Increasing use of narcotic can have repercussions for children and families

I HAVE been a pediatrician in a small community on the Olympic Peninsula for a quarter of a century, and in the past decade have witnessed an alarming increase in the number of babies born to mothers who have been prescribed long-term narcotics for a variety of chronic pain symptoms. We rarely saw babies with Neonatal Abstinence Syndrome (NAS) until about 10 years ago. Now we sometimes have two or three at a time in our small nursery.

These babies are born addicted, and must be withdrawn from narcotics after birth. Ironically, they must be treated with morphine, which is slowly increased and then weaned, often over a long period of time. It is difficult for the nurses and doctors caring for them to witness their suffering, including poor feeding, diarrhea, severe irritability and, in the worst cases, seizures.

Being born addicted interferes with mother-child bonding and breast-feeding, stretches the already scarce resources of our small rural hospital and, most important, may produce permanent changes in the neonatal brain.

This problem is not unique to our community, but is happening all over Washington state and the rest of the United States. In the past decade, recommendations for treatment of chronic pain have changed, and physicians have been urged to treat patients with chronic noncancer pain aggressively, often with narcotics. Advocacy groups have helped to spearhead these changes, and have been supported by the pharmaceutical industry, which has developed and marketed newer, longer-acting, and much more expensive and potent narcotics.

Unlike patients with cancer-related pain, many of these patients are in their 20s and 30s, in the prime of their working and childbearing years.

They are prescribed narcotics for a variety of chronic-pain symptoms — headaches, back pain, dental pain, fibromyalgia, etc. They obtain narcotics from their physicians; they may go to emergency rooms to get more, and sometimes they buy and sell them on the street

I do not treat patients with chronic pain. They are the parents of the children for whom I provide care — and I see the wreckage that narcotic dependence and addiction leaves in its wake. In addition to the NAS babies, I see the children who are neglected and abused, the mothers who fall asleep while talking to me, the fathers who are in jail, the toddlers and small children who accidentally overdose on narcotics and have to be airlifted to Seattle, and the teens who use their parents' narcotics and either overdose or become addicted themselves.

I see a whole generation of children being cared for by their grandparents, or in the foster-care system, and I see a community disrupted and damaged.

Despite the enormous personal suffering and the staggering cost to society, I am not aware of any good science that suggests that long-term narcotic use is helpful for patients with chronic noncancer pain. In fact, several studies show that patients with chronic pain who are treated with narcotics have a poorer quality of life then those who are not.

This makes sense to me. Chronic pain is a problem with many factors, and these patients often have coexisting depression, anxiety and social stressors. Adding narcotic dependence or addiction to these issues compounds rather than solves them.

I am not naive enough to believe we can change overnight the problems that have arisen from the dramatically increased use of prescription narcotics over the past decade. But we can do better, starting with relying on evidence-based medicine, rather than on drug-company propaganda to make decisions about the treatment of chronic noncancer pain, especially in young adults. Prescription-drug use is a complex societal problem, with measurable profits for some of the players.

The pharmaceutical industry is marketing these medications, patients are asking for them, doctors are writing the prescriptions, but innocent children are paying the price.