KINGSPORT — If you are pregnant, trying to get pregnant or not using birth control, don’t take Subutex or Suboxone, for the sake of your unborn child.
And if you are a physician, don’t continue to prescribe those drugs containing buprenorphine to anyone who is pregnant.
Those are the messages of some local doctors say newborns affected by mothers taking those drugs — designed to help ease people off opioids — can suffer irritability, jitteriness, tremors, sneezing, diarrhea, seizures, inconsolable crying, poor sleep, poor feeding, breathing problems and persistent weight loss.
Beset with an increase in the number of babies born addicted to drugs, Mountain States Health Alliance has launched an initiative targeting about 100 greater Tri-Cities physicians approved by federal authorities to dispense the drugs.
MSHA facilities in Tennessee have seen a 31.3 percent increase in babies born addicted to drugs comparing a seven-month period from July 10, 2010, to Feb. 11, 2011, to the period of July 11 to Feb. 23, 2012. The seven-month 2010-11 total was 99, versus 130 in the seven months of 2011-12. The numbers are from Johnson City Medical Center, Indian Path Medical Center, Franklin Woods Community Hospital, the former Johnson City Specialty Hospital and Sycamore Shoals Hospital.
Wellmont spokesman Jim Wozniak said that 20 percent of the infants in Kingsport’s Holston Valley Medical Center’s Neonatal Intensive Care Unit were there for neonatal abstinence syndrome, and that the longest treatment for those has been 45 days.
“This takes a lot of resources to care for these children,” Wozniak said Thursday afternoon.
Dr. Joy Anderson, a Mountain States Medical Group obstetrician and gynecologist practicing in Kingsport, said pregnant women are being told by physicians prescribing the two drugs “it’s a safe drug in pregnancy” when it is not.
At a Thursday morning news conference at Indian Path Medical Center, Anderson said two other MSHA providers said they are particularly concerned about the prevalent use among pregnant women of prescription opiates, Suboxone and Suboxone, both used to treat opiate addiction.
Lisa Smithgall, vice president of women’s service for MSHA, said the increase puts a strain on the health care and health insurance, including the public TennCare system.
In most instances, Anderson said, the drugs are given in an effort to wean the woman off opiates such as OxyContin.
Anderson said that if a woman is not willing to forgo Subutex and Suboxone, she should defer become pregnant. Options for already pregnant woman include detoxification no later than two months before birth, with appropriate tests of the unborn child. Methadone is the recommended medication used for detoxification during pregnancy, the MSHA literature says.
She said the same avoidance strategy goes for smoking tobacco and drinking alcohol — which Dr. Des Bharti, a neonatologist and East Tennessee State University professor, said are the No. 1 and No. 2 drugs taken by pregnant woman — as well as diabetics keeping their blood sugar under control.
Bharti said when he first came to Johnson City Medical Center in 1990, one or two drug-addicted newborns came into the world there a year, a number he said has grown to about 50 a year now.
Anderson said that 60 percent of users of Subutex and Suboxone during pregnancy are also using completely illegal drugs or alcohol.
In the Tri-Cities, he said about 30 percent of pregnant woman smoke, compared to 15 percent nationwide. And of those using Subutex or Suboxone, he said about half got the drug illegally on the street, not through a prescription.
Bharti said those drugs have in many instances replaced methadone, legally with a prescription and illegally without one.
Aside from immediate health problems, the babies face long-range problems, particularly with future pain management needs. Bharti said the normal cost of a birth and two days in a hospital for a newborn is $2,000 to $3,000, compared to $15,000 to $50,000 for a 10-day stay including a neonatal intensive care unit, while he said the lifetime cost of care is an estimated $1.5 million per child — with about 50 percent being on TennCare. He also said that the difficulty in taking care of the drug-addicted babies can lead to more physical abuse of them.
And in some cases, symptoms of the addiction won’t emerge in the first two days, which Bharti said means some infants are sent home addicted with no special treatment.
Dr. Amy Marlow, an MSMG Pediatrics pediatrician in Kingsport, said doctors often seek a neonatologist’s advice and strive to make sure addicted babies get follow-up care at home.
Since Subutex and Suboxone became legal to help with opioids withdrawal, Marlow said many of the addicted newborns are going to foster care and have issues with growth, failure to thrive and developmental delays. She said long-term studies on the drugs’ effects on newborns as they grow up do not yet exist, but she suspects learning problems, including attention deficit disorder, metal retardation and low IQs would be among outcomes.
That’s why she said MSHA sent the letter, background information and brochures to 88 providers on a list of those that issue the drugs and on a case-by-case basis to other providers not on the list but able to prescribe the drugs.
Ninety-four doctors signed off on the letter, which she said also seeks community support and awareness.
“We hope everyone can help us with this communication,” Marlow said.
Bharti said Subutex and Suboxone both contain buprenorphine, but Suboxone has another medicine included that counters the high that results in crushing the pills and injecting the powder. Subutex is all buprenorphine, Bharti said.
He said doctors can issue prescriptions for Suboxone after attending an eight-hour class.