Pill mills' effects showing up in neonatal units, doctors say

Mar. 25, 2012
Pill mills' effects showing up in neonatal units, doctors say
Sara Kennedy | Bradenton (Fla.) Herald

MANATEE, Fla. -- On any given day, more than one-third of the babies in the neonatal intensive care unit at Manatee Memorial Hospital have been exposed to drugs.

Their mothers have passed the curse of substance abuse to their newborns.

In their cribs, the infants suffer from withdrawal.

They shake with jitters, they cry inconsolably. They fight skin rashes, vomiting and diarrhea.The number of newborns in Manatee County hospitals experiencing drug withdrawal as a result of their mothers' substance abuse rose from 2 to 27 during the years 2007-2010, an increase of 1,250 percent, according to the Manatee County Substance Abuse Coalition.

Nearby, other Tampa Bay area hospitals are seeing similar trends: From 2009-2011, the number of babies born at Tampa General Hospital who were exposed to opiates and/or Methadone skyrocketed from 12 per year to 64.Those who provide medical care to babies blame prescription drug abuse.

The Manatee County Commission on Tuesday will consider a strict new ordinance designed to shut down bogus pain management clinics called "pill mills" that are really just businesses that sell highly-addictive prescription medication for profit.

One question commissioners will have to decide is whether pain clinic doctors should be required to test women for pregnancy, and if they test positive, whether to refuse them highly-addictive, opiate pain killers like Oxycodone.

Quite apart from its social and health consequences, the situation entails a huge financial drain: Each child in a pediatric intensive care unit costs thousands of dollars per day, say those who operate them.

"In this county, it's in epidemic proportions," said Dr. Bernard Cartaya, director of neonatology for Manatee Memorial Hospital. "It's associated with pill mills."

On any given day, one-third of the infants in the hospital's neonatal intensive care unit are drug exposed, he said.

When staff members at the Bradenton hospital see an infant with signs of drug withdrawal, they order drug screens of the mother.

"The numbers of patients with positive drug screens we're reporting is just massive amounts, compared to two or three years ago," said Debbie Polis, nurse manager for the hospital's Family Birth Place.

Once mothers learn they are pregnant, they often want to try to wean themselves off pills by taking instead Methadone, which is used to prevent withdrawal symptoms in patients addicted to opiate drugs, said Rebecca Bouchard, a Manatee Memorial Hospital nurse manager.

However, Methadone itself can cause a less-pronounced withdrawal in newborns as well, she said.

Sometimes, pregnant women will go to a Methadone clinic in order to kick their habit, but continue to take prescription pain killers and Methadone at the same time, Bouchard said.

"We need to eliminate pain clinics as they exist now," she added.

Pregnant women who take such drugs are also dying in greater numbers, according to Dr. Washington C. Hill, a specialist in maternal-fetal medicine at Sarasota Memorial Hospital.

"We have seen an increase in deaths of pregnant women using drugs, and increase, too, in the number of patients who do drugs when they're pregnant," he said, adding, "Some legal, some illegal."

From 2003-2009, the death rate for prescription drugs increased 84.2 percent, according to statistics from the federal Centers for Disease Control and Prevention, a section of the draft ordinance said. The death rate jumped from 7.3 to 13.4 per 100,000 population, it said.

The greatest increase in the death rate observed was for the prescription drug Oxycodone, up 264.6 percent, it said.

Hill said some doctors don't care whether their patients are pregnant or not.

"I could take you to a place where pain doctors are giving pregnant women these medications, knowing they're pregnant," he said.

Realistically speaking, addicts are not going to stop popping pills when they learn they are pregnant, he said.

But the doctor still supported the idea of pregnancy testing required by county ordinance.

"Is it going to make a difference? -- it may not make a difference; but even if it stopped one doctor from prescribing that drug, it'd be worth it," Hill said. The numbers at other Tampa Bay area hospitals show similar trends.

At Tampa General Hospital in 2009, 12 babies were born with signs of exposure to opiate drugs or Methadone; in 2010, 45; by 2011, it was 64, according to Nina Pascoe, care coordinator for the hospital's newborn intensive care unit.

Of those, only one infant was admitted in 2009 to the neonatal intensive care unit; by 2011, that number had jumped to 53, she said.

The average stay ranges from 20-45 days, but some impaired babies stay for as long as 50 days, she said, adding, "You're looking at millions and millions of dollars."

The demographic profile of prescription drug addicts might surprise you, said Lisa Colen, chair of a task force focusing on drug-exposed newborns.

"The demographic is older, late-20s, early 30s, predominantly white, educated," said Colen. "It's an expensive habit. Basically, their stories are the same -- they've had a car accident or dental surgery, maybe knee or shoulder surgery, and they get legitimately-prescribed for pain, and it goes along from there."

The college-age son of one of Colen's friends recently had minor dental work, she said. The dentist prescribed 30 Oxycodone pills initially and two refills -- 90 pills altogether, which Colen considered way too much.

A draft ordinance is expected to go before the board for a vote during a public hearing scheduled for 3 p.m. Tuesday at County Administrative Center, 1112 Manatee Ave., Bradenton.

"The intent of the ordinance is to prohibit pill mills, No. 1," said Chief Deputy County Attorney Jim Minix during a workshop meeting with commissioners in February.

Officials explained that pill mill operations prescribe or dispense controlled substances inappropriately, unlawfully or for nonmedical reasons, while legitimate pain management clinics provide genuine medical care to their patients.

"It's our belief that, when it comes down to it, most doctors who don't get involved in pain management will not even be covered by the ordinance, so they shouldn't have a problem with the ordinance," Minix said. The draft ordinance defines a pain management clinic generally as one that provides more than 25 prescriptions per day of controlled substances for pain.

Every such clinic in the county would need a permit to operate, beginning 30 days after the ordinance is adopted, officials said. Minix noted Saturday that there are many exemptions, such as for hospice care, surgical clinics, and facilities that specialize in cancer treatment.

A section requiring pregnancy tests before an opiad-based prescription is given has been dropped.

The clause would have required that, if a woman of childbearing age refused pregnancy testing, her doctor would either decline to prescribe the medication and offer alternative treatment, or obtain a waiver from the patient. The county staff developed reservations about including such a clause, according to comments written in the latest version of the draft ordinance posted on the county's website.

They objected because: n It is unnecessarily controversial and may subject the ordinance to litigation. n It intrudes on the doctor/patient relationship. n Its enforcement would expand the limited capabilities of the staff. n It is tangential to the general scope of the ordinance. Minix is recommending the language requiring pregnancy tests be dropped from the ordinance, but hopes for the ordinance's passage, he said.