More Canadian babies than ever are being born with symptoms of opioid addiction and withdrawal, according to numbers from the Canadian Institute for Health Information.
There were 1,744 hospitalizations for neonatal abstinence syndrome across Canada in the 2015-16 fiscal year, according to CIHI. That’s nearly 300 more babies than four years previously, and these numbers don’t even include Quebec.
Neonatal abstinence syndrome is essentially withdrawal from opioid drugs, such as many prescription painkillers or illicit substances like heroin. Babies are exposed to these drugs in the womb if their mothers are using them, and when they are born, the supply is cut off and they suffer various symptoms.
“They can be jittery, they can have a lot of crying. Often their heart rate is much higher,” said Astrid Guttmann, a pediatrician and chief science officer and senior scientist with the Institute for Clinical Evaluative Sciences. “If it’s unrecognized that the mother was exposed to high levels of opioids while she was pregnant, and those early signs aren’t caught, babies can have seizures as well.”
The infants are treated in a similar way as adults: after they’re born, they’re given a low dose of morphine that gets tapered off as their symptoms improve, said Guttmann.
Hakique Virani, a public health and addiction medicine specialist at the University of Alberta, said that unlike adults, babies really only have the physical dependency of addiction, not the behavioural changes adults display. “It’s characterized by social dysfunction and compulsions and cravings and those are things that the baby would not have.”
It’s much quicker and easier to wean an infant off of opioids than an adult, he said.
It’s hard to say whether an infant suffers any lasting effects as a result of neonatal abstinence syndrome, said Guttmann. “These are high-risk mothers, high-risk families in other ways.” As such, it’s difficult to tell whether negative mental or developmental outcomes are a result of being exposed to drugs in the womb, or something else.
Guttmann blames the increasing numbers on Canada’s growing opioid epidemic. But in her research into the syndrome, which focused on Ontario, she found that the majority of women were on prescription opioids and not street drugs.
And although the number of cases in B.C. has increased over the last four years, Vancouver’s Fir Square Combined Care Unit, which treats substance-using mothers and their babies, said that they have not seen a rise in cases related to fentanyl — the powerful opioid that prompted the provincial government to declare a public health emergency in 2016.
Preventing the problem
Close medical supervision during pregnancy can help to reduce the number of babies born with opioid withdrawal, said Guttmann. “For many during pregnancy the protocol is to try to get them on a replacement like methadone and as possible wean the dose.”
Virani said that any woman who is pregnant and taking opioids must be very careful about managing her treatment.
“The risk is pre-term labour. It’s never pleasant to have to manage a neonatal abstinence syndrome of course, but it’s also never pleasant to hand a mom a 26-weeker.”
He thinks that women should seek out medical advice to determine the best course of treatment during pregnancy. “The patient would need to have a lengthy discussion both with the person who’s managing their addiction disorder and the physician who’s managing their pregnancy with them to make sure that they optimize outcomes for both mom and baby.”
And for women who are using opioids illicitly, more general harm reduction programs can help to reduce the problem.
Guttmann believes it’s counterproductive to blame the mothers. “I don’t think women go and deliberately try and harm their fetuses,” she said. “Most of these women are very dependent if not addicted to these substances and I think we need to develop strategies to help them with that.”
“My reaction is, these are very vulnerable women and we need to solve this problem.”