Growing up on an island off the coast of southern Maine, Lena was using alcohol and marijuana by the age of 9. She continued to experiment with more potent drugs, tried to quit and found out several years later she couldn’t on her own, so she enrolled in a methadone treatment program.
While on the methadone, she found out she was expecting her first child.
Lena’s baby boy was born addicted to methadone, but the school-age boy now seems to be healthy, thanks to comprehensive addiction treatment Lena got during and after her pregnancy.
Her experience is becoming more common as an explosion in prescription drug abuse fuels addiction problems in Maine, and health care providers are looking for ways to deal with the epidemic of drug-affected babies in a state where the means for such treatment often aren’t available.
It was painful knowing her baby’s withdrawal symptoms were caused by her own methadone treatment, said Lena, who spoke on condition her real name not be used. But to continue to use illicit drugs could have caused more serious health issues for her baby, including death.
“It’s important to have a combination of physical and emotional treatment,” said Lena. She received high doses of methadone during pregnancy to treat an addiction to opiates, and her baby boy had many symptoms after birth, such as vomiting, diarrhea, tremors and restlessness.
“That was the most painful experience of my life,” she said.
The director of Maine’s Office of Substance Abuse said that the household medicine cabinet has become the new neighborhood drug dealer, with friends and relatives being some of the most frequent suppliers of illicit prescription drugs.
The result is that drug dependence is beginning very early for some Mainers.
Neonatal abstinence syndrome, withdrawal symptoms experienced by newborns exposed to illicit or prescribed narcotics during pregnancy, includes symptoms like irritability, high-pitched crying, tremors, seizures, poor feeding, diarrhea and vomiting.
If mothers receive treatment for addiction during pregnancy, a baby’s overall prognosis is usually better. But the number of facilities and health care professionals equipped to provide treatment to addicted mothers in Maine is inadequate, officials say.
Guy Cousins, director of the state’s Office of Substance Abuse Services, said that while the number of drug-affected babies in Maine has risen dramatically, resources for providing treatment to mothers in recovery are dwindling. Cousins cited Department of Health and Human Services statistics showing the number of drug-affected babies reported in Maine rose from 165 in 2005 to 667 in 2011 — a fourfold increase.
Maine topped the list of states reporting increased hospital admissions for treatment of non-heroin opiate addictions between 1998 and 2008. A report from the federal Substance Abuse and Mental Health Services Administration reveals Maine reported the highest increase in their rate of admissions for treatment of non-heroin opiates of any state in the nation during those years. Maine admissions increased from 28 per 100,000 to 386 per 100,000.
Maine has the highest prescription drug addiction rate in the country per capita, according to Cousins.
However, Cousins said that despite increasing numbers of addictions reported, Maine’s resources for treatment of drug addictions are dwindling. During rounds of recent state budget cuts, treatment expenditures decreased by $1.4 million between 2009 and 2011.
The director of Mercy Hospital’s Recovery Center, physician Mark Publicker, said some of the more serious health issues experienced by drug-affected babies are caused by alternating high and low levels of narcotics in the bodies of expectant mothers who use drugs without physician supervision. The fluctuating drug levels can cause constriction of blood flow to the baby and result in spontaneous abortion, pre-term birth, or small for gestational-age babies he said.
“The biggest problems are the untreated, unrecognized addicts,” said Publicker.
Publicker also expressed concern regarding recent passage of L.D. 1746, which limits MaineCare funding for Methadone from a maximum of six years to two years, starting in January 2013. He’s concerned the law will result in an avalanche of relapses and crimes “of a magnitude this state’s never experienced before.”
Methadone is one of the drugs of choice for treating heroin and other addictions, but weaning a person off Methadone may require a lengthy process.
“You can’t just stop using methadone,” said Publicker.
State officials say there’s still flexibility in the new funding provisions for methadone. The two-year limit contained in the new law can be exceeded with prior authorization, according to John Martins, spokesman for the Department of Health and Human Services .
“DHS has been directed to seek input for prior authorization rules from stakeholders and experts in the field of substance abuse addiction and recovery including individuals with expertise in medication-assisted treatment,” Martins said.
Lena knows firsthand about the difficulties of methadone withdrawal. She said addicts refer to methadone as “liquid handcuffs” because of the strong grip it has on their physical being when they attempt to discontinue treatment.
Lena participated in a University of Miami clinical trial, traveling to Mexico for treatment, in order to finally discontinue methadone.
Although she received medical treatment, Lena said she lacked emotional support and suffered a relapse shortly after her baby’s birth.
“It was so horrible. I had no support,” she said. “There was a lot of judgment toward me as a parent in the beginning. My little newborn baby was whisked away from me and I was treated like a horrible person and had to watch him suffer. Toward the end I had more support and one of the nurses actually befriended me.”
Lena’s newborn son was treated for methadone withdrawal in the neonatal intensive care unit at Maine Medical Center in Portland for a week and then spent 5 1/2 weeks in the Barbara Bush Children’s Hospital before he could go home with his mother.
The nursing director at the neonatal intensive care unit, Geri Tamborelli, said the length of drug-affected babies’ hospital stay and the medications used to treat them varies depending upon the severity of their symptoms. She said trained volunteers rock the babies who are difficult to calm and whose high-pitched cries pierce the air of the intensive care unit day and night.
Lena’s now been clean for about four years. She found the help she needed through Alcoholics Anonymous, where she said she worked through the program’s 12 steps and got to the root of her problems.
“Now if I have those thoughts, I know there are things that I can do like call someone or journal or pray. It helps to know the thoughts are just temporary and those will pass,” Lena said.
Lena urges other mothers struggling with addiction to not only seek medical treatment but to “build as vigorous of a support system as they can” and not to give up hope.
Meanwhile, health care professionals involved in the statewide project Snuggle Me are collaborating to develop consistent care for drug-affected babies and mothers, according to Maine Medical Center’s childbirth educator, Kelly Bowden.
“We realize the earlier that we recognize there’s a problem, the earlier we can get moms into treatment,” Bowden said.
Physicians at Maine Dartmouth Family Practice in Fairfield now offer treatment for mothers with buprenorphine, an alternative to methadone.
“Some women prefer to be treated in a private office setting rather than a methadone clinic,” said nurse practitioner Alane O’Connor, who’s developing patient care standards.
Physician Kelly Harmon, who practices obstetrics at MaineGeneral Medical Center, is educating family practice residents regarding the care of drug-affected babies and their mothers.
“One real benefit of the residency program is that we’re able to train family docs to understand the issues,” Harmon said.
Chief of Obstetrics and Gynecology at Inland Hospital, Bill Bradfield, said health care professionals throughout the state are working to support expectant mothers’ efforts toward recovery. However, he said it’s sometimes challenging to maintain a positive attitude after investing hours in education and comprehensive care, only to have some expectant mothers continue to use illicit drugs during subsequent pregnancies.
“It’s frustrating,” said Bradfield.
Many women are reluctant to seek help because they’re afraid the Department of Health and Human Services will take away their babies, Bradfield said. Rarely does that actually happen, he said, though all affected babies must be reported.
The department then classifies the reports and makes decisions about what to do — if anything. Some are referred to alternative response programs, which are community-based programs in each district that follow-up and establish services. Others are referred to public health nursing for follow-up care and services.
Only if there are allegations of abuse, neglect or other concerns does the department order an assessment by Child Protective Services.
The department does not remove children from others who are receiving medication — such as replacement therapy treatment for substance abuse — solely because the baby is born affected by the replacement treatment, according to Therese Cahill-Low, director of the Office of Child and Family Services at DHHS.
“There have to be many other factors present,” she said. “All babies present challenges but these medically fragile babies are often difficult to pacify, and caseworkers often work with parents on how best to deal with these challenges.”