EVERETT — Unborn children and newborns aren’t being spared from the heroin epidemic, and the Everett area has some of Washington’s highest rates of expectant mothers using opiates, according to new state hospital data.
Since the 1990s hospitals statewide have seen a three-fold increase in the rate of pregnant women with drug addictions. Additionally there has been a four-fold increase in the number of newborns being diagnosed with substance abuse conditions, including fetal alcohol syndrome and drug withdrawal syndrome, according to a report released earlier this year by the state Office of Financial Management.
The most significant increase happened between 2008 and 2014. Hospitals reported that the number of expectant mothers with drug addictions doubled in those years while the rate for newborns identified as drug-affected was slightly higher. Washington state appeared to have rates higher than the national average, according to the state report.
The study of hospital admissions also found that Everett, the Olympic Peninsula and Tacoma have the highest rates in the state for expectant women using opiates.
Given the overall increase in drug use it isn’t surprising to see more drug-addicted women giving birth or newborns experiencing the effects of their mothers’ substance abuse, said Dr. Gary Goldbaum, health officer and director of the Snohomish Health District. What is surprising is the relatively rapid increase in the last decade, he said.
“It is proving difficult to address by traditional approaches,” Goldbaum said.
From prescription abuse to heroin
It’s widely accepted that the national heroin crisis followed a spike in prescription drug abuse. Heroin, a powerful opiate, is cheaper and more readily available than prescription painkillers. It also is highly addictive.
“What we’re witnessing is predictable in the context of the conditions that have been created by public policy,” Goldbaum said.
There was an increase in access to prescription pain medications, and there’s been a lack of resources to treat people with addictions or to prevent substance abuse, he said.
Goldbaum also pointed out that today’s heroin user is much younger than those in the past. That means more women of child-bearing age.
“If you’re using drugs, you may not be paying much attention to birth control,” said Linda Grant, the chief executive officer of Evergreen Recovery Centers.
The private nonprofit offers specialized addiction treatment for pregnant or parenting mothers. Moms can begin treatment while pregnant, give birth, and return to the program. While mothers are in treatment during the day, their children are in on-site therapeutic daycare.
Between March 2015 and February, 80 pregnant or parenting moms were enrolled in Evergreen’s inpatient programs in Everett and Seattle. Of those 34 identified heroin as their drug of choice, Grant said.
In Snohomish County, 42 pregnant women received state-funded outpatient treatment last year, and 64 percent of those identified as heroin addicts, said Cammy Hart-Anderson, a division manager for chemical dependency with the county. There were 35 women who received state-funded inpatient care, and 71 percent of them were opiate users.
Snohomish County pregnant women made up 26 percent of the women across the state who received state-funded inpatient treatment for opiates last year, Hart-Anderson said.
“Often times if a woman finds out she’s pregnant that is a key milestone to seek treatment,” she said.
Expectant mothers a priority for services
In Snohomish County pregnant or parenting women receive priority for state-funded treatment services, Hart-Anderson said. They also get priority for medication-assisted treatment, such as methadone. In 2015, 794 county human services clients received methadone treatment, and out of those 102 were expectant mothers.
It is less risky to the fetus to transfer an expectant mother to methadone than have her go through heroin withdrawals, Hart-Anderson said.
The state study used by the Office of Financial Management was collected as part of a national report.
It looked at hospital stays for expectant mothers and newborns, and whether those also included a substance abuse diagnosis, said Joe Campo, a senior research analyst with the state Office of Financial Management.
Campo’s report focuses on Washington’s rates, including some of the hardest hit regions and specific drugs being used by expectant mothers, including opiates, methamphetamine and marijuana.
The report says that in 1990 statewide there were 126 hospitalized pregnant women who reported opiate use. That was equivalent to 1.5 cases per every 1,000 women discharged from hospitals whose primary diagnosis was pregnancy. That number jumped to 436 cases in 2006 and 1,524 cases in 2014. The number of newborns diagnosed with drug withdrawal syndrome also has increased in those years. There were 114 cases reported in 2000 and 881 cases in 2014.
The report shows that newborns born to mothers who reported drug use or were diagnosed with substance abuse had higher rates for respiratory distress, difficulty feeding and low birth rate.
Babies who have been exposed to a steady dose of opiates in utero often will go through sudden withdrawals at birth, or neonatal abstinence syndrome, said Dr. Sabrina Middleton, a pediatrician with Providence Medical Group. That may include diarrhea, vomiting and difficulty settling. The infants require close monitoring, and often are given low doses of opiates until they can be weaned from the powerful drugs.
“This is all cause for longer hospital stays,” Middleton said.
Rise in prescription opiate use, too
Studies indicate that it may not just be illegal drug use that is increasing the rates of babies diagnosed with neonatal abstinence syndrome, Middleton said. There has been a rise in prescription opiate use among pregnant women. That may be done under a doctor’s care, say for chronic pain, but has the same effect on newborns.
The state study looked at patients’ zip codes, and found that the Everett area and the Olympic Peninsula led the state for the percentage of expectant mothers using opiates. In Everett there were 4,521 expectant mothers who were admitted to hospitals from 2012 to 2014, and of those 233 women were identified as opiate users, according to report.
The state report doesn’t explore why the rates are higher in certain locations. It’s probably a complicated equation, Goldbaum said.
He pointed out that poverty is a risk factor for drug abuse. Cost for about 40 percent of the births in 2014 in Snohomish County were covered by public health insurance.
The state report raises questions for Hart-Anderson. Are more drug-using women seeking medical treatment in Snohomish County than other parts of the state, and is that reflected in the higher rates? Are there more substance abuse treatment options for pregnant women here?
“If providers are serving people in a non-judgemental way, that word gets out,” she said. “We have found within the opiate-user population word travels fast.”
Treatment for expectant mothers is challenging, Grant said. The Evergreen program offers parenting classes and coaching in addition to substance abuse treatment. Services also are provided to the infants, including working with the babies’ pediatricians.
“Some of women come out better parents than the rest of us,” Grant said.