Substance abuse among pregnant women increasing, says St. John's pediatrician

For people in pain, the powerful prescription opioid, oxycodone, can be a life-saver. But oxycodone is also at the root of many serious problems in our communities. Addicts are fixated on getting their next hit of the drug to avoid debilitating withdrawal symptoms. 

In recent years, CBC Newfoundland and Labrador has reported on pharmacy robberies, illegal sale of the drug on the street and desperate pleas from families of criminals who want federal prison time for their loved one, so they can receive addiction treatment.

I've had more than one mom say, 'This baby saved my life.- Pediatrician Dr. Anne Drover

Those kinds of stories have not gone away. The drug continues to be a huge problem for addicts. Now, some of the most vulnerable people in our society are innocently caught in the grip of opioids like oxycodone — newborn babies.  

Dr. Anne Drover, a pediatrician with Eastern Health, has been looking after mothers and babies for the past decade.

She's worried about the amount of prescription drug abuse she's seeing among pregnant women.

"In the last 10 years the rates have doubled or tripled and it seems to be increasing," she explained.

Drover says newborns suffer from neonatal abstinence syndrome. The baby is essentially in withdrawal after birth, craving the opioid taken by the mother.

"They would have symptoms of irritability, jitteriness, quick breathing and a high temperature," said Drover.

Doctors try and treat babies with a non-pharmacologic approach at first. Babies are kept in a quiet, calm environment with low lighting and constant soothing from their mothers. In some severe cases, though, drugs have to be used.

"The baby is craving that medication and until we can wean the baby off it gradually, we don't want the baby in pain or distress, so we do give that baby liquid morphine. Unfortunately we do have to do that with the baby and that would be under close observation in the neo-natal intensive care unit," said Drover.

Drover said this situation has been an area of learning for physicians like her.

"This has really snuck up on us, or I guess crept up on us in the last 10 years, just slowly increasing and increasing and many of us in our training didn't really have any expertise in dealing with this situation. And hopefully now we're gaining a lot of expertise, as well we're getting used to seeing moms in this situation."

Drover says Eastern Health is getting advice from other hospitals in the country on how to treat opioid-addicted mothers and babies. In the meantime, another opioid drug, methadone, is giving her optimism about outcomes for these families. 

I want them to know there is help and there are services and that there is no judgment here and hopefully they would reach out.- Addictions counsellor Vanessa McEntegart

"It's a harm reduction program obviously given a choice you wouldn't be on any opioid in the pregnancy but the methadone program gives the mom at least an opportunity to have a healthy pregnancy."

For addicts, oxycodone withdrawal can mean vomiting, relentless abdominal pain, extreme agitation, sleeplessness and, of course, the unending quest for more oxycodone. Methadone is used to treat the symptoms of the withdrawal. Pregnant mothers on the methadone program are regularly dispensed the drug by a pharmacist. 

"The idea is that instead of spending every day looking for the medication to take, how am I going to get it today, how am I going to pay for it today, that's all taken off the plate and you know exactly every day when you're getting your dose," said Drover. 

That way, Drover said, mothers are able to focus on staying well themselves. She has seen proof of the positive effects of methadone. 

"The methadone moms have had healthy pregnancies with healthy looking babies, good birth weights and they go home with their babies breast-feeding," said Drover.

I spoke with one new mother on the methadone program. She didn't want to be identified. I asked her about the difference in her life before and after methadone treatment. "No comparison," she told me. "The difference is night and day." 

The challenge, though, is getting more mothers to admit they have a problem and then getting them to ask for help with their addiction. 

Fear of losing their children

Vanessa McEntegart is an addictions counsellor with Eastern Health. She said it's not an easy step for young mothers to take. 

"I think sometimes for women, it's harder for them. We know to reach out and access services, especially if they're struggling with an addiction pregnant or not, there's a lot of guilt and shame around that."

McEntegart said mothers who may have other children may fear losing their family. "They're concerned about what that means, you know, what impact is that going to have on their life if they come forward and say yes, I am struggling with x-y-z and I do have children in my care," she said. 

Vanessa McEntegart does want to get an important message to mothers who may be struggling with opioid addictions or any kind of addiction. 

The methadone moms have had healthy pregnancies with healthy looking babies, good birth weights and they go home with their babies breast-feeding.- Pediatrician Dr. Anne Drover

"If we look at treatment for example, they certainly would be prioritized. They would be able to access treatment as soon as they needed to and that's because we would want to make sure that they're safe as well as the baby that they're carrying," said McEntegart.

Mothers may worry about how they'll be viewed by others in the community. McEntegart hopes moms would have the strength to see past negative reactions  and make the health of their baby a priority. 

"I want them to know there is help and there are services and that there is no judgment here and hopefully they would reach out," she said. 

Dr. Drover is hopeful too. She has see many opioid-addicted mothers go on to lead healthy, normal lives and the methadone program has been a critical step in their recovery. "I've had more than one mom say, this baby saved my life."