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Born addicted: What to do about a growing problem in the Bakken: babies born addicted to drugs

WILLISTON -- As drug use continues to rise in Williams County and the surrounding area, illicit substances are increasingly turning up in the most vulnerable sector of the population.

WILLISTON - As drug use continues to rise in Williams County and the surrounding area, illicit substances are increasingly turning up in the most vulnerable sector of the population.

More babies than ever before are testing positive for drugs just minutes after drawing their first breath in local delivery rooms.

“There has been a rise over the last few years with infants testing positive for controlled substances as well as an increase in reports related to prenatal exposure to drugs,” Christi Osborn, child protection services supervisor for Williams County Social Services, wrote in an email.

She attributes the increase in part to a growing population, better education for healthcare workers as to when and how prenatal substance abuse can be reported, and a lack of in-patient addiction services in the Williston area.

According to the Department of Human Services, which tallies numbers from across the state, the rate of pregnant women assessed for substance abuse problems has spiked in past years. In 2012, 61 pregnant women suspected of using drugs or alcohol were evaluated. By 2014, that number climbed to 83.

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In the northwest corner of the state, made up of Divide, Williams and McKenzie counties, eight women were assessed in 2012, and 15 in 2014.

Records from those two years were the most recent available from the agency, LuWanna Lawrence, public information officer for the Department of Human Services, said.

Helpless victims of addiction

Although marijuana, methamphetamine and cocaine are the substances most often seen here, an increasing number of local newborns have heroin in their systems.

“The most common is methamphetamine, and the one that’s increasing the most is heroin. Pot has been present for years… most of the time they’re multi-users, and it’s hard to narrow it down,” said a source who works closely with foster care and social services in Williams and surrounding counties.

The source, who asked not to be named due to safety and confidentiality concerns, said the babies are often born to mothers who have had no prenatal care, and arrive at the hospital in labor.

If healthcare workers suspect something is amiss, both the infant and the mother are tested for drugs. Positive results usually result in intervention by social services.

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“Depending on the child’s toxicity, it is not uncommon for infants to need medical assistance in detoxing, especially in situations where they are positive for heroin or other opiates,” Osborn said.

Usually, babies experiencing withdrawal are treated at Trinity Hospital in Minot, N.D., although it’s not uncommon for an infant who is still showing symptoms to be placed in a foster home.

Others, though, suffer so much that they must remain in the hospital during the entire detox process, and some even need morphine for pain.

“I have had babies that have been heroin addicted, that have been in the NICU for seven and a half weeks,” the source said. “The cries that these babies have raises the hair on the back of your neck.”

Infants who are dependent on methamphetamine are often born premature.

“When they start with their withdrawal, they’re harder to arouse, they have poor quality of movement, and if their meth exposure is large enough, there’s twitching, sneezing, sweating, and you’re unable to calm them,” the source said.

Shielded information

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The topic is sensitive, and one that a number of local agencies and educators declined to talk about.  

Administrators at Williston’s Mercy Medical Center, the only hospital in the region that delivers babies, would not provide any information on the frequency of infants born there who test positive for controlled substances.

Randy Schwan, a spokesman for Trinity Hospital, where babies born in Williams County are often sent for treatment of withdrawal symptoms, said the facility keeps records of infant patients’ birthplaces, but does not track how many are admitted for addiction.

If such information was available, he added, he did not know whether it would be released.

The owner of a Williston laboratory and drug testing business said he could not speak about the issue after asking permission to do so from agencies, including local medical facilities and social services offices, that he run tests for.

Murky record-keeping

The problem is hard to quantify, due mostly to record-keeping systems that don’t specifically track instances of infants born with controlled substances in their systems.

Positive drug tests done on newborns are reported to the state, but the information is recorded under an umbrella category of child abuse and neglect. Once the incidents are documented, there is no way to pull out numbers specific to rates of prenatal drug exposure, because no separate classification for it exists.

On top of that, there is no defined standard for testing infants. Reasonable suspicion of a mother’s drug use seems to be the barometer used by hospitals, creating the possibility that some exposed babies slip through the cracks.

“We suspect that not all of these cases are being reported,” said Marlys Baker, administrator for child protection services in the children and family services division of the Department of Human Services. “There is a state law that does give doctors permission to test without the parent’s permission, but how often that’s happening and under what circumstances we don’t know. We think there are varying policies in different hospitals on testing.”

The state’s child welfare system, developed in 2009,  is operated by the Department of Human Services. The agency’s information collection is designed to capture what it needs to report to the federal government, which in turn uses three benchmarks - safety, permanence, and well-being - to measure child health state by state.

Regardless of cumbersome record-keeping, Sandy Richter, child protection supervisor for Ward County Social Services in Minot, said she has seen a “significant” rise in babies testing positive for controlled substances at birth, along with older children who are exposed to drugs at home.

Although rising drug use is an obvious culprit, Richter pointed out that increased awareness and mandatory reporting requirements are likely contributing to the jump in numbers there as well.


Task force to examine scope of problem

Such increases aren’t limited to the Bakken region. The issue is causing concern statewide.

At the beginning of last year, the North Dakota legislature created a task force made up of lawmakers and representatives from health care, social services and law enforcement to research the severity of the problem across the state.

The group aims to examine the cost of treating mothers and babies affected by substance abuse, evaluate existing services that offer them help, and figure out how to increase public awareness about the dangers controlled substances pose to unborn babies.

“This (task force) was absolutely needed. We know that this is a concern, we know it’s happening in North Dakota, but we don’t know the incidence or severity. North Dakota does not have one data source concerning neonatal abstinence syndrome,” said Kim Mertz, maternal and child health director for the state Department of Health.

In the meantime, the health department has applied for a grant to study health decisions made by North Dakota women during their pregnancies. A monitoring system like that hasn’t been in place in this state for more than 10 years, Mertz added.

State Sen. Nicole Poolman, R-Bismarck, was the driving force behind the creation of the task force.

Motivated by a foster mother in her district who expressed concern over the number of babies in the foster care system there who’d been exposed to drugs, Poolman realized that gathering information was a critical first step in addressing the issue.

The group’s primary focus, for now, is to figure out the scope of the problem statewide, and how to help pregnant drug users.  

“There is no doubt in anyone’s mind that it is a problem and it is increasing,” Poolman said. “We just want to get as many healthy babies born as we possibly can.”

The group aims to devise ways to offer resources to expecting women, rather than threatening them with legal consequences.

“One of the goals of the task force is insuring that we don’t make it a crime...our focus is much more about providing services for pregnant women,” Poolman said.

Prenatal exposure not a crime

Tennessee is the lone state that considers drug use during pregnancy a crime. In 18 other states, mothers can be accused of child abuse only if their babies test positive for a controlled substance after birth.

In North Dakota, the state’s sole requirements are that a baby be tested and the results reported if there is suspicion that the mother used drugs during her pregnancy.

Local law enforcement is alerted to the births through doctors, social services and sometimes even the baby’s family members. Often, police will present the cases to the State’s Attorney’s office, said Sgt. Detective Amy Nickoloff of the Williston Police Department. Charges are filed in some situations, primarily those that involve older siblings who test positive for drug exposure.

In 2013, Williams County prosecutor Nathan Madden appealed to the state supreme court after district court judge Joshua Rustad dismissed charges of child endangerment against three local mothers whose babies tested positive for methamphetamine immediately after birth.

The court ruled in favor of the women, upholding Rustad’s dismissal of the charges.

In their opinion, the justices wrote that a mother cannot be held liable for prenatal drug use, because unborn children are not considered people under state law. According to the North Dakota Century Code child endangerment statute, a child “means an individual who is under the age of 18 years.”

The law stipulates that the age of a minor or child  “must be calculated from the first minute of the day on which persons are born.”

Madden argued that because methamphetamine remained in the babies’ systems after delivery, causing exposure after birth, the mothers’ prenatal use of the drug counts as child endangerment.

But since offenses such as killing or assaulting an unborn child are clearly defined by the legislature, the court reasoned that the lack of a statute criminalizing a pregnant woman’s use of drugs or alcohol means that those actions, even if they affect a baby after birth, are not considered crimes.

The court cited rulings made in 13 states over more than three decades holding to the same decision. “A majority of states have held that a viable fetus is not a child for purposes of criminal prosecution of a mother who ingests a controlled substance during pregnancy,” the justices wrote.

Madden declined to talk about the case.


Gauging the need for separation

Although separation of mother and baby isn’t a preferred option, a number of factors, foremost of which is the child’s safety, play into what comes next after a positive drug test.

Social workers take into account what substances were found in the infant’s system, the severity of the exposure, whether other family members or close friends are willing to care for the baby, and if the mother is receptive to seeking help for substance abuse.

Keeping families together is a primary goal, but when authorities are skeptical, arrangements are made with a foster home. Mothers who cooperate with social services by undergoing addiction evaluation and agreeing to regular drug tests have the chance to regain custody of their babies within about a month. Those who don’t work with authorities are likely to lose custody for up to a year. If the mother hasn’t made efforts within about 15 months, she could face termination of her rights as a parent.

‘We can’t get them into treatment’

Citing numerous instances involving egregious drug use in Williams County by mothers and pregnant women, including examples of some who used cocaine for labor pains en route to the hospital and others whose drug use resulted in deformities for their babies, the source who’d spoken on the condition of anonymity expressed frustration at limited consequences for women who abuse controlled substances while pregnant.

The lack of criminal charges, or a mandatory requirement for treatment, grants license for mothers to continue with heavy drug use and walk away from babies after they are placed in foster homes, she said.

“The addiction is so strong, unless they’re charged we don’t have anything to hang over their heads. My reasoning is the addiction is stronger than the maternal instinct. None of them chose to be addicted but we’re stuck because we can’t get them into treatment,” she said. “It sounds like I’m on a witchhunt to prosecute drug abusing mothers… I’m not, I just want them to get help. Where does society say enough, because all these children are affected by their mother’s prenatal drug use.”

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