TAMPA — Babies born addicted to drugs aren't easy to spot at first. Contrary to popular belief, they are usually the same weight and size as healthy babies.
About two days later, though, withdrawal kicks in. The babies have difficulty nursing and feeding. They are sensitive to light and touch; the addiction passed down from the mother can cause digestive issues and diarrhea. They cry more than the other babies, a high-pitched wail peculiar to a newborn kicking a habit it didn't know it had.
The medical term sounds clinical — neonatal abstinence syndrome — but the symptoms are anything but.
“To see a baby like that is stressful,” said Dr. Kenneth Solomon, a neonatologist with Pediatrix Medical Group at St. Joseph's Women's Hospital in Tampa. “It takes a toll on the nurses if you spend 12 hours with a child who is going through withdrawal.”
In recent years, doctors and nurses have seen plenty of such babies. In 2007, Hillsborough County had 24 reported cases of drug-addicted newborns. In 2012, the number had increased five-fold, to 125.
Pinellas and Pasco saw similar increases: 43 cases in 2007 rose to 140 in 2012 in Pinellas; Pasco County went from six to 34.
There's another difference besides the frequency, one attributable to Tampa Bay's huge increase in prescription drug abuse that authorities just now are beginning to get a handle on.
They used to be crack babies. Now they're Oxy babies.
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Prescription drug abuse soared in the United States in the 21st Century, and Florida was one of the leaders. Lax regulation, high profits for unscrupulous doctors and inadequate tools for law enforcement left the state at the epicenter of a booming trade in addictive painkillers like oxycodone and hydrocodone. Word spread: Florida was the place to get OxyContin or Roxicodone or Vicodin when you couldn't get it anywhere else.
The epidemic — the U.S. Department of Health and Human Services says prescription painkillers now are the second most-abused drugs after marijuana, with 7 million Americans using them illegally — played out in many different ways.
The number of pharmacy robberies skyrocketed. Emergency rooms across the country treated more than twice as many drug overdoses in 2008 as in 2004. And the population of babies born addicted to painkillers boomed.
The number of babies born with opiate addiction is difficult to quantify because Florida hasn't had a standardized statewide reporting system in which hospitals and birthing centers break down the numbers by type of addiction — cocaine, say, or OxyContin. That should change soon; the state has set a goal to begin counting baby's born with neonatal abstinence syndrome this year. The 2014 numbers should be released in 2015.
Locally, the Healthy Start Coalition of Hillsborough County started the Substance Exposed Newborn Task Force in 2006. One of its goals was to get hard numbers of babies born addicted to prescription opiates and methadone.
In 2009, the number of newborns addicted to prescription opiates was fewer than 20. By 2013, the number was more than 120. Even those statistics probably underestimate the problem because the figures are reported voluntarily by Hillsborough County agencies that work with newborns.
“It's still a major problem. It's still a major issue,” said Dr. Jason Fields, associate medical director at the Drug Abuse Comprehensive Coordinating Office, or DACCO, in Tampa. “You still have a large population that are addicted to prescription opiates.”
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At St. Joseph's Women's Hospital, the lights are kept low and the rooms quiet for babies going through withdrawal. The hospital has special chairs because the babies prefer not to be rocked, said Solomon, the neonatologist.
Standard treatment is to keep the babies at the hospital for several weeks and treat them with methadone, morphine or morphine and clonidine, which treat withdrawal symptoms; when they've done their job, the newborns are weaned off the medication.
At DACCO, a substance abuse and mental health treatment center in Tampa, women with an opiate addiction are treated with methadone to prevent opiate withdrawl. Women addicted to opiates can't quit cold turkey because it could be dangerous to the fetus, Fields and other doctors said.
The center now treats about 70 to 80 pregnant women a year with methadone, Fields said.
The program also offers the women counseling and prenatal care and teaches them about what they can expect giving birth to a child with an addiction.
“I've seen women transform into productive citizens,” Fields said. “I find it very rewarding.”
Centers like DACCO help by giving mothers treatment during the pregnancy, said Terri Ashmeade, medical director of the neonatal intensive care unit at Tampa General Hospital and chief of the division of neonatology for the University of South Florida Morsani College of Medicine.
“That is better for the baby, the mom and us as a community,” Ashmeade said. “The mom is better prepared to care for the baby.”
Decades ago, when drug-addicted babies were more likely to have been born to mothers who were using cocaine or crack, the treatment model was more punitive for the mothers. Today, the approach is to work with the addicted mother and family to get the mom off drugs and teach her how to care for her child, Solomon said.
“The Florida approach is more compassionate,” Solomon said.
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The state also has been making strides in cracking down on the root cause of the problem. The Legislature has passed laws cracking down on pill mills and prescription-drug abuse, crimping the state's reputation as a place to easily obtain prescription drugs.
In 2011, the state started Florida's Prescription Drug Monitoring Program where doctors can access information to learn what prescription pills their patient have been prescribed, currently and in the past.
In 2012, the Statewide Task Force on Prescription Drug Abuse and Newborns was created. Attorney General Pam Bondi chairs the task force, which also counts as members Solomon and Jane Murphy, executive director of the Healthy Start Coalition of Hillsborough County.
Last year, Bondi's office and several other state agencies helped start and promote a website and a helpline phone number to inform pregnant women about the risks of using prescription pain pills during pregnancy and ways to get help for women who are addicted.
In the last two years, the state Legislature has appropriated millions of dollars to assist pregnant women using drugs and prescription pills, and for drug-dependent mothers with young children.
“We are in a better place,” Ashmeade said. “Awareness has increased significantly.”
But experts warn that the medical community, government and law enforcement can't lose focus. With the crackdown on prescription drugs, law enforcement authorities report they are beginning to see warning signs that some addicts are turning to heroin, which also is an opiate.
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Doctors still don't know what impacts babies born addicted to pain pills will see as they grow up.
“We don't know what to expect when the children get to first grade or high school,” Ashmeade said. “We don't know the long-term effects.”
And, she said, until society tackles drug-abuse head on, doctors, nurses and police will only be able to treat the symptoms.
“We've made some progress in terms of how mom and babies are being treated,” she said. But, “Drug abuse is a mental health problem. It's a much more broad problem — a societal issue.”