The head of Social Emergencies Center at the State Welfare Organization has urged hospitals across the country not to release abused children and infants addicted to drugs from birth, into their parents’ custody even after recovery, following the recent tragic incident in which a four-month old girl Roya, passed away at one of Tehran’s hospitals due to substance intoxication.
“Hospitals must contact the Social Emergency Center hotline ‘123’ or the Law Enforcement Forces number ‘110’ to get clearance before releasing an addicted or abused child,” Dr. Hossein Asadbeigi told IRNA.
The rate of addiction among neonates and infants has increased, prompting authorities to take strict action in order to prevent further deaths and abuse.
A large number of children are dependent on opioids from birth since their mothers, who usually come from economically-weaker strata or are homeless, are drug addicts. But the callousness on the part of some doctors in not alerting social services in such instances is causing grievous harm to children in families shattered by narcotics.
“Most of such children enter the world hooked on drugs – a dependency inherited from a mother battling addiction – or are regularly drugged to draw sympathy to their parents’ state of mendicancy,” Asadbeigi noted.
Neonatal Abstinence Syndrome (NAS) also termed neonatal narcotic withdrawal syndrome, is one of the most common forms of newborn drug dependency where children tremble and wail inconsolably, clenching their muscles and sometimes gasping for breath as they go through withdrawal symptoms.
However, if these drug-dependent children recover enough to be discharged from the hospital, they are sent home to families ill-equipped to care for them, thus sealing their fate.
Many young babies die after swallowing toxic doses of methadone, heroin, or other opioids. In one case, the parents of a baby admitted to the same hospital as Roya’s, had made a commitment to sell their four-month-old methadone-intoxicated Ali after recovery, something which they had done earlier with his older sibling.
“With cooperation from the hospital and help from the civil society and NGOs, the child was not released to his parents, and is now safe under the protection of the SWO,” Asadbeigi said.
Lack of Coordination
The cases illustrate flaws in efforts to address opioid addiction among newborns, a crisis fed by the easy availability of prescription painkillers and cheap illicit drugs.
Noting that lack of coordination among executive bodies is a major problem when dealing with such cases, Asadbeigi urged competent authorities to cooperate on the vital issue.
“Had hospital authorities informed responsible social service organizations in a timely manner, Roya could have survived her tragic fate,” he added.
There are around 1.3 million drug addicts in Iran, among whom 10% are women. About 31% of the babies at the Tehran Province State Welfare Organization centers had parents addicted to illegal drugs, and 25% were abandoned.
Pregnancy among homeless women has also emerged as a new challenge to the Health Ministry. There are 5,000 homeless women in Tehran according to the Tehran Municipality. Many are addicted to drugs and suffer from diseases such as HIV, putting their babies at great risk.
They are elusive and stay hidden and refuse to visit health centers fearing legal consequences.
IJN Study on NAS
A study published in February 2015 in the Iranian Journal of Neonatology examined 100 neonates born from narcotic addicted mothers; the most used narcotic was crack (36%) and 60% of neonates showed signs of NAS. Neonates born from crack abusers, in comparison with other drugs, were significantly at risk of NAS (100% vs.87%).
The cross-sectional study was carried out on drug addicted mothers who were referred to labor emergency rooms at the Imam Khomeini Hospital (a tertiary multi-specialty hospital with roughly 1,500 deliveries a year) and also Akbar Abadi Hospital (specialized in gynecology and obstetrics with approximately 3,000 deliveries a year) during 2010-2011.
The study was scientifically and ethically approved by the Ethics Committee of Research Council of Tehran University of Medical Sciences.
Over a one-year period, the study was carried out on 100 (1.5%) pregnant women who were narcotic abusers referred to the two hospitals. Around 56% of deliveries were natural and 43% cesarean section. The mean age of mothers was 27 plus.
Nearly 36% of the addicted mothers were crack abusers, 40% were taking other narcotics (opium and heroin), and the remaining had a history of sedative use. While 21 mothers (21%) used narcotics once a day, six (6%) addicted mothers took the last dose of the drug one hour before delivery; 2% until the last two hours before childbirth and 6% used drugs a day before delivery.
Given the high incidence of NAS in neonates born from drug addicted mothers, public education on the adverse effects of substance abuse in pregnancy should be seriously taken as a preventive measure, the study noted.
A separate retrospective cohort study in 2012 covered a five-year period on medical records of pregnant women at four major hospitals (Mahdieh, Taleghani, Imam Hossein and Akbar Abadi Hospitals) in Tehran.
From 100,620 deliveries, substance abuse was recorded among 519 women with a prevalence rate of 0.5%. Opium was the most prevalent substance abused followed by crack (a mix of heroin and amphetamines). The exposed group had significantly more obstetric complications including preterm low birth weight and postpartum hemorrhage than the non-exposed group.
