Opioid withdrawal in Ontario newborns way up over 20 years

The number of newborns suffering from opioid withdrawal in Ontario has increased 15-fold over the last 20 years, researchers have found.

Researchers at Toronto's Saint Michael's Hospital and the Institute for Clinical Evaluative Studies, who carried out a recently published study, found most of that increase happened in the last five years. 

The increase reflects an increase in prescriptions for potent and addictive pain killers, researchers said.

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"Most of the women treated with methadone over the time period were addicted to prescription opioids, like OxyContin or codeine, not illegal drugs such as heroin, which is the common perception," said Dr. Suzanne Turner, the study's lead author.

The research, published Wednesday in CMAJ Open, found the incidence of newborn opioid withdrawal grew from 0.28 per 1,000 live births in 1992 to 4.29 per 1,000 live births in 2011.

'It killed me'

Over the 20-year period, data showed there were almost 3,100 infants born in the province suffering symptoms of neonatal abstinence syndrome, which mimic those in adults going through withdrawal from an opioid.

Aryanna-Lynn is only six months old but has already suffered through the pain of withdrawal. 

Her mother, Jessica Ballantyne, was addicted to prescription painkillers when she found out she was pregnant.

She didn't tell her doctors about her addiction, but they eventually found out.

Her doctors weaned her off of the painkillers, replacing them with methadone – a synthetic, less dangerous medication that prevents mother and baby from going through withdrawal during pregnancy.

Aryanna-Lynn was born one month premature and addicted to methadone.

Her mother was forced to watch her newborn struggle.

"It killed me in the hospital, seeing her go through all the pain she was going through."

Babies do well with treatment

Debbie Bang, a nurse who runs the addiction services centre at St. Joseph's Healthcare in Hamilton, is not surprised by the upward trend.

"You know from seeing one or two per cent of our population coming in with opiate withdrawal [a decade ago] now to 20 or 25 per cent of the women who are coming for withdrawal," Bang said.

Bang has seen first-hand the impact of drug addictions on newborns.

Infants experiencing post-natal withdrawal are often irritable, cry more, and can have vomiting and diarrhea, all of which can affect weight gain and put them at risk for seizures if the condition is not identified.

It can't stop shaking, its heart is racing, it feels lousy and its answer is to cry to let people know it needs help.- Debbie Bang, St. Joseph's Healthcare

"You can imagine that newborn is brand new to this world and has no idea what is going on nor the ability to communicate that they are feeling very, very unwell," Bang said.

"Here is this baby who is having vomiting, it can't stop shaking, its heart is racing, it feels lousy and its answer is to cry to let people know it needs help."

While both Bang and Dr. Turner are concerned about the growing numbers, they do have some comforting words for mothers like Ballantyne.

"The reality is, if we treat these babies appropriately with opioids, they do very well in the long-term."

Turner says these babies can "live perfectly healthy lives."

Women should be counselled

Still, having a newborn in the nursery or in the neonatal intensive care unit for two or three weeks can be stressful for
families, Turner said, suggesting that preventing addiction by using alternative pain-relief therapies when possible would pay dividends for both mothers and their babies.

"It speaks to the fact that doctors need to be aware there is the risk of addiction if women are prescribed opiates prior to pregnancy, and if they're of child-bearing age, those risks should be assessed."

As well, women should be counselled that the use of any opioid during pregnancy can cause neonatal withdrawal, especially since unplanned pregnancies are common among women with addictions, she said.

As for Ballantyne, she is no longer addicted to painkillers and is looking forward to her future.

"Being drug free, it's amazing. It is. You are healthy, you feel so much better. I am having a happy baby and happy family, healthy family. I am happy now."