BANGOR — Mariah arrived last summer, on schedule and weighing in at 7 pounds, 2 ounces.
To her much-relieved mother, she looked and behaved like a normal newborn: very cute and very sleepy.
By Mariah’s third day, however, it was clear she had not escaped her mother’s addiction to pills.
Whenever the baby was awake, she cried. What little she ate, she spit up. And her entire body was stiff, as if all of her muscles were cramping.
Her mother knew what Mariah was feeling. She had experienced the pain of opiate withdrawal once herself.
“I feel bad that she’s in this situation,” said her mother, a thin, soft-spoken 20-year-old from the Rockland area.
Mariah’s mother, like others who were interviewed for this story, agreed to talk about her addiction and her daughter’s withdrawal, but did not want her name published.
As addiction to prescription painkillers spreads in Maine, it touches even some of the most innocent and fragile.
More than 570 babies were born last year to mothers who used prescription painkillers or other drugs while pregnant, according to hospital reports to the state. The number more than tripled in six years, and it doesn’t include the mothers who didn’t tell their doctors about their drug habits.
Most of the drug-exposed newborns experience opiate withdrawal and require weeks of hospital treatment, often with small daily doses of morphine or methadone, a drug to treat adult opiate addicts. It costs about $25,000, on average, to treat each baby in withdrawal.
The most fortunate babies have mothers who got into addiction programs during pregnancy and took controlled doses of a treatment drug. The long-term effects on the children are still unknown, but most of the babies go home after two to four weeks of detox with no immediate complications.
On the other hand, an unknown number of pregnant addicts do not get treatment. They take street drugs throughout their pregnancies, or they try to quit cold turkey in the belief it will help their babies. In both cases, doctors say, the women are much more likely to miscarry or give birth prematurely to babies with higher rates of birth defects.
“When someone is using street narcotics, it’s a seesaw of high, low, high, low. For a baby, that’s very dangerous,” said Dr. Brenda Medlin, a pediatrician who cares for drug-affected babies at Maine Medical Center in Portland.
Quitting suddenly during pregnancy threatens the unborn baby because the mother’s body rebels, causing the uterus to twitch and contract, said Dr. Mark Brown, a neonatologist at Eastern Maine Medical Center in Bangor. “We don’t want (expecting) mothers in withdrawal.”
CRYING OUT FOR ANOTHER DOSE
Treatment during pregnancy with controlled doses of methadone or Suboxone dramatically improves a baby’s chances of avoiding complications, doctors say. It doesn’t mean a baby will be spared all the effects of its exposure to the drugs.
The newborns are watched closely. About 55 percent of the opiate-exposed babies begin showing symptoms a day or two after birth, as their bodies cry out for another dose.
“It’s very difficult to see a baby go through withdrawal,” Brown said. “They’re not cuddly; they’re not lovable. They can’t engage their surroundings. They can’t even eat.”
Doctors and nurses assess the severity of each baby’s symptoms, including fever, diarrhea and vomiting. A baby in withdrawal will often have all of its muscles contracted.
“They are very stiff. If you try to lift them up, instead of their head hanging back a little, they are like a board,” Medlin said.
Once doctors are certain that a baby is experiencing withdrawal, not gas or some other discomfort, they begin medications. They use medicine droppers to put small doses in the babies’ mouths and typically taper the doses off over about two weeks.
Several days into her methadone treatments, 1-week-old Mariah slept peacefully in her mother’s arms. The private hospital nursery room was quiet and dark except for the light coming through a large window overlooking the Penobscot River.
Mariah’s mother sat in a rocker, a towel draped over her shoulder. She had the tired look of a sleep-deprived new mother, but the shadows under her eyes were especially dark. And she didn’t smile.
“It doesn’t feel real good, seeing her like that,” she said quietly.
Mariah’s mother started taking Percodan and OxyContin pills when she was 18. She had a 2-year-old daughter at the time and lived with the girl’s father, a lobsterman who bought the pills and crushed them into powder so they could snort them and get high together.
After just two weeks of using the drug every day or two, she was addicted, she said. “One day I just woke up and I was throwing up and felt sick. Then I used (the pills) and I felt better.”
That’s when she started using the pills not so much to get high, but to keep from being sick.
Three or four months later, she started addiction treatment at a methadone clinic in Rockland. For a year, she took daily, measured doses of the powerful narcotic and attended counseling in hopes of gradually reducing her dependence.
In August 2010, the clinic closed. She went back to getting pills on the street, she said.
She started taking buprenorphine, or Suboxone. The drug is used to treat addiction but has become a street drug for addicts who are desperate to get high or avoid withdrawal.
In October 2010, Mariah’s mother realized she was pregnant and knew immediately that the unborn baby could be in trouble. The only treatment program within reach of her home couldn’t help her, she said.
“They put you closer to the top of the waiting list when you’re pregnant, but you’re not in automatically,” she said.
Treatment centers across the state say they give priority to pregnant mothers because of the risks to their babies.
Her doctor could not help because he was not licensed to prescribe buprenorphine. He effectively sent her back to the street to medicate herself, and her baby.
“He told me ‘Don’t stop taking it,’ ” she said. “Some days I would go without and I felt so bad. I didn’t want it to affect her.”
Finally, about four months into the pregnancy, she went to a hospital suffering from withdrawal. Her body ached, she had sweats and chills, and she was vomiting and unable to eat.
“I hadn’t had any (buprenorphine) in about a week and I was getting pretty sick and I didn’t want the baby to … I didn’t want to miscarry,” she said.
She was taken into a treatment program and put on controlled doses of buprenorphine for the rest of her pregnancy.
Three weeks after Mariah’s birth, she was still at the hospital. But the baby was eating well, cuddling in her mother’s arms and nearly ready to go home, her mother said.
Some babies have withdrawal symptoms, such as crying or irritability, for months. It’s not known what long-term physical effects may await Mariah and the other babies.
Researchers haven’t had time to answer that question. But there is cause for concern about the effects of opiate exposure before birth, as well as the withdrawal process and drug treatments that newborns experience in their first days and weeks of life, said Marie Hayes, a professor of psychology at the University of Maine.
“The little brain is in a critical period,” she said. “There is actually potential damage to the brain from the withdrawal process itself.”
GETTING HELP TO STAY CLEAN
Hayes and a team of Maine researchers have been studying the effects in about 150 children during their first year of life. Brain wave tests have shown developmental delays in a higher percentage of babies who go through opiate withdrawal, but it is too soon to know if the children will have long-term problems. “Are those enduring (developmental) deficits?” Hayes said. “We don’t know.”
It’s also difficult to sort out the effects of the opiates from the effects of alcohol exposure and other factors.
Among the risks that most concern Hayes are the sleep deprivation and fragmentation that accompany withdrawal. She fears that sleep disturbances at such a sensitive time may make the babies less arousable and more at risk of sudden infant death syndrome.
The most immediate concern about the babies’ future well-being is that their mothers could start abusing drugs again. Pregnancy brings many mothers into treatment for the first time.
“They’re really taking a step in the right direction. Our role is to welcome them with open arms and to not alienate them from treatment,” said Brown, at Eastern Maine Medical Center.
Simply discharging the mothers back to their communities with new babies to care for is risky for both. So the hospitals work with community agencies to set up support so the mothers continue treatment.
“Addiction is a chronic medical disease,” said Mark Moran, a social worker at Eastern Maine Medical Center who works with the new mothers. “You have to manage that over a long period of time.”
Hospitals also notify the Maine Department of Health and Human Services whenever babies experience opiate withdrawal.
DHHS sends a public health nurse to work with the mother and baby. As long as the mother is getting treatment and there are no other circumstances that jeopardize the child, such as domestic violence, the state does not move to take custody of a child from her mother.
More than 95 percent of the opiate-affected babies born at Eastern Maine Medical Center go home with their parents, Moran said.
Two years after giving birth, 27-year-old Sarah of Brunswick is confident that her daughter made it through the experience unscathed.
The little girl shows no visible effects of her mother’s addiction. She walks around her mother’s apartment with a sippy cup, feeds crackers to the dog and likes to try to climb the stairs.
Sarah, who did not want her last name published, continues to take Suboxone to control her cravings for OxyContin and other drugs.
“I think about the pills still now,” she said. “But I haven’t acted on it. … I never want to do it again, because of my daughter.”
At Maine Medical Center, Medlin checked on a 3-week-old boy who was nearly ready to go home to Biddeford with his mother and father.
The baby, who weighed 5 pounds, 12 ounces at birth, had to be fed through a tube during withdrawal. At three weeks, he was eating from a bottle and gaining weight.
“He’s just like a normal baby,” said his mother.
The 20-year-old first-time mother, who also wanted her name withheld, said she grew up around drugs and started taking pills when she was in eighth grade. It took pregnancy to get her into treatment, she said. And she wasn’t alone.
“When I went to detox, every girl there but two were pregnant. There were maybe eight women there,” she said.
Now, even though she will return to the same community where pills are easy to get, she is determined to stay clean and protect her son, she said.
“He did change my life,” she said. “I wouldn’t think of messing up now.”
By the time Mariah left the hospital in Bangor, her mother was feeling optimistic, too.
She broke up with her boyfriend, who had gone to jail for selling pills, she said. She also cut off contact with all of her old friends. She and Mariah, and her older daughter, were moving in with her parents in Rockland.
“It’s starting to look a lot better,” she said. “I wouldn’t ever do that again.”
Staff Writer John Richardson can be contacted at 791-6324 or at: firstname.lastname@example.org