Fentanyl Crisis & Obstetrical Practices: Is There a Connection?

This issue is complicated by many factors such as street-level  availability as well as reporting and lab standards for assigning cause of death etc. Still …

In May 2016, a group of national health experts issued an urgent plea in a private letter to high-level officials in the Obama administration. Thousands of people were dying from overdoses of fentanyl — the deadliest drug to ever hit U.S. streets — and the administration needed to take immediate action. The epidemic had been escalating for three years.

The 11 experts pressed the officials to declare fentanyl a national “public health emergency” that would put a laserlike focus on combating the emerging epidemic and warn the country about the threat, according to a copy of the letter.

“The fentanyl crisis represents an extraordinary public health challenge — and requires an extraordinary public health response,” the experts wrote to six administration officials, including the nation’s “drug czar” and the chief of the Centers for Disease Control and Prevention.

The administration considered the request but did not act on it.

The decision was one in a series of missed opportunities, oversights and half-measures by federal officials who failed to grasp how quickly fentanyl was creating another — and far more fatal — wave of the opioid epidemic.

In the span of a few short years, fentanyl, a synthetic painkiller 50 times more powerful than heroin, became the drug scourge of our time. Fentanyl has played a key role in reducing the overall life expectancy for Americans.

If current trends continue, the annual death toll from fentanyl will soon approach those from guns or traffic accidents. Among the dead are the anonymous and the famous, including musicians Prince and Tom Petty . It is so powerful that just a few flecks the size of grains of salt can cause rapid death.

[Vertical axis is US overdose deaths, scale 0, 10k, 20k, 29k.   Horizontal is year, range 1999-2017 with dotted vertical  at 2013.  The purple curve is synthetic opioids, next one down is prescription painkillers, bottom is heroin.  Note the inflection point at 2013.  -rw]

*The recent rise in synthetic opioid deaths has been fueled almost entirely by fentanyl.  It can be mixed into other drugs like heroin, counterfeit pain pills and cocaine.

Between 2013 and 2017, more than 67,000 people died of ­synthetic-opioid-related overdoses — exceeding the number of U.S. military personnel killed during the Vietnam, Iraq and Afghanistan wars combined. The number of deaths, the vast majority from fentanyl, has risen sharply each year. In 2017, synthetic opioids were to blame for 28,869 out of the overall 47,600 opioid overdoses, a 46.4 percent increase over the previous year, when fentanyl became the leading cause of overdose deaths in America for the first time….

https://www.washingtonpost.com/graphics/2019/national/fentanyl-epidemic-obama-administration/

Administration of multiple doses of opiates, barbiturates and nitrous oxide to mothers during delivery were found to increase the occurrence of subsequent opiate (RR 4.7, 95% CI 1.8-12.0, p = 0.002) or amphetamine (RR 5.6, 95% CI 1.6-16.9, p = 0.005) addiction in the offspring as compared to when no drug was given [22, 23].  (2000)

http://www.cirp.org/library/pain/anand4/

Abstract: Our purpose was to investigate whether obstetric analgesia, particularly by nitrous oxide, constitutes a risk that the infant might develop amphetamine addiction in later life. Of 200 current amphetamine addicts born between 1945 and 1966 in Stockholm, proportionately more were born at hospitals where pain medication had been administered in large doses (p less than 0.05). A blind matched comparison was made between 73 addicts and 109 non-addicted siblings by logistic regression, in which nitrous oxide administration was tested in competition with 12 other natal variables as possible confounders. The risk for amphetamine drug addiction in offspring was found to increase with duration of intermittent administration of pure nitrous oxide, i.e. it was estimated to be 5.6 times greater (95% confidence intervals 1.6-16.9, p = 0.005) when nitrous oxide had been given for greater than or equal to 4.5 h vis-à-vis less than or equal to 0.25 h. Calculated risks are probably underestimates. Results can be explained as an effect of imprinting. It is concluded that local or regional anesthesia are preferable to general anesthesia which allows substantial amounts of drugs to cross the placenta. (1988)

https://pubmed.ncbi.nlm.nih.gov/3250180/

Results: In subjects who had subsequently become addicts a significant proportion of mothers had received opiates or barbiturates, or both, compared with unmatched siblings (25% v 16%, chi 2 = 5.83, df = 1, p = 0.02), and these mothers had received nitrous oxide for longer and more often. After controlling for hospital of birth, order of birth, duration of labour, presentation other than vertex, surgical intervention, asphyxia, meconium stained amniotic fluid, and birth weight the relative risk for offspring subsequently becoming an adult opiate addict increased with the number of administrations of any of the three drugs. When the addicts were matched with their own siblings the estimated relative risk was 4.7 (95% confidence interval 1.8 to 12.4, p for trend = 0.002) for three administrations compared with when no drug was given.

Conclusions: The results are compatible with the imprinting hypothesis. Therefore, for obstetric pain relief methods are preferable that do not permit substantial passage of drugs through the placenta.  (1990)

https://pubmed.ncbi.nlm.nih.gov/2249068/

Abstract: The study was undertaken to test whether obstetric procedures are of importance for eventual adult behavior of the newborn, as ecological data from the United States seem to indicate. Birth record data were gathered for 412 forensic victims comprising suicides, alcoholics and drug addicts born in Stockholm after 1940, and who died there in 1978-1984. The births of the victims were unevenly distributed among six hospitals. Comparison with 2,901 controls, and mutual comparison of categories, showed that suicides involving asphyxiation were closely associated with asphyxia at birth, suicides by violent mechanical means were associated with mechanical birth trauma and drug addiction was associated with opiate and/or barbiturate administration to mothers during labor. Irrespective of the mechanism transferring the birth trauma to adulthood–which might be analogous to imprinting–the results show that obstetric procedures should be carefully evaluated and possibly modified to prevent eventual self-destructive behavior.  (1987)

https://pubmed.ncbi.nlm.nih.gov/3425362/

Here’s what Janel posted to facebook on august 2019 ( https://www.facebook.com/birthfilmforfathers/posts/10156190713941010 ):

Do you think that pregnant women in Iowa City, Iowa in 1987-9 KNEW that they were and their babies were research subjects? With drugs never researched to be shown safe for her and baby before using? The same drug destroying lives and families now in 2019?
“A randomized double-blind study evaluated the analgesic efficacy and influence of maintaining a continuous epidural infusion of 0.75% lidocaine during the second stage of labor in nulliparous women. When the cervix was 8 cm or more dilated, unidentified study solution was substituted for the known 0.75% lidocaine solution and continued until delivery.” 1987
“During the first stage of labor, 36 of 41 (88%) women in the bupivacaine-fentanyl group, and 37 of 39 (95%) women in the bupivacaine-only group, had analgesia of excellent or good quality (P = NS). During the second stage, 22 of 37 (59%) women in the bupivacaine-fentanyl group, and 23 of 35 (66%) women in the bupivacaine-only group, rated their analgesia as excellent or good (P = NS).” 1988
I’ve tracked the researcher for these, Dr. DH Chestnut – the earliest researcher I’ve found to research lidocaine, bupivacaine, and fentanyl on NON-consenting, UN-informed babies at birth. It appears he has done quite well.
“While at the University of Iowa, Chestnut developed a National Institutes of Health-funded laboratory model for the study of maternal and fetal responses to stressors such as hemorrhage and inadequate oxygenation. In 1994, Dr. Chestnut became the Alfred Habeeb Professor and chair of Anesthesiology, and professor of Obstetrics and Gynecology, at the University of Alabama at Birmingham School of Medicine. During his 11-year tenure as chair at UAB, he helped lead that department to national and international prominence.”
National Institutes for Health funded him. The government. Let that sink in …. WHERE, WHO, and perhaps WHY … using fentanyl on laboring mother-baby was funded by the same NIH that squelched research of Dr. James Prescott*, a neuropsychologist, who found that babies need to be carried for a year and breastfeed for 3-5. 1979. Still a protector of women and babies, speaking about the needs and rights of the mother-baby.
What fully informed woman would consent to this? Be the guinea pig for testing out drugs that have not been shown to be safe for birth – for her and her baby – before using? Agreeing to use a drug that is known to be extremely unstable and addictive. No concern for how it will impact HER neurology (addiction) or her baby’s life with the consequences. Not even compensated!?!? While the rich get richer?
It is not safe prenatally, but it is at birth? And, they know this, how? They’ve discovered a mechanism by which the laboring baby’s neurodevelopment goes to “off” when receiving the drug at birth, in a hospital?
“Fentanyl is a SYNTHETIC, lipophilic phenylpiperidine opioid agonist with analgesic and anesthetic properties. Fentanyl selectively binds to the mu-receptor in the central nervous system (CNS) thereby mimicking the effects of endogenous opiates. Stimulation of the mu-subtype opioid receptor stimulates the exchange of GTP for GDP on the G-protein complex and subsequently inhibits adenylate cyclase. This results in a decrease in intracellular cAMP and leads to a reduction in the release of neurotransmitters such as substance P, GABA, dopamine, acetylcholine and noradrenaline. The analgesic effect of fentanyl is likely due to its metabolite morphine, which induces opening of G-protein-coupled inwardly rectifying potassium (GIRK) channels and blocks the opening of N-type voltage-gated calcium channels, thereby resulting in hyperpolarization and reduced neuronal excitability.”
Why are women and babies allowed to be research subjects this way? Then and now. How about in 2019? Will it affect the adult?  We have a history of this abuse. Speaking about thalidomide,
“During the 1962 Congressional hearings about the thalidomide scandal, it was discovered that many patients receiving the drug were not informed that it was an investigational agent, or had not given informed consent. On October 10, 1962, Congress passed the “Drug Amendments of 1962” (P.L. 87–781), and the Food and Drug Administration (FDA) published regulations to implement them on February 7, 1963. Researchers testing investigational new drugs had now to obtain consent, but there were loopholes to the consent requirement. FDA attempted to improve this in August 1966, with new rules modeled after the Nuremberg Code. These FDA regulations had requirements for obtaining written consent and rules for informing subjects that they could be used as control subjects, that a placebo could be used, and that, if applicable, alternative therapies exist.”
Did anyone wonder before approving this research using epidural with fentanyl? What is the long-term, LIFE LONG consequence of exposure to fentanyl at birth, when the LIMBIC brain is in critical development???? And, seriously, WHY was it ever allowed to do this to pregnant women and their babies? ANY OF IT? The stupid, fearful approach to letting the cord pulse. Lord of mercy. Why aren’t they protected in research studies?
“Opioid-related harm has now reached epidemic levels: emergency department visits for nonmedical use of prescription opioids more than doubled from 2004 to 2011, accounting for an estimated 488 000 visits in 2011.1 Deaths have more than tripled since 1999, with an estimated 16 235 deaths attributable to prescription opioids in 2013.2,3”
Do you know? Have you thought about HOW MANY JOBS have been created today because of using Fentanyl in epidural at birth for almost thirty-five years?
“the National Institutes of Health today selected four research sites for the HEALing Communities Study in four states hard hit by the opioid crisis. This ambitious study aims to reduce overdose deaths by 40 percent over three years in selected communities by testing a set of proven prevention and treatment interventions, such as distribution of naloxone to reverse overdose and linking individuals in the criminal justice system with treatment for opioid addiction.”
It took fifteen years for the epidural to “take off” – be institutionalized in obstetrics, despite the efforts of women to not use it, and to promote physiologic, midwifery birth. CHOICE. And now in as many as 90% of hospital births, the baby is born “under the influence of fentanyl.”
Now we have an epidemic of overdoses and deaths. Such handwringing over how could this be? NO one is looking at the act of giving birth or being born “under the influence of fentanyl”.
Can you even begin to fathom the amount of money being generated because of Dr. Chestnut’s and other’s research in 1987?
GOVERNMENT funded. From the drug war, the opiates in Afghanistan which is a whole ‘nuther story, to the profit from using fentanyl in epidural – doubling of cesarean, and all of the medical complications. Ensuring a life long patient. To the research, to the social programs to prevent, treat, adjudicate, and incarcerate? Money for local health, ambulance, and law enforcement?
Because there was never any intention to PROTECT WOMEN AND BABIES in obstetrics.
“Obstet Gynecol. 1987 Mar;69(3 Pt 1):323-7.
Continuous infusion epidural analgesia with lidocaine: efficacy and influence during the second stage of labor.
Chestnut DH, Bates JN, Choi WW.
Abstract
A randomized double-blind study evaluated the analgesic efficacy and influence of maintaining a continuous epidural infusion of 0.75% lidocaine during the second stage of labor in nulliparous women. When the cervix was 8 cm or more dilated, UNIDENTIFIED (to the patient -rw)  study solution was substituted for the known 0.75% lidocaine solution and continued until delivery.
The study solution for 26 patients was 0.75% lidocaine; 27 subjects received saline. During the first stage of labor, 88% of women in the lidocaine group and 81% of women in the saline group had analgesia of excellent or good quality, a nonsignificant difference. During the second stage, there was a tendency (not statistically significant) toward improved analgesia quality in the lidocaine patients, but there was no significant difference in the frequency of perineal anesthesia (23% lidocaine, 7% saline). There was no difference between the groups in the duration of the second stage of labor (73 +/- 63 versus 76 +/- 48 minutes). Operative delivery frequency was similar (31 and 37%), as were umbilical cord blood acid-base values.
It is concluded that maintenance of the continuous epidural infusion of 0.75% lidocaine did not prolong the second stage of labor, but it also did not significantly differ from saline in quality of second stage analgesia or frequency of perineal anesthesia.”
Great, and how did that affect the baby’s neuro and connection to mother?
Now at Vanderbilt, “Chestnut has served as president of the Society for Obstetric Anesthesia and Perinatology (SOAP) and as the American Society of Anesthesiologists’ liaison to the American College of Obstetricians and Gynecologists. For 12 years, Chestnut served as a director of the American Board of Anesthesiology (ABA), and subsequently, for the past five years, has served as executive director for Professional Affairs for the ABA. He also served for 12 years on the editorial board for the journal Anesthesiology and for 11 years he was editor-in-chief of the Year Book of Anesthesiology and Pain Management. The fifth edition of Chestnut’s Obstetric Anesthesia: Principles and Practice will be published this month.”
Profit-based, misogynist, limbic capitalistic obstetrics, y’all.
“Limbic capitalism refers to a technologically advanced but socially regressive business system in which global industries, often with the help of complicit governments and criminal organisations, encourage excessive consumption and addiction.”
*”James W. Prescott, Ph.D., was a health scientist administrator at the National Institute of Child Health and Human Development (NICHD), one of the Institutes of the US National Institutes of Health (NIH) from 1966 to 1980. He created and directed the Developmental Behavioral Biology Program at the NICHD where he initiated NICHD supported research programs that documented how the failure of “Mother Love” in infant monkeys adversely affected the biological development of their brains.”

Chestnut named head of Division of Obstetric Anesthesiology (2014)

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