Ranks of drug-addicted babies growing in SW Florida

Frank Gluck | The (Fort Myers, Fla.) News-Press

FORT MYERS, Fla. — The number of babies born hooked on painkillers at Lee County hospitals rose to a record high in 2014, despite a years-long public education campaign to thwart the problem and a state crackdown on so-called pill mills.

Instances of this kind of chemical addiction, known as neonatal abstinence syndrome, jumped nearly 24% between 2013 and 2014 to 114 babies, according to Lee Memorial Health System.

Such cases have grown a whopping 1,325% since 2005, when medical staff identified eight drug-dependent newborns.

The figures have again dashed hopes that the frequency of NAS, which usually requires weeks of hospitalization for newborns, might finally level off in Southwest Florida. The number of cases has seemingly stabilized statewide, but many regions — including Southwest Florida and the Panhandle — continue to see more, according to state and local records.

"We knew that it wasn't getting less," said Dr. William Liu, medical director of the neonatal intensive care unit at the Lee Memorial-owned Golisano Children's Hospital of Southwest Florida. "But the numbers show us, quantitatively, that we're actually seeing more."

Babies exposed to these drugs in the womb can suffer painful withdrawals that doctors must treat with morphine and the sedative phenobarbital.

Common symptoms include nausea; uncontrolled twitching; seizures; excessive and particularly high-pitched crying; problems feeding; an inability to sleep; and fever. The long-term effects of NAS are not clearly understood.

The needed extra hospitalization can add tens of thousands of dollars to the cost of care. Taxpayer-supported Medicaid commonly foots the bill.

The increase in cases here doesn't seem to be simply the result of population growth. In 2012, nearly 12 of every 1,000 babies born in Lee Memorial Health System hospitals showed signs of NAS, according to Liu. The rate was nearly 18 per 1,000 last year, he said. That is more than twice the reported state average.

About half of the women delivering these babies had been using methadone, Liu said. When used as part of a drug-treatment program, methadone is considered the safest option for pregnant women addicted to painkillers. Quitting cold turkey increases the chance of miscarriage.

While prescription medications such as oxycodone have gotten harder to find on the streets, Southwest Florida addicts have turned to illicit drugs such as heroin or other powerful pharmaceuticals, such as a morphine-derivative known as Dilaudid, he said.

"I think out on the street, the common prescription drugs are harder to get," Liu said. "But it's like Whack-A-Mole — you hit on one thing, and there's another thing keeps popping up."

Liu said he's unsure why Lee County is seeing more cases than other parts of Florida. Rates in neighboring Collier and Charlotte counties are far lower, state records show. But Liu said said Lee Memorial hospitals may simply be looking more closely for them.

The Lee Memorial-owned Golisano Children's Hospital established its program to identify such cases in 2002. A 2010 News-Press investigation found that NAS cases had risen 800% in the preceding years in Lee and had nearly tripled throughout Florida.

In 2013, state Attorney General Pam Bondi launched a task force to help educate the public about the problem and encourage hospitals to better screen for such cases. NAS was added to the list of mandatory reportable conditions in June 2014.

One bright spot in the Lee County numbers: NAS babies, who previously averaged a month in the hospital after delivery, now leave after an average of 20 days. Liu said hospital staff have become much more skilled in drug weaning over the years.

"We've really cut down," Liu said. "I'm really happy about that."

A report last month from Florida Surgeon General John Armstrong found that rates had nearly tripled in Florida between 2008 and 2012.

But incidence in Florida has been relatively stable overall in recent years. In 2013, NAS accounted from about 6.9 per 1,000 births statewide, according to the report. Between 2011 and 2013, 4,365 of the state's 636,128 live births were diagnosed with NAS.

The report concludes that more work is needed to understand why rates remain high in certain areas, despite the crackdown on pill pushers.

Department spokeswoman Natalie Spindle released a written statement Friday that said Florida public health officials are monitoring the problem and are addressing NAS prevention in a "meaningful and effective manner," including "prevention messaging."

The Centers for Disease Control and Prevention also looked at Florida's problem.

It noted that NAS cases have actually been increasing statewide for the last two decades. Its report, also released in March, found that diagnosed babies are more likely to suffer serious medical complications, including early births and low birth weights.

The CDC study, performed at the request of the state's Department of Health, looked at three hospitals with high rates to investigate was was driving the trend. It reviewed cases involving 242 babies.

While NAS could apply to any kind of drug exposure in the womb, nearly 97% of the new mothers included in the CDC study had used some sort of opiate or opiate-mimicking drugs.

More than 96% were illicit drug users or using methadone as part of their drug treatment, the CDC said. Their average age was 27, and they were mostly non-Hispanic whites. The infants averaged 26 days in the NICU after they were born, the study found.

Dr. Jennifer Lind, a CDC epidemiologist and lead author of the report, said that only 10% of the women had been referred to drug counseling, though 90% had been drug screened at the hospitals.

Though limited in scope, Lind said the report shows the significance of the problem in Florida and the need for good reporting of such cases and getting these mothers help.

"We feel this report shows NAS as the important public health issue it is," she said.