The youngest heroin addicts aren’t even born yet.
Still in the womb, they are exposed to opiates by expectant mothers with drug habits sometimes so insatiable and all consuming the pregnancy goes undetected for months.
And, fueled by opioid use by pregnant women, more of these young addicts are born every day. Nearly 1,700 drug-exposed babies were born in Ohio in 2013, a nearly nine-fold increase from 2004, according to the Ohio Department of Health.
The babies often require complex — and expensive — medical care to wean them off drugs, requiring lengthy hospital stays that can run into the tens of thousands of dollars.
Some of the mothers use right up until the day of the birth. Leigh Ann Marburger of Kettering was two and a half years into a heroin habit, using up to 10 caps a day, when she learned she was five months pregnant. When her son Jameson was born about two months later, she was still shooting a cap a day.
“I didn’t plan it but that’s what happens. People are using,” she said. “They’re not taking birth control because their only thought is heroin, heroin, heroin, heroin. I got to get my fix. I got to get my fix. And they’ll do anything to do it besides do what they need to do.”
Marburger said she tried to get help after a positive pregnancy test but was told there wouldn’t be space open in a treatment program for weeks — a common complaint among heroin addicts. She was able to wean her habit down some with help from family members, but she wasn’t completely clean.
Then her water broke.
“So I had to go to the hospital with heroin still in his system, heroin still in my system,” she said. “Once I saw that baby — three pounds, nine ounces — it was devastating. All I could do is sit there and watch him cry in the incubator.”
Her son, who turns two on Sunday, spent the first weeks of his life in the hospital and then in court-ordered foster care. Marburger’s mother now has legal custody of Jameson and Layna, who was born 14 months after her brother and suffered even worse withdrawal symptoms at birth.
Layna’s addiction was methadone. For 34 weeks prior to her birth, she shared the same medicine her mother drank daily at Project C.U.R.E to keep her off heroin.
“She went through methadone withdrawal. Screaming, crying, tremors, uncomfortableness, restlessness— the same signs as heroin,” Marburger said.
Layna spent 54 days in the hospital, her mom said. Today she’s bright-eyed and agile on all fours, crawling around her grandmother’s apartment where the two children live.
“Neither one of them have any problems, thank God,” Marburger said. “Knock on wood I hope they don’t later on in life.
Ohio has never before encountered the staggering number of infants born with opiates in their systems, and the mounting costs are threatening to overwhelm social service agencies and government at all levels.
It’s become such a problem that the state is spending millions to discover ways to better treat drug-exposed infants, so hospital stays can be reduced.
The average infant born in Ohio in 2013 spent about 3.8 days in a hospital before being discharged at a cost of $13,541, according to the Ohio Department of Health. A drug-exposed baby, however, was hospitalized on average about 15 days in 2013, the most recent year complete state records are available.
The $57,897 cost in 2013 was nearly double that of 2004. Medicaid, the taxpayer-funded health system for the poor and disabled, covered 87 percent of the babies diagnosed with Neonatal Abstinence Syndrome, or NAS, that year, running the tab to taxpayers to $28 million. The total cost for drug-addicted infants in 2013 was more than $97 million.
While Ohio’s 2014 numbers have yet to be finalized, local totals show another increase in cases. Hospitals in 10 counties represented by the Greater Dayton Area Hospital Association reported 216 drug-addicted newborns last year — up from 195 in 2013 and a 38 percent increase from 2011.
Babies’ brains become addicted to heroin in much the same way adults do.
“Once in the baby’s bloodstream (opioids) have access to the brain,” said Dr. Marc Belcastro, a neonatologist with MEDNAX and medical director of Miami Valley Hospital’s neonatal intensive care unit. “They then stimulate all the receptors that those drugs attach to and start to produce the chemical changes that create a dependency situation in the baby’s physiology.”
Withdrawal, when it occurs, typically hits within 72 hours after birth.
“The lack of the drug then causes a very marked set of signs and symptoms that we have to deal with,” Belcastro said.
‘You can’t console the baby’
Lisa Jasin knows too well the sounds of a drug-addicted baby.
“They do a lot of crying,” said Jasin, a neonatal nurse practitioner at Dayton Children’s Hospital where 18 babies were treated for drug exposure last year.
“The cry that goes right through you — you can’t console the baby. They are kids that need alot of attention.”
Excessive or continuous high-pitched crying is the first category listed on the Finnegan Scoring System, used widely by the country’s neonatal intensive care units to guide the treatment of newborns whose mothers test positive for drugs.
Beginning two hours after birth, a baby is evaluated every three to four hours after a feeding using a 22-point checklist of symptoms to gauge neurological, gastrointestinal and autonomic health. Additional signs that an infant is suffering from withdrawal include tremors, frequent yawning, vomiting, diarrhea, poor feeding, dehydration, nasal stuffiness and mottling.
If a Finnegan score is low enough, an infant may get through withdrawal without medication, but huge hospital resources still go into frequent smaller feedings along with holding, swaddling and rocking the babies for 8-10 hours a day, Jasin said.
“Holding a baby for that period of time is much better than giving that baby morphine or methadone after their exposure,” Jasin said.
Most drug-exposed babies — upwards of 80 percent — require medication, however.
“We don’t really believe that opiates for babies are a good thing, but withdrawal in babies is definitely not a good thing, so it’s the lesser of two evils,” Jasin said.
Treating opiate withdrawal in a newborn with morphine or methadone is a balancing act, Belcastro said.
“It’s challenging because you want to make them comfortable because they are in a significant amount of discomfort from the symptoms,” he said. “But you don’t want to over treat and make them so sedate that you’re creating a new problem by aggravating the dependency they already have.”
More than a quarter of all NAS babies exhibit low birth weight, according to statistics kept by the Ohio Hospital Association. The other two most common health problems cited were feeding difficulties and respiratory symptoms.
Seizures also occur, though only in about 2 percent of the cases. Babies born with drugs in their systems are at 10 times greater risk for seizures compared to other newborns, according to ODH.
“I’m very thankful I have not seen a baby seize from withdrawal,” Jasin said.
Ohio’s efforts to reduce hospital stays using best practices have shown results. A May progress report for a study involving hospitals around the state found the average length of treatment for drug exposure went down by a day and overall hospital stays by one to two days, said Rebecca Dupras, a nurse specialist at Soin Medical Center in Beavercreek who also sits on the committee that reports birth data to the state project.
‘Where did my mommy go?’
It’s not always clear if a child’s medical conditions are caused by a mother’s drug use.
Seven-year-old Delaney Godek can belt out “Edelweiss” from The Sound of Music in near perfect pitch but can’t ride her bike without straps holding her feet to the pedals.
Though vibrant and articulate, Delaney runs with difficulty and is prone to falling down, said Becky Short of Beavercreek Twp. who is raising her granddaughter diagnosed with mild cerebral palsy.
“She even asks me, ‘Grandma, am I always going to walk this way? Am I always going to fall down?’ I tell her … it should get better as you get older,’” Short said.
It’s not clear if Delaney’s cerebral palsy was caused by her mother’s drug use. But this much is clear: her mother’s drug use deprived Delaney of a mother.
“About a week and a half ago she said, ‘Grandma, where did my mommy go?’” Short said. “And I said, ‘Delaney, I just hope she went to heaven.’”
Rachel Van Winkle, 36, Delaney’s mother, overdosed on heroin and died last June.
Short believes her daughter’s drug use during her pregnancy, which included alcohol, marijuana, cocaine and the opioid Vicodin, is why Delaney was born seven weeks early. Delaney weighed four pounds seven ounces, was in the hospital for three weeks on oxygen, and came home on oxygen.
Doctors did an MRI when Delaney was two and diagnosed her cerebral palsy, Short said.
“She has trouble paying attention and staying focused. She falls down all the time because she doesn’t have good balance. She walks obviously different from other children,” Short said, and Delaney has experienced grand mal seizures that have required hospitalization.
Short said her daughter felt guilty about Delaney’s situation.
“Throughout the years I’d say to Rachel — because I’d see commercials that would say, ‘If your child has cerebral palsy, call these lawyers and we’ll help you sue.’ I’d say ‘Rachel, why don’t you?’ Short said. “And she’d say, ‘No, mom, no.’ She was real adamant about it. That was why she couldn’t pursue it because she knew it was her own doing.”
As a staff nurse specialist in Soin’s Obstetrics Department, Rebecca Dupras sees two or three drug-exposed babies a month.
Their mothers shouldn’t be ostracized, she says.
“If you sit down and talk with them they all have a reason why and how they got addicted and it’s just so hard for them to get off of it,” she said. “Having a baby just adds one more thing that they are worried about and stressed about.”
Dupras in March began teaching a class to addicted and expectant mothers at the Women’s Recovery Center in Xenia. She hopes to hold similar classes in the Greene County Jail.
Dupras goes step-by-step through what the women and their new borns will experience. She tells them about the Finnegan scale, the potential effects the drugs may have on their babies, the weaning process for opiates, and the realities of Ohio law, which requires health providers to turn over the results of drug screens to children services agencies.
“I have a passion for these moms and babies. They’re human, too,” Dupras said. “Sometimes when I hear people say we need to just throw them in jail, there’s more to them than that. They need the whole gamut: the counseling, the rehab. Just throwing a mom in jail because she’s doing heroin isn’t going to solve the problem.”
Because the heroin surge is a recent phenomenon, data on long-term effects from opiod exposure is limited. What little is known, however, suggests maternal opiate use may impact a child’s mental, motor and behavioral development — at least initially.
Other risks often associated with heroin use include a lack of prenatal care, poor nutrition and other negative socio-environmental factors, health care providers say.
“Babies that are born prematurely — depending on how premature — are at risk for cerebral palsy, they are at risk for lung disease, they are at risk for growth problems, they’re at risk to need oxygen for their lifetimes, they are at risk of asthma,” Jasin said. “All of those things that go along with prematurity.”
Drug-exposed babies don’t exhibit a high mortality rate in the hospital, but the same children are more typically exposed to other environmental factors that increase infant mortality later, Belcastro said.
“Nutrition, socio-economic conditions, access to medical care, follow up, and exposure to other high-risk situations like potentially smoking in the home or other drug use in the home can lead to conditions like SIDS and other respiratory conditions,” he said.
Belcastro did say that maternal opioid use doesn’t seem to negatively impact organ development or cause malformation in a newborn.
‘Just walk away’
Leigh Ann Marburger said she was introduced to heroin by Jameson and Layna’s father.
Soon the two were scrambling to feed a $100-a-day habit, she said.
“It was to the point where I was selling my jewelry, selling my clothes, I was selling everything I could: my laptops, my iPods. Anything I could sell I did besides myself.”
At times she resorted to stealing steaks from grocery stores and reselling them for drug money.
Those days are done, she said.
Marburger reached a milestone in her recovery two weeks ago when she took her last dose of methadone. She has a date in court next month hoping to regain custody of her children.
Marburger said heroin is readily available on nearly every street corner — from Germantown where she went to high school to Miamisburg where she lived for a time and to Kettering where she lives now.
When Layna was in Miami Valley Hospital during her weeks-long stint recovering from her methadone exposure, Marburger was approached as she went for a walk near the hospital by someone peddling heroin.
“My baby was in the hospital on methadone,” she said. “It’s everywhere. I wouldn’t wish it on anyone. If anyone would offer you heroin just walk away. Because once you do it you do it again. It won’t stop.”