional than in the
previous 25 years combined. Ashmeade said that at Tampa General, about
25 babies have been treated so far this year for prescription drug
withdrawal, compared with 17 in all of 2009.

The trend is also evident in area treatment centers such as Operation
PAR. Dr. Michael Sheehan, medical director of the nonprofit group,
says that at any given time, 40 to 50 pregnant women are receiving
treatment for prescription drug abuse at one of its four clinics in
Clearwater, New Port Richey, Bradenton and Fort Myers.

Sheehan added that the pregnant women seeking treatment are getting
younger. Years ago, they were in their late 20s and early 30s. And
now? "Late teens and early 20s," he said.

Newport agrees, often referring to the mothers she sees as "girls."
She said they usually obtain the drugs illegally, and often take
multiple kinds.

"We're seeing oxycodone, Vicodin, methadone, a lot of Xanax," Newport
said. "I'm amazed at the number of girls on antidepressants,
antianxiety drugs, even during pregnancy."

Just about anything consumed by a pregnant woman passes to the fetus
through the placenta.

Consuming alcohol can lead to fetal alcohol syndrome, putting the baby
at risk of heart defects, poor growth and delayed mental and emotional
development. Babies born to mothers who smoke cigarettes during
pregnancy are more likely to be born too soon and too small.

Babies with prescription drugs in their system often suffer from
neurological symptoms such as hypertonia, or stiff limbs. If the drugs
are opioid painkillers (such as oxycodone and methadone), the babies
can also have gastrointestinal symptoms like vomiting and diarrhea,
Ashmeade said. If they're withdrawing from antianxiety medications
like Xanax, the babies can have tremors and cry constantly.

Put it all together, and you have a baby in misery for weeks and even
months.

"Some of the worst withdrawals I have seen were babies whose mothers
were taking Xanax and methadone," Newport said.

Babies can suffer withdrawal even in cases where the mother was taking
the drugs in amounts prescribed by a doctor.

Opioids such as oxycodone and Vicodin are considered Pregnancy Level C
drugs, which means that they have not been studied in pregnant women,
but in animal studies are linked to birth defects. But they can be
prescribed during pregnancy if the doctor believes the benefit to the
mother outweighs possible risk to the fetus.

Newborns are often weaned off their addiction with another opioid
painkiller, morphine. Typically, the baby receives doses that decrease
over time, until the withdrawal symptoms go away. Newport says that
can take anywhere from three weeks to two months, depending on the
severity of the symptoms and the type of drugs in the system. In some
cases, symptoms can persist for months after the baby has left the
hospital, she said.

Ashmeade added that doctors often don't know exactly what drugs the
mother was taking until they test the baby's blood or urine. "Some
moms will not admit, some will," she said.

When drugs are found in a newborn, doctors call the hospital social
worker, who may summon the Florida Department of Children and
Families, but not always, doctors say.

In some cases, the mothers have already been dealing with social
workers or state officials during pregnancy, Ashmeade said.

"But oftentimes, these moms are legitimately taking medications,
taking them for chronic pain," she said. "It doesn't necessarily mean
the mom was abusing the drugs."

Treatment for prescription drug abuse begins for some women during
pregnancy, at centers like Operation PAR, created about 40 years ago
to help parents deal with drug addiction.

Sheehan, the medical director, says that pregnancy is often a wakeup
call for women. They arrive at Operation PAR at different stages of
pregnancy, though Sheehan says that the earlier women seek treatment,
the better.

The most common treatment is with methadone, which gradually reduces
or eliminates craving for other opioid drugs and can help save the
baby's life. The Centers for Disease Control and Prevention says
methadone is particularly effective because it blocks the euphoric and
sedating effects of other opioids. The treatment does not cause birth
defects, but the Substance Abuse and Mental Health Services
Administration acknowledges, "some infants may go through withdrawal
after birth."

Sheehan adds that it helps mothers beat addiction while delivering
babies that will most likely survive.

But doctors say babies don't have an easy time of it. Newport says
treating a baby with methadone withdrawal usually takes longer than if
the mother continued on her original drug. But Newport agrees
methadone is the best medical option to get mothers off drugs so they
can care for their children.

The worst idea is quitting cold turkey, a sudden withdrawal that is
agonizing and possibly fatal.

"The baby could have seizures and die," Newport said.

Federal health agencies say the prescription drug epidemic is too new
to know what the long-term impacts could be on babies born hooked.

But doctors like Ashmeade say that no matter what kind of addiction a
mother suffers from, her children run a much greater risk of being
neglected or abused if she can't stay clean and sober.

Ashmeade said the key to helping ensure these babies' welfare is to
provide more treatment opportunities for their mothers. At centers
like Operation PAR, pregnant women receive top priority, but there are
waiting lists for others.

"We need to increase the number of treatment programs, or make it
easier for people to get into treatment," she said. "People are going
to find a way to get the drugs."