COST OF ADDICTION
• Average TennCare costs for a healthy newborn: $4,237.
• Average TennCare costs for an infant born dependent on drugs, diagnosed with neonatal abstinence syndrome: $66,973.
Source: Tennessee Department of Health
Tennessee's addiction to prescription painkillers has reached the womb.
The majority of drug-addicted babies in the state's hospitals these days are not crack babies. They are babies dependent on drugs like oxycodone, hydrocodone, morphine and methadone.
And withdrawal from these drugs can be excruciating for the infants. The babies cry inconsolably. They may be wracked by tremors, cramps and seizures. They don't eat, or they eat too fast. They vomit, and they have diarrhea.
"They just don't make eye-to-eye contact with caregivers the way sweet little babies usually do," said Dr. Gary Bell, a neonatologist in Erlanger hospital's Neonatal Intensive Care Unit. "They sweat. They get red marks from writhing around. It's heartbreaking."
Through the first nine months of this year, the number of Tennessee babies born with drug dependencies outnumbers those born addicted in all of 2011.
By the first week of October, 643 babies had been born dependent, compared with 629 for all of 2011, a report released this week by the Tennessee Department of Health showed.
The agency projects that the number of babies born dependent will top 800 by the end of the year.
About 42 percent of the mothers of these babies used only substances prescribed to them for legitimate treatment, while 33 percent used substances obtained through illegal sources. Twenty percent used a mix of prescribed and nonprescribed substances.
Bell, who has worked in Erlanger's NICU for 26 years, said he has watched the shifting drug trends play out in the tiny bodies of the babies he helps care for.
"We've changed drugs again," he says. "We're not seeing the same ratio of babies on crack [cocaine] that we used to see. We're seeing many more babies on narcotics, and I think we will see a lot more."
Tennessee has ranked near or at the top of national lists for prescription drug abuse over the past several years. It's the leading cause of accidental death in the state, with 1,062 people dying from drug overdoses in 2011.
It's an epidemic that state officials have been battling with a series of new laws and initiatives. Bell is the Southeast Tennessee's leader for statewide study of "neonatal abstinence syndrome" -- infant drug withdrawal.
Every month, he gets on a conference call with neonatologists from across the state to discuss new protocols and best practices.
The epidemic is far more pronounced in the Appalachian areas surrounding Knoxville and Johnson City -- the East Tennessee Children's Hospital had to create a new unit for drug-addicted babies -- but it's getting worse here.
"We really started [the program] this year because we're seeing such an increase of babies with this problem," Bell said.
Julie Dyer, a neonatal nurse practitioner, monitors a baby girl showing signs of drug addiction at the Erlanger Neonatal Intensive Care Unit in Chattanooga. The number of babies born addicted to drugs is growing across Tennessee. Erlanger, too, is seeing more drug-dependent babies.Photo by Maura Friedman.
Part of the new initiative means more closely tracking the numbers of babies with the syndrome. This year, Erlanger has recorded 11 official diagnoses, though staff members say the number of babies brought in for history or symptoms of withdrawal is probably much higher.
The NICU staff tries to treat the babies without medicine -- swaddling them; placing them in dark, isolated rooms; cuddling and rocking them.
If that doesn't work, the staff resorts to morphine, slowly weaning them off. The average stay for a baby going through withdrawal is 25 days.
The spectrum of parents with drug-addicted babies is also shifting, spanning socioeconomic ranges. There are still mothers who are drug addicts, but there are many others who were on pain medicines legitimately.
"Our data show the majority of these births involved a mother taking medicine prescribed by a health care provider," said Tennessee Department of Health Commissioner John Dreyzehner.
Other mothers were taking methadone during their pregnancy to quit other opiates. That's a dilemma, Bell said. The mother typically shouldn't be taken off of methadone during her pregnancy, because her withdrawal symptoms could hurt or kill the baby. But staying on the methadone eventually means withdrawal for the baby.
Another sensitive predicament comes with mothers who stay on medication for depression and anxiety during pregnancy, as infants can grow dependent on drugs like Valium and Xanax.
Dreyzehner said doctors must have more intentional discussions with patients about planning for a pregnancy or preventing one while on certain medications. He also said more doctors need to refer pregnant women using illicit drugs to treatment.
State officials say they're fighting the growing problem on several fronts.
Tennessee is the first state to require medical centers to report each case of a drug-dependent newborn. The state also has a new controlled substance database that allows doctors to review patients' prescription history.
Tennessee officials are also ramping up education efforts.
They have lobbied the Food and Drug Administration to require more detailed warnings on prescription drug bottles about the dangers of taking drugs while pregnant, and in September the federal agency announced that it would.
Bell said these efforts help, but the only way to see a dent in the number of babies addicted to prescription drugs is to see a marked dent in prescription drug abuse.
"Trying to prevent this is a very worthy goal," Bell said. "But that will ultimately have to depend on a society program -- not just a medical program."
Contact staff writer Kate Harrison at firstname.lastname@example.org or 423-757-6673.