When Courtney Castonguay gave birth to her daughter Emma 15 months ago she just knew something wasn鈥檛 right.
Emma had an unnaturally high-pitched cry and she was inconsolable.
鈥淪he was very irritable,鈥� Castonguay recalled. 鈥淚t didn鈥檛 sound like a normal newborn cry. She had the shakes. She was shaking a lot.鈥�
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鈥檚 knowledge.
鈥淚 felt horrible having to seeing her like that knowing what I did,鈥� 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鈥檚 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 鈥� 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鈥檚 Hospital in Hamilton, Ont. about it.
鈥淚t was just hard to bring myself to tell people because it鈥檚 not something you want to have to tell people, especially when you鈥檙e pregnant and doing that to your baby,鈥� 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鈥檚 St. Michael鈥檚 Hospital, described it as a 鈥渨ithdrawal鈥� syndrome.
鈥淚t basically looks the same as withdrawal in an adult,鈥� Dr. Turner told CTVNews.ca in November. 鈥淏abies can be very irritable, [they have] difficulty feeding, they can be jittery, sometimes have diarrhea, vomiting, temperature instability.鈥�
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鈥檛 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鈥檚 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.
鈥淸We tell them] we are here to support them through whatever struggles they鈥檝e had in the past or are currently working through and that we are not here to judge them by any means,鈥� Simpson said.
Once an infant has been diagnosed with NAS, they鈥檙e typically treated with tiny doses of morphine in hospital until they鈥檙e 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鈥檚 Hospital in Vancouver for 10 years, said morphine treatment generally takes one to two weeks, although severe cases may take longer.
In Emma鈥檚 case, the symptoms were apparent almost immediately after she was born and she was sent to St. Joseph鈥檚 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.
鈥榃e鈥檙e very, very busy鈥�
Cases like Emma鈥檚 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鈥檚 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鈥檚 total 1,846 cases.
It鈥檚 a staggering statistic when it鈥檚 compared to the CIHI鈥檚 data for 2012 when there were nearly 200 fewer hospitalizations for NAS in Ontario.
From a first-hand perspective, Simpson said she鈥檚 鈥渁bsolutely鈥� noticed a rise in babies with NAS at St. Joseph鈥檚 Hospital over the past few years. She said she believes it鈥檚 directly related to the larger opioid crisis currently gripping the country.
鈥淚t鈥檚 worrisome,鈥� Simpson said. 鈥淚t 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.鈥�
In Vancouver鈥檚 Downtown Eastside, where Fir Square is located, Dr. Hunt said they have seen a rise in what she calls 鈥渟ocially-complex鈥� pregnancies involving drug use that stems from living in poverty.
鈥淲e鈥檙e very, very busy,鈥� Dr. Hunt said. 鈥淢aybe busier than we ever have been.鈥�
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 鈥渘ational public health crisis,鈥� Minister of Health Ginette Petitpas Taylor announced in November , which include allowing provinces to open temporary overdose prevention sites, testing drugs so they鈥檙e 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 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 .
- 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 for emergency workers.
- The funding is also intended to create more safe injection sites and 鈥渞apid access鈥� clinics.
The Ontario government also announced the 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.
鈥淭his is all hands on deck,鈥� he said. 鈥淧hysicians, nurses, pharmacists, dentists, everyone who鈥檚 involved in the prescribing or dispensing of opioids needs to take an active role.鈥�
Simpson agrees that there needs to be more vigilance in the prescription process.
鈥淲e 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,鈥� she said.
Dr. Turner, on the other hand, isn鈥檛 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.
鈥淪he鈥檚 so smart,鈥� Castonguay gushed. 鈥淚 can鈥檛 believe how smart she is and she鈥檚 very happy considering what she went through. I didn鈥檛 expect her to be so lively and thriving.鈥�
Castonguay is also thriving. The young mother left Emma鈥檚 father in the spring and has been clean for nine months.
鈥淪he [Castonguay] is somebody that I鈥檓 so proud of,鈥� Simpson said. 鈥淪he鈥檚 now back on the right track and she鈥檚 doing really, really well with Emma."
