Opioid Addiction Is So Pervasive That U.S. Hospitals Need ‘Baby Cuddlers’ To Help Newborns In Withdrawal


As America’s opioid crisis affects millions, babies nationwide are born with harrowing inherited-withdrawals from their addicted mothers.

Intubated Newborn

Wikimedia CommonsAn intubated newborn in a neonatal unit, 2011.

The opioid epidemic has become a national crisis. While most victims of this modern phenomenon are addicted adults, there are newborn babies born of those addicts who suffer from withdrawal the moment they enter the world. These babies end up in the Neonatal Intensive Care Unit (NICU) — an ICU for infants — and experience pain and suffering before they can experience anything else in their world.

The nationwide consequences of America’s opioid epidemic have become so stark and prevalent that the National Institute on Drug Abuse reported that a baby is born suffering from opioid withdrawal every fifteen minutes.

In response, hospitals across the country have received volunteer aid by regular citizens who serve as “baby cuddlers” and rock the ailing infants to sleep, provide a necessary human connection, and allow them a small semblance of peace.

Hospitals across the country are opening up individual “cuddler” programs as part-time jobs to combat the crisis and can be found from Iowa and Virginia to Massachusetts and San Antonio.

Baby In Nicu

Wikimedia CommonsA newborn in the Neonatal Intensive Care Unit.

University Hospital is in Bexar County, San Antonio, Texas has the largest number of babies born with NAS in the entire state of Texas. A third of babies born with NAS are born there — and the number of babies born with NAS has spiked by 60 percent over the last five years.

So when the University Hospital put out a call for its cuddling program in the NICU, Army veteran Doug Walters was quick to volunteer Texas Public Radio reported.

“Jonathan is supposed to be going to sleep, but we’re having some challenges right now,” said Walters in reference to an infant he volunteered to care for. “He’s three and a half months. So he’s been a resident for a little while.”

Walters has been a part-time baby cuddler for over three years now and said he has specialized on those who enter the NICU with neonatal abstinence syndrome (NAS) — opioid withdrawal inherited from their mothers.

Crying Newborn

Wikimedia CommonsA crying newborn.

The symptoms of NAS include tight muscles and subsequent body stiffness, tremors, seizures, and overly increased reflexes. Newborns with NAS are prone to gastrointestinal problems, and thus, have trouble with being fed. These babies can also have trouble breathing.

All of the infants suffering from NAS let out a unique, high-pitched shriek which Walters said is immediately identifiable as a cry stemming from that particular syndrome.

“You can tell when kids cry because they’re mad, or they’re hungry, and (babies with NAS) just…it’s a very sad cry,” he said. “It’s just sad, because they don’t understand what’s happening, and they don’t understand why things hurt. They just don’t understand.”

Laurie Weaver has been a nurse in the University Hospital NICU for 27 years and has come to care for babies with NAS more than any other type of patient. For her, it’s the fairness factor — a tipping of the scales that dealt these infants a heavy hand — that draws her to them.

“I just feel like they were given a rough start, and I just like holding them and comforting them,” she said.

Newborn Girl In Nicu

PixabayA newborn girl in the Neonatal Intensive Care Unit.

“Touch is so important to babies,” said Vicki Agnitsch, a former nurse now part of the 22-person Cuddler Volunteer program at Blank Children’s Hospital in Des Moines, Iowa. “Without that, there would be failure to thrive.”

Agnitsch said that the more cuddling and physical touch these infants get has a direct correlation to fewer required and administered medications. The human connection provided through these programs literally supports the immune systems of babies born with NAS.

“When they know someone else is touching them, it gives them that warmth and safety and security that they crave,” she explained. “They had that inside the mom, and then they come out into this cold, bright world. They don’t have that, so all of that swaddling, touch, and talk helps their development.”

Agnitsch said that the simple act of spending a few hours per week with newborns with NAS can help physically course-correct the very direction of their early lives. She also said that thee Cuddler Volunteer program, which she’s been a part of since 2011, is “the best part of my week.”

She doesn’t seem to be the only one who finds catharsis in that, as the Blank Children’s Hospital Cuddler Volunteer program — one of many across the country — has a two-year waiting list of volunteers.

Volunteer Cuddler

Tennessee Department of Children’s ServicesA volunteer cuddler at the East Tennessee Children’s Hospital.

Halfway across the country, Warrenton, Va.’s Fauquier Hospital has established a cuddler program of its own. Director of women services Cheryl Poelma told WTOP that infants born with NAS received morphine shortly after birth to help assuage their withdrawal symptoms.

Babies in withdrawal “tend to be irritable, they aren’t coordinated with their suck, they can’t eat well, they can sneeze a loot, have loose stools — it’s all part of withdrawing,” she said. Fauquier Hospital decided to implement a two-pronged cuddler program in conjunction with the administering of morphine.

“They sit, and they rock infants and hold them tight,” she said. “They tend to like to have their hands close to their chests, they like a tight blanket swaddled around them. They also like to suck on pacifiers, so it’s rocking, sucking, keeping them in a quiet environment, reducing stimuli.”

Poelma explained that volunteer cuddlers have shown results in a matter of weeks.

“You’ll see them engaging you more, their eye contact will be better, they’ll start feeding better, not being so fussy, and they’ll start to sleep better,” she said.

Newborn Wrapped In Blanket

PixabayA newborn being cuddled, wrapped in a blanket, 2015.

A study published in 2014 in the Biological Psychiatry journal suggested that infants born in the NICU formed healthier sleep habits and showed increased attention if they were regularly cuddled from birth.

The New York Presbyterian Brooklyn Methodist Hospital, UCI Health in Orange County, Calif., the Blank Children’s Hospital in Des Moines, Iowa — these programs are springing up all over the United States, and those are just the ones currently at capacity.

It’s proactive empathy like this that makes all the difference in the world — especially for those least able to help themselves.

The Opioid Crisis Might Hinge on Length of Drug Use, Not Dosage, Doctors Say


The National Institute on Drug Abuse reports that 90 Americans die every dayfrom opioid overdoses, both from legally prescribed drugs — oxycodone, hydrocodone, morphine, etc. — and from illegal drugs — heroin, illegal fentanyl. This overdose death rate increased 280 percent from 2002 to 2015, and by all accounts, it continues to rise. There’s no mistake: opioid abuse has become a public health crisis. And while there are many concurrent factors that contribute to the opioid crisis, including the unsupported medical claim that opioids aren’t addictive, doctors want to get a better idea of the degree to which prescribing practices can lead to drug abuse.

 close-up%20of%20Oxycodone%20bottle

In a paper published Wednesday in The British Medical Journal, doctors found that patients prescribed opioid medications to manage pain after operations were much more likely to misuse the drugs the longer they took the drugs. They also found that the length of opioid use was a stronger predictor of misuse than the dose of an opioid prescription.

“Overall rates of misuse were low, but rates grew rapidly with increasing opioid use,” write the study’s authors.

Doctors say opioid misuse is closely related to the length of time someone takes a prescribed drug.
Doctors say opioid misuse is closely related to the length of time someone takes a prescribed drug.

To conduct this research, the team, composed of doctors at Harvard Medical School, the University of Florida, and Johns Hopkins University, along with a data analyst at health insurer Aetna, examined medical records of over one million patients who had had operations. These patients weren’t already taking opioids at the time of their operations and had no documented history of opioid misuse. Out of these patients, 568,612 (56 percent) received post-operative opioid prescriptions. 90 percent filled their prescriptions within three days of leaving the hospital.

Of this group, 5,906 (0.6 percent) had insurance diagnosis codes that indicated signs of misuse, including opioid dependence, abuse, or overdose. It’s a relatively low number, which supports the argument that medical prescribing isn’t the main driver of the opioid crisis.

The study’s authors then analyzed the drug dosages and the number of prescription refill patterns for these patients, and they found that the rate of opioid misuse doubled with a single refill. They also found that each prescription refill translated to a 44 percent higher rate of misuse and each week of use was associated with a 20 percent higher chance of misuse.

opioid pills
Doctors say the longer a patient takes opioids after surgery, the more likely it is that they’ll misuse the drugs.

“These findings suggest a more nuanced understanding of the relation between duration and dosage,” write the study’s authors. These findings, they say, suggest that the optimal way to prescribe opioid drugs after operations, such that pain relief is maximized and misuse risk is minimized, “may be achieved with moderate to high opioid dosages at shorter durations, a combination that merits further investigation in population based and clinical studies.”

Abstract:

OBJECTIVE To quantify the effects of varying opioid prescribing patterns after surgery on dependence, overdose, or abuse in an opioid naive population.

DESIGN Retrospective cohort study.

SETTING Surgical claims from a linked medical and pharmacy administrative database of 37651619 commercially insured patients between 2008 and 2016.

PARTICIPANTS 1,015,116 opioid naive patients undergoing surgery.

MAIN OUTCOME MEASURES Use of oral opioids after discharge as defined by refills and total dosage and duration of use. The primary outcome was a composite of misuse identified by a diagnostic code for opioid dependence, abuse, or overdose.

RESULTS 568,612 (56.0%) patients received postoperative opioids, and a code for abuse was identified for 5,906 patients (0.6%, 183 per 100,000 person years). Total duration of opioid use was the strongest predictor of misuse, with each refill and additional week of opioid use associated with an adjusted increase in the rate of misuse of 44.0% (95% confidence interval 40.8% to 47.2%, P<0.001), and 19.9% increase in hazard (18.5% to 21.4%, P<0.001), respectively.

CONCLUSIONS Each refill and week of opioid prescription is associated with a large increase in opioid misuse among opioid naive patients. The data from this study suggest that duration of the prescription rather than dosage is more strongly associated with ultimate misuse in the early postsurgical period. The analysis quantifies the association of prescribing choices on opioid misuse and identifies levers for possible impact.

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