Oklahoma health-care professionals reported to the state a record 517 cases of newborn infants who tested positive for dangerous drugs or alcohol last year, up from 320 when officials began compiling statistics in 2013.
State officials said they couldn’t determine how much of the 62 percent increase was attributable to rising drug use among pregnant women and how much to improved reporting and testing by health care personnel.
Much of the reported increase involved prenatal exposure to marijuana. Health professionals told Oklahoma Watch that not enough research has been done to determine the long-term effects of prenatal pot exposure on infants and children.
Yet the statistics, which cover fiscal years ending June 30, make it clear that significant numbers of babies are born with addictive opioids or illegal methamphetamine in their bloodstreams. Both can cause extreme distress, and sometimes withdrawal, and in some cases contribute to the stillbirth of a baby.
It can be a heartbreaking sight, health professionals said: A days-old baby, often undersized, crying and trembling, wincing from mere exposure to light in a neonatal intensive care unit.
For Dub Turner, head of the drug-endangered children’s section at the Oklahoma Bureau of Narcotics and Dangerous Drugs Control, observing one such child was a “gut-wrenching” experience.
“It would shake and scream and cry. There was nothing they could do … It was trembling, kind of like a seizure,” said Turner, who visited a southern Oklahoma hospital to see for himself what happens after a meth-addicted mom gives birth.
Turner said he stood outside the window of the hospital’s NIC unit observing the 5-day-old boy until he could take no more. “I wasn’t going in there,” he said, his eyes tearing up at the recollection. “I lasted about 30 minutes.”
A blood test confirmed large amounts of meth in the baby’s system. “As soon as they confronted the mother, she left the hospital,” Turner said. “She left the baby.”
The increase in prenatal exposure reports appear to coincide with other indicators, including the increasing availability of high-potency marijuana, a flood of imported meth and high rates of opioid painkiller use.
Several health professionals told Oklahoma Watch they believe the official counts are understated because they are based solely on reports phoned in to the Department of Human Services from doctors, social workers and other medical personnel.
An undetermined number of exposure cases probably go undetected or unreported, health officials said. Lab tests generally are performed only when mothers are believed to be users or their babies show signs of exposure after delivery.
“Some of the outlying hospitals in the rural areas don’t have the testing mechanisms and may not recognize that this baby that appears to be colicky is actually in withdrawal,” said Charlotte Kendrick, DHS program administrator for prevention.
Even when cases of infant exposure are recognized, some doctors might not pick up the phone.
“We have physicians in this state that will not report … that will not allow their staff to report,” Turner said. “One reason, they say, is they’re afraid that if they report, the mothers won’t come back for care.”
Investigations and Removals
Of the 517 reported incidents during the 12 months ended June 30, 2016, DHS found evidence of child neglect or abuse in 232 cases. Of those, drug or alcohol use was determined to be a major contributing factor to child neglect or abuse in 220 cases.
The department recommended the removal of the babies from their immediate families in 90 of those cases.
Removal recommendations are made to local district attorneys, who must obtain court approval. If DHS workers believe a baby faces immediate risk at home, they can ask police to remove the child while the district attorney considers the evidence.
DHS officials said removal from the home is not necessarily the best outcome in cases involving drug or alcohol abuse by a mother during pregnancy. In some cases, mothers regret their drug use and are willing to commit to a treatment plan after childbirth. In others, fathers, grandparents or siblings are willing and able to protect the child from harm.
“We look at the totality of the situation,” said Debi Knecht, DHS program administrator for child protective services and co-director of the substance exposure hotline. “We don’t just take a drug test and say, ‘We’re going to recommend that your child be removed from you.’ Each family really is different. Each baby really is different.”
DHS officials said Oklahoma’s rates of child abuse and neglect are among the nation’s highest. In 86 percent of substantiated physical abuse cases recorded by DHS during the year ending June 30, 2016, substance abuse was a major contributing factor.
A 2015 report to Congress by the U.S. Department of Health and Human Services ranked Oklahoma 8th from the bottom based on the number of victims of child abuse and neglect. The state’s victimization rate in 2014 was 13.8 per 1,000 children, compared to a national average of 9.4.
Drugs of Choice
Last year, the type of infant exposure cases reported to DHS covered the spectrum of controlled dangerous substances and alcohol, the most prevalent being marijuana.
The number of marijuana exposures has more than doubled since 2013, when the number of positive tests for pot was 107.
The figures for meth and prescription drugs have bounced up and down over the four-year period, but changes in DHS’ reporting methodology make it difficult to discern year-to-year trends.
DHS officials also said they could not provide a breakdown of prescription drug exposures, a category that includes most opioid painkillers as well as other controlled drugs such as benzodiazepine tranquilizers. They said they intend to track opioids separately in future reports.
Of the 517 newborns with controlled drugs or alcohol in their systems, 99 experienced withdrawal symptoms, DHS reported.
Not all controlled substances cause a user to experience intense physical withdrawal when they are discontinued. The most severe withdrawals are associated with opioids.
Opioid-exposed newborns sometimes must spend several weeks in the hospital, where they receive morphine or other substitute drugs to wean them off their physical dependency.
Babies born with high levels of methamphetamine exhibit their own forms of acute distress.
Alicia Vanbuskirk, DHS child welfare state nurse manager, said meth-exposed newborns often experience agitation, erratic sleep, slight tremors and difficulty feeding and sucking.
“They are irritable and hard to console,” Vanbuskirk said in an email. “Sounds and lights are very irritating to them.”
In some cases, the mother’s meth use causes or contributes to an infant being stillborn, autopsy reports obtained by Oklahoma Watch show.
In October last year, for example, a stillborn Payne County girl was brought to a hospital and, based on a toxicology test, the Office of the Chief Medical Examiner attributed the death to “probable toxic effects of methamphetamine.” The death was ruled an accident.
The presence of meth in the fetal brain of a stillborn girl in Adair County in August last year was noted in the autopsy as a possible contributing factor.
More than 20 autopsy reports in 2016, all involving stillborn babies or deaths within several days of birth, referred to the mother’s use of drugs during pregnancy or a positive test of the child for various drugs.
Oklahoma State Department of Health statistics show a steady increase in recent years in the number of newborns who received a doctor’s official diagnosis of neonatal abstinence syndrome, another term for withdrawal.
The number of primary diagnoses of withdrawal rose to 42 last year from fewer than 10 in 2010. The number of secondary diagnoses rose to 377 last year from 110 in 2010.
The department warned that the numbers might understate the extent of the problem. The 2016 figures also might rise as more data is compiled.
According to the Oklahoma Health Care Authority, the number of NAS diagnoses involving babies of mothers enrolled in Oklahoma’s Medicaid program rose to 474 last year, up from 418 in 2014.
Doctors and other health care authorities said not enough is known about the longer-term developmental implications of prenatal drug exposure.
The most detailed research data involves fetal alcohol syndrome. A mother who drinks heavily during pregnancy, particularly during the first trimester, is at much higher risk than non-drinkers of having a baby with embryonic or fetal abnormalities. The children also are at higher risk of experiencing developmental problems during childhood and adolescence.
A 2013 report by the American Academy of Pediatrics concluded that fetal alcohol syndrome has a “strong effect” on long-term physical growth, behavior, cognition and achievement, and some effect on language skills. The report is prenatal alcohol exposure is “the most common, preventable cause of non-genetic intellectual disability.”
Less research has been done on the prenatal and long-term effects of prenatal exposure to meth, cocaine, opioids and marijuana, the report said. But it noted at least some effects in each category of drugs. The least-studied drug was methamphetamine, it said.
“What we do know is that all drugs that affect the central nervous system can adversely affect the nervous system of newborns,” said Hal Vorse, an Oklahoma City physician who specializes in addition treatment. “A lot of times, the subtle effects might not be apparent until they’re 4 or 5 years old.”
Those effects might show up as hyperactivity, learning disabilities or behavior problems.
Vorse said prenatal drug exposure is not the only factor that puts these newborns at risk. If a mother goes back to using drugs, the child might be exposed to environmental threats caused by parental drug use, neglect and abuse, poor nutrition and psychological trauma, he said.
“It’s a big deal,” Vorse said. “The moms of these children need to have services for an extensive period of time to help them get clean and sober and stay that way.”
Turner, the drug law enforcer, said that while he is not a medical expert, he’s convinced all mind-altering drugs pose a risk to unborn children.
“I don’t care what drug it is, it’s going to wire that baby from day one to be more susceptible to drugs and alcohol for the rest of its life … All of them take lives and take the lives of children.”