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Utah's problem with prescription pain pills has hit the maternity ward, with more babies being born hooked on narcotics.
Nearly 5 percent of Utah mothers used opiates — mostly pain pills — during pregnancy last year. And compared to a healthy baby, it costs six times more to treat a newborn born dependent on the drugs, according to research scheduled to be presented Sunday at the Pediatric Academic Societies conference in Denver.
"We have a problem with prescription pain meds in this state, and this is how it spills down to sub-populations of the pregnant women" and their babies, said Karen Buchi, chief of the University of Utah's division of general pediatrics and one of the authors of the research.
Utah has one of the nation's highest rates of nonmedical use of pain relievers. And the number of prescription drug overdose deaths reached 310 in 2009.
Last year, researchers tested umbilical cord samples from 850 deliveries at 13 hospitals in Utah, finding that 4.7 percent tested positive for narcotics.
Fifty-eight samples were positive for one or more substances, with 40 positive for opiates that could have included heroin. But most of the drugs were prescription pain pills. That's more than the number of women who used alcohol, amphetamines, cocaine, marijuana and other drugs combined.
Researchers don't know if the babies born to the 1 in 20 pregnant women who used opiates were affected. Nor is it known if they were using the drugs as prescribed — for fibromyalgia or pregnancy-related back pain, for example — or if they were using them illegally, Buchi said.
But she noted that few of the drugs would have been given for labor and delivery pain.
And while she says there are legitimate reasons a woman would be on pain pills during pregnancy — taking an addicted woman off narcotics cold turkey can lead to miscarriage or preterm labor — she wants doctors who prescribe the drugs to know there will likely be consequences to the newborn.
"I get called all the time now about kids in withdrawal, newborns in withdrawal, and they're seeing it in rural hospitals where they've never had to encounter it before," said Buchi, who treats babies with what is called neonatal abstinence syndrome (NAS).
About half to nearly all of babies exposed to opiates will experience NAS at birth, depending on the type of drug the mother used and how long she took it, according to national research.
The babies cry, they're stiff and jittery. They vomit and have diarrhea. Their breathing and heart rate quickens, and they may have a fever.
Weaning them from the drugs requires extensive and expensive hospitalization.
In another study, Buchi and her colleagues found that 134 Utah babies were born with NAS at Intermountain Healthcare hospitals during the study timeframe, which wasn't available Saturday.
Using Intermountain's electronic medical records, the research team compared hospital charges for babies born with the syndrome to healthy babies born at the same hospital with the same gestational age.
They found addicted babies were hospitalized for 13 days, compared to 3 days for healthy babies. Their hospital charges were nearly $28,900, versus about $4,700. The increased costs continued during the first 18 months of life.
It's a cost that Medicaid is more likely to pick up: The previous study showed that women who use narcotics during pregnancy are more likely to be on public insurance or have no insurance.
The amount of care that medical providers must give to newborns who are dependent on opiates is more extensive than for newborns who were exposed to methamphetamine or cocaine, Buchi said.
"Medically, those babies have very little problems that we have to intervene in a medical management kind of way. But an opiate-dependent mother will have an opiate dependent baby," she said.
She said pediatricians nationally are "desperate" to find the best way to help the newborns withdraw quickly and reduce their hospital stays. Recognizing and caring for newborns with NAS is not standardized, she said.
Utah doctors are also seeking ways to prevent NAS.
In a separate effort, prenatal providers want to know if they're contributing to the oversupply of prescription drugs that can fuel addiction.
Kristina Milan, an ob-gyn at the U., wants to survey providers to know what type of pain drugs and how many they prescribe to mothers after a delivery.
"Ultimately what we would like to do is establish some guidelines for what we should be doing for post-partum pain relief and [offer] guidelines for evaluating patients who are requesting refills," said Milan, who has noticed an increase in the number of pregnant women using chronic pain medications.
"What we don't want are bottles of Percocet sitting around the house that people are using to self medicate or selling on the black market."
Utah's pain pill problem is also leaving babies without their mothers.
A recent review by Utah Department of Health of the number of women who died within a year of completing a pregnancy and found 16 women died from drug overdoses from 2005 to 2009. That could explain the increase in Utah's maternal mortality rate. It's doubled since 2004, to nearly 15 deaths per 100,000 live births.
The majority of the 16 deaths involved prescription drugs, said Michael Varner, an ob-gyn on the health department review committee, who also worked with Buchi on the study of prenatal opiate use.
"Several of these women had records of getting prescriptions from 10 to as high as 20 different providers in the year before they died," he said.