When Courtney Castonguay gave birth to her daughter Emma 15 months ago she just knew something wasn’t right.
Emma had an unnaturally high-pitched cry and she was inconsolable.
“She was very irritable,” Castonguay recalled. “It didn’t sound like a normal newborn cry. She had the shakes. She was shaking a lot.”
As alarmed as she was, the then-21-year-old mother from York, Ont. was pretty sure she knew what was ailing her daughter.
Emma was experiencing the symptoms of withdrawal, her doctor confirmed. Statistics from the Canadian Institute of Health Information (CIHI) show that an increasing number of infants are being hospitalized because their mothers took addictive opiates during pregnancy.
Castonguay took fentanyl and hydromorphone during her pregnancy without her doctor’s knowledge.
“I felt horrible having to seeing her like that knowing what I did,” she told CTVNews.ca in a telephone interview from her home in November.
The young mother started taking opioids soon after she graduated high school when she was 18 years old. Castonguay had just met her former partner, Emma’s father, who was already addicted to opioids. Although she was unfamiliar with drugs before that time, Castonguay quickly became a regular user.
A few years later, Castonguay found out she was pregnant. She tried to stop using, but by that time it was too late – she was already addicted.
Terrified and ashamed about her drug use, the young woman waited until the day after her daughter was born to tell the doctors at St. Joseph’s Hospital in Hamilton, Ont. about it.
“It was just hard to bring myself to tell people because it’s not something you want to have to tell people, especially when you’re pregnant and doing that to your baby,” she explained.
Born addicted
Emma was diagnosed with neonatal abstinence syndrome (NAS), a medical condition that can develop when a fetus is exposed to narcotics in the womb.
Dr. Suzanne Turner, a family doctor who has researched NAS and runs a substance use in pregnancy program out of Toronto’s St. Michael’s Hospital, described it as a “withdrawal” syndrome.
“It basically looks the same as withdrawal in an adult,” Dr. Turner told CTVNews.ca in November. “Babies can be very irritable, [they have] difficulty feeding, they can be jittery, sometimes have diarrhea, vomiting, temperature instability.”
Although the long-term effects of NAS are still being studied, Dr. Turner said the short-term risks can be dangerous if the condition isn’t treated properly. Infants suffering from NAS can have seizures or they can become extremely dehydrated from a loss of fluid, she said.
Diagnosing NAS can be difficult if a mother is reluctant to share her history of drug use to her doctors for fear of judgment or intervention from child protective services, Sarah Simpson, a registered social worker, told CTVNews.ca last month.
Simpson, who has been working at the Special Care Nursery at St. Joseph’s Hospital for the past 20 years and helped Castonguay with Emma, said there can be a lot of stigma for mothers who have taken drugs during their pregnancy.
“[We tell them] we are here to support them through whatever struggles they’ve had in the past or are currently working through and that we are not here to judge them by any means,” Simpson said.
Once an infant has been diagnosed with NAS, they’re typically treated with tiny doses of morphine in hospital until they’re weaned off.
Dr. Georgia Hunt, a perinatal addiction specialist who has been working at the Fir Square Combined Maternity Care Unit at the B.C. Women’s Hospital in Vancouver for 10 years, said morphine treatment generally takes one to two weeks, although severe cases may take longer.
In Emma’s case, the symptoms were apparent almost immediately after she was born and she was sent to St. Joseph’s Neonatal Intensive Care Unit (NICU) to begin morphine treatment. Castonguay said her daughter was given morphine for about a month and a half in the hospital before she was completely weaned off.
‘We’re very, very busy’
Cases like Emma’s are far from rare these days.
Hospitalization rates for infants with NAS have been steadily rising in most Canadian provinces over the past five years, according to the latest statistics from the Canadian Institute for Health Information (CIHI).
The total number of acute hospitalizations for NAS in Canada has jumped from 1,448 in the 2013 fiscal year to 1,846 in the 2017 fiscal year ending in March 2017, nearly a 30 per cent increase. The data excludes Quebec and the territories, where the statistics were unavailable.
B.C., Alberta and Ontario, in particular, have seen significant increases in hospitalizations over the past five years, according to the data.
In Ontario, the country’s most populous province, there have been 988 hospitalizations due to NAS from April 2016 to March 2017. That number represents more than half of the country’s total 1,846 cases.
It’s a staggering statistic when it’s compared to the CIHI’s data for 2012 when there were nearly 200 fewer hospitalizations for NAS in Ontario.
From a first-hand perspective, Simpson said she’s “absolutely” noticed a rise in babies with NAS at St. Joseph’s Hospital over the past few years. She said she believes it’s directly related to the larger opioid crisis currently gripping the country.
“It’s worrisome,” Simpson said. “It seems that it certainly has increased a great number over the last couple of years. A couple of weeks ago we had seven babies in our 15-bed NICU who were on medication treatment for neonatal abstinence syndrome, which is almost half of our unit.”
In Vancouver’s Downtown Eastside, where Fir Square is located, Dr. Hunt said they have seen a rise in what she calls “socially-complex” pregnancies involving drug use that stems from living in poverty.
“We’re very, very busy,” Dr. Hunt said. “Maybe busier than we ever have been.”
In B.C, the number of hospitalizations for NAS has gone up steadily every year since 2012, according to the CIHI. The latest figures show that there were 252 hospitalizations in the province from April 2016 to March 2017, up from 233 the year before.
Hospitalization rates for NAS in Alberta have nearly doubled in the last five years with 207 cases recorded in the most-recent data from the CIHI.
2,800 deaths in 2016
From a government perspective, finding a solution to rising rates of NAS will mean curbing opioid use overall. There were 2,800 apparent opioid-related deaths in 2016, a number that is expected to surpass 3,000 for 2017, according to the federal government.
In an effort to combat what they call a “national public health crisis,” Minister of Health Ginette Petitpas Taylor announced in November a host of new initiatives, which include allowing provinces to open temporary overdose prevention sites, testing drugs so they’re not laced with opiates at supervised safe injection sites and supporting a pilot project to find safer opioid alternatives.
In the latest budget, the federal government has also pledged to set aside $100 million over five years to combat the opioid crisis.
On the provincial level, governments have had to work with municipalities to come up with practical solutions.
B.C.:
- The government has established an Overdose Emergency Response Centre in Vancouver.
- The teams there will work regional and community teams to offer overdose prevention sites.
- They will also assist with finding housing for opioid users.
- The centre will distribute naloxone, a drug used to reverse the effects of an overdose.
Alberta:
- The province has set up an Opioid Emergency Response Commission.
- The commission will make recommendations to the government to fund supervised consumption sites.
- They have also recommended increasing the number of beds for drug treatment.
- Making naloxone widely available without a prescription was also on the list of recommendations.
Ontario:
- The government has earmarked $222 million over three years to fight the crisis.
- The money will go towards providing more life-saving naloxone kits for emergency workers.
- The funding is also intended to create more safe injection sites and “rapid access” clinics.
The Ontario government also announced the creation of an opioid task force in the fall, which is made up of front-line workers and experts in the field who will lend insight into how to respond to the crisis.
Allan Malek, the executive vice-president and chief pharmacy officer of the Ontario Pharmacists Association and a member of the task force, told CTVNews.ca that he believes the government should allow pharmacists to take a more active role in the prevention of opioid abuse because they are the ones dispensing the drugs.
He said pharmacists could ensure that opioid prescriptions are warranted for particular patients, review dosage amounts, and check that prescribing guidelines are being followed.
Currently, pharmacists do not have the ability to change prescribed dosages for opioids or controlled substances as they do for other traditional therapies, Malek said. He thinks pharmacists, in conjunction with doctors, should be allowed to lower dosages and offer alternative therapies in certain cases.
“This is all hands on deck,” he said. “Physicians, nurses, pharmacists, dentists, everyone who’s involved in the prescribing or dispensing of opioids needs to take an active role.”
Simpson agrees that there needs to be more vigilance in the prescription process.
“We absolutely need to get more regulated with our opiate prescribers, with our physicians who prescribe opiates. We really need to make sure that we monitor that very closely,” she said.
Dr. Turner, on the other hand, isn’t sure if she has a solution to the problem, but said she hopes women who are using opiates will realize there are treatments available to them and to their babies.
Treatments similar to what helped Castonguay with Emma, who is doing better than ever these days.
“She’s so smart,” Castonguay gushed. “I can’t believe how smart she is and she’s very happy considering what she went through. I didn’t expect her to be so lively and thriving.”
Castonguay is also thriving. The young mother left Emma’s father in the spring and has been clean for nine months.
“She [Castonguay] is somebody that I’m so proud of,” Simpson said. “She’s now back on the right track and she’s doing really, really well with Emma."
