Babies born with opioid addiction

by L

Caring for babies born with opioid addiction – what are Totebaggers’ thoughts? What policies would help? What do you think about this mother’s chances of gaining custody? How about her naming choices?

A tide of opioid-dependent newborns forces doctors to rethink treatment

Also:

When the Mother of an Opioid-Dependent Newborn Hears, ‘You Can’t Have Your Baby’

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69 thoughts on “Babies born with opioid addiction

  1. When my son was in the NICU, there were some babies who were in there for this reason. It was heartbreaking. Unlike the preemies who were quiet and resting most of the time, these babies were agitated and seemed to be in pain. Some people really just have no chance in life.

  2. In terms of the front of the class vs. back of the class nature of America’s problems, I wonder if part of what makes these problems so daunting is that the people charged with fixing them fundamentally can’t (for lack of a better term) grok those who have them.

  3. Based on the fact that they gave custody of the newborn to the grandparents, I think the mother’s odds of getting custody of her kids are quite good. In the situation I’m thinking of where long-term custody was improbable (pregnant mother was in prison; already had 4 kids in foster care), DHS gave the mother the option of choosing adoptive parents from a portfolio as a voluntary adoption or telling her the twins would be put in foster care at birth with a slim chance the mother could regain custody after her release from prison. I know the situation because the mother chose my acquaintances as the adoptive parents.

    Like Birdie, when I spent a month in the antepartum unit at the hospital, I was the exception for being educated/middle class. Nurses are used to mothers sneaking out of antepartum care without permission for harmless stuff (like non-hospital food) and harmful stuff (like drugs, alcohol, smoking). I just stayed in the hospital and ate their crappy food. None of my observations (I was across from the nurse’s station) conflicted with my worldview.

  4. Babies can suffer withdrawl from a wide variety of drugs and alcohol used in high levels during pregnancy. The treatment seems to be fairly consistent – to wean the child off the drug or give drugs that reduce the withdrawl symptoms. The bigger issue with opioid withdrawl appears to be the treatment is with narcotics as well.

    I sometimes thing we look too much at first cost and not total cost. Based on the article, we don’t seem to provide encouragement for those who are trying to get off the drugs. I understand there is a highly likelihood of relapse, but taking a child away from a mother who wants them and is trying to get clean seems to be a disincentive.

  5. When it was crack-addicted black babies born to black women, no one was trying new models or writing sympathetic articles. Instead, it was all about “put those babies in foster care and throw that evil mom in jail!”. Funny how times change, or maybe it is the skin color?

  6. I don’t know what the right answer is here because I think it is extremely difficult for anyone to completely get off these drugs. To answer your question about policy, the doctors and dentists in this country have to stop prescribing so much of this garbage for simple procedures. If someone has a tooth pulled, the normal course of treatment doesn’t have to be vicodin or percocet.

    We spend a lot of time and money at the dentist and dental specialists. We don’t have a high tolerance for pain, but we always manage to survive by using ibuprofen or acetaminophen to avoid filling the prescriptions that they routinely give us after major procedures. We don’t have any of the same providers, but all of our dental providers continue to offer these strong narcotics -even if it just for a few days.

    I think the system can start to take small steps to insure that fewer people ever try, or utilize an opioid. As for the people that are already on this road, it seems obvious that there are not enough beds in the right types of treatment centers to help them through a real recovery.

  7. MM – or maybe it’s just the sheer numbers.

    My dad’s good friend is raising his grandson at age 60 because his daughter is addicted to heroin. I don’t think the kid was addicted to opiods when he was born but I could be wrong. The mother gets her act together and then falls off the wagon again and again. It’s really sad and this is an upper middle class nice family. My cousin was friends with the mother in high school and I think my cousin did dabble in drugs but never went down the heroin path.

  8. Lauren – totally agree. We were prescribed oxy after DD’s appendectomy and she was completely fine with just ibuprofin.

  9. Lauren,

    I’m sure most of us have taken a Percocet or a Vicodin prescribed and thought, “Meh.” A small percentage of people take their first Percocet or Vicodin and they instantly think, “OMG this is the best thing EVER!’ For the 95% of the population that isn’t going to get addicted why should we suffer? Maybe implantable naltrexone that renders opiods ineffective is a better bet than immiserating 95% of the non-opiod addiction susceptible population.

    http://alcoholrehab.com/drug-addiction-treatment/naltrexone-implant-for-opiate-dependence/

  10. Remember that the under-treatment of pain was a real thing. Advocates really wanted doctors to treat pain more seriously so that patients could be more comfortable, especially those with chronic diseases. That said, the pendulum has swung too far.

  11. I don’t think 95% of us are suffering when we have minor dental or medical procedures. If you have real pain, then the stronger drugs are warranted. I just don’t think that some people even need to start on the stronger drugs.

  12. I worked in Newark at the height of the crack epidemic, so I saw firsthand the pain and devastation it caused. It was very similar, and terrified everyone, but white people only saw it in terms of how it was increasing the crime rate, how it was costing taxpayers money to treat those babies and children, how cities like Newark couldn’t attract white professionals because of it, yada, yada, yada. The discourse of the era was very much about the white “us” being scared of the crack addicted “them”. Democrats and Republicans alike pushed tough on crime bills that decimated the inner cities even further. Nowdays, the coverage is all about the pain and sadness of white rural America, and the evil healthcare system that preyed upon them. But the crack epidemic was also about despair and poverty, but no one was listening then.

  13. MM – I would like to think it is because we have a greater understanding and more empathy. But I don’t think that is the reason.

  14. Both articles mentioned UK Med Center. I worked there in the summers when I was in college, back in the dino days. UK Med Center is the main advanced level hospital serving Eastern KY – it is where the cancer patients, and trauma victims get sent. I saw a lot of very depressing people – sometimes famiilies where the kids had no shoes and the adults no teeth – sitting around in the waiting areas. Drug addiction was already a big issue – mainly heroin then – and addicted babies were coming in even back then. Marijuana was a big cash crop, and the turf wars over it often resulting in people getting shot – trauma victims racing in by helicopter. Social dislocation and addiction are not new to the area.

  15. If you have real pain, then the stronger drugs are warranted

    Who decides what real pain is? What criteria should they use?

    WINSTON-SALEM, N.C. – Brain imaging confirms that some individuals really are more sensitive to pain than others, report researchers from Wake Forest University Baptist Medical Center in this week’s on-line edition of the Proceedings of the National Academy of Sciences

    https://www.sciencedaily.com/releases/2003/06/030624090043.htm

  16. The rea issue is the lack of research into better methods of treating pain. Opioids are not even all that effective over time, as I saw when my father struggled for years with severe back pain. The real shocker to me, though, was when my kid was in treatment. They would try to use morphine for his pain, and it just didn’t work. His breathing would get too depressed too quickly and they would have to back off. Later, when he spent 2 years in an exceedingly painful treatment regimen, the morphine and other painkillers would make him itchy and cranky (like really cranky, like throwing things across the room cranky) but never touched the pain. The only other thing they could offer was a woman who did integrative medicine, something kind of like Lamaze for very sick toddlers. She worked with all the kids on that trial. It was a little bit effective, and didn’t depress breathing or make them crazy angry, but clearly something better than that was needed. Unfortunately, good treatments for chronic pain are not seen as all that important.

  17. Opium has been a problem for decades. Prior to the 1900s it was used widely in a variety of forms includeing laudanum and in patent medicines. It was the ibuprofen of the day. Mother’s gave it to fussy babies even and because its strength wasn’t regulated, sometimes killed them. In the early 1900s it became a controlled substance, in part due to the wide spread use and addiction.

    So history repeats itself. Only now the problem is two-fold – those who become addicted to the illegally obtained drug and those who become addicted to the legally obtained version.

  18. Atlanta Mom, the issue with PT is that it isn’t all that effective for real pain. It probably helps to heal from not-so-serious injries and orthopedic issues, but after a certain point, it just doesn’t help.

  19. Birdie, I agree, and in Appalachia, addiction has been a problem for 40 or more years – alcohol, heroin, later meth, and now opioids.

  20. What a sad story, but since you asked about the baby’s name — what is with the hyphens? This poor child was handed a raw deal from conception, and when she is older she will waste hours of her life spelling her name over the phone and correcting errors in official paperwork.

    And interesting that there was no mention of a father. The rooming-in idea seems to be a good solution though.

  21. It makes sense that babies would improve from being with their mothers and being touched more (less stress). From what I’ve read addiction stems from being in a low dopamine state (as do a lot of neurodegenerative diseases and depression) and low dopamine is caused by bad sleep, poor diet, cell phones, lack of full spectrum sun, and stress. Poor people have chronic stress which leads to low dopamine and I think the reason you’re seeing an increase in addiction across class lines is the increase in all of the things that happen in modern life – blue light/stress/disrupted sleep and poor diet. It’s no wonder that the opiaite crisis has increased exponentially in the past 15 years.

    My MIL always says she has an addictive personality (not drugs but gambling, cigarettes and shopping) and a messed up sleep schedule (likes to sleep from 3 in the morning to noon) but I think she could easily improve all of that if she was willing to go outside in the sun in the morning and eat better. She watches television until 3 a.m. and drinks tea/coffee into the night and then throws her hands up and says she can’t sleep. And when she goes outside she has these sunglasses that let in zero light. I took her to the casino twice while visiting and I could not get to sleep for hours afterwards – all of those blinking lights late at night.

  22. Scarlett – that was what got me (although I thought it was apostrophes?). Rhett’s technocratic utopia with a list of approved names sounds good to me, although I would also have the SSA kick back names if not OK. Jayla? Fine. Jay’la? NO. Of course I realize that this is a pipe dream.

  23. What’s behind the name? Is it to stamp them as white trash in an act of class solidarity?

  24. Apostrophes in names are very common in the black community. I get piles of such names in my classes (De’Andre, Na’Kyla, for example). I think the practice is migrating to white people in a similar economic class, though, probably for a similar reason ( a sense of uniqueness and hope for one’s baby in a world where there isn’t much of that)

  25. I think part of the issue for giving high level pain meds for “everything” is that people have a low tolerance for believing they should experience any pain. Some people believe that we live in the Star Trek era meaning that after the initial injury, your treatment and healing should result in no pain and the doctor should give you as much as it takes to keep all pain at bay.

    I think this is why people do not follow through with PT. If often requires dealing with some discomfort if not pain. When I had frozen shoulder (both shoulders) I was seeing a PT. When one shoulder wasn’t responding she sent me to an orthopedist. He gave me an injection in that shoulder and suggested I continue with PT. He said, we can operate, but fair (haired/eyed) people tend to scar more easily. You could be in more pain after surgery. If at all possible, work through what the PT does, even if she makes you cry. You’ll most likely have a more pain-free future. He was right, at a certain point in almost every visit, the treatment was painful. But, in the end I have full range of motion and no residual pain.

  26. The mom had already lost custody of her first child to the grandparents. The state had ample reason to award custody of the second child to the same grandparents. The mom also delivered not in the hospital where her supportive OB GYN was located, but in the ambulance and was transferred to the nearest small hospital. The baby needed treatment in a suitable facility, so any plans that might have been worked out with the doctor at his hospital fell victim to circumstance. The mom spends all day caring for the baby in her parents’ home, but the authorities won’t let her be there at night – perhaps they have good reason to think she will abscond with the kids while the grandparents are sleeping. It seems to me that the particular situation here is being handled reasonably well and the kids are loved.

    Would anything change if the kid’s name was Sophia?

  27. hope for one’s baby

    Hope that their resumes end up in the trash? I can’t believe it’s about hope. It’s got to be something else.

  28. I think this is why people do not follow through with PT.

    So the options are treat the pain of fundamentally changing human nature? I don’t know that option 2 has a lot of promise.

  29. Rhett, a lot of these women have never written a resume. How would they know?

  30. AustinMom, I am with you on PT for conditions that are fixable. But what do you tell the person who has severe degenerative arthritis in their spine? It isn’t fixable. PT may help at the margins, but if it is very painful to do the PT, many people (and their doctors too) get scared and think they are making things worse. It is often very hard to tell if the specific exercised are a good idea or not. Even many physical therapists disagree as to approach, which makes it scarier and more confusing for the patient.

  31. Rhett, I think willingness to experience pain to minimize risk of addiction or in light of some greater good (long-term freedom of motion, for example) ties into the overall ability to defer gratification that is both a cause and an effect of social class.

    I think addiction among black mothers was written about more frequently a decade ago because journalists disproportionately live in places where disadvantaged people are black. (Partly this is because journalists tend to live on the East Coast.) I think Trump’s election has influenced journalists to write about black, Hispanic and white disadvantaged people. The percentage of disadvantaged people by race varies geographically. I don’t think disadvantaged people have changed; I think journalists have changed.

  32. MM – I don’t disagree with you. The only point I was trying to make is that more and more people seem to have this notion that nothing should ever “hurt”.

    My mom had polymyalia rhuematica, which can be quite painful, and PT is not a solution for dealing with the pain. She took meds for pain control and then she could do mild exercise. She also fell and broke her pelvis, but not so severely to need surgery. They needed her to start walking within 48 hours in the hospital. Enough pain meds to take all the pain away meant she couldn’t feel her feet to walk. They gave her enough to take the edge off, but those first couple days of walking were painful. The PT/OT said that often the elderly won’t push through that pain and end up in a wheelchair.

  33. I have encountered this with the OT prescribed for my thumb joint pain. The therapists keep telling me that right way to do the exercises is so weakly that they don’t hurt. Well, my thumb joints hurt much of my waking hours even at rest. I don’t mind the pain when I do the exercises if they reduce the amount of time in a day I have pain. (I can’t take ibuprofen for unrelated medical reasons). I am perplexed by the advice and have given up on the appointments, although I kept the exercise sheets.

  34. I think people’s perception of pain varies dramatically. Much like how different people report different sensitivities to things like tags on clothing. Or certain shoes. That stuff has never bothered me. I have a really high pain tolerance. I think it all goes together. You can’t really blame someone for wanting pain relief if that person perceives it to be worse than others do.

  35. Birdie – agreed. Although I think it can also vary by age with the same person. I am not that old and I can’t wear itchy wools like I used to. However, I have a really high pain tolerance (in the judgment of the docs who delivered my kids).

  36. Completely unrelated threadjack. Can someone explain to me why Comcast insists on this weird business model where the more services you get, the less you pay? I wanted to remove the home security system from the California house and they wanted to jack up my total monthly payments by $45! I don’t get it. I really don’t. And when I was fussing with about the Denver service I had to get phone service (which I don’t ever use) in order to get a decent monthly rate. It’s really weird.

  37. Huh. I keep an eye on the monthly bills, and when my Denver one went up sharply, I called immediately. That was when it turned out I had to add a phone to bring it back down. Well, I won’t worry about that one for another two years. Who knows, maybe in two years technology will have completely changed.

  38. RMS, I think you’ve got their system figured out– just call them when your current deal expires and they jack up your price, and get whatever is the cheapest deal they’re offering at the time.

    We should try that approach now that Comcast has bought out our cable provider (formerly Time Warner). But I’m not sure how much that’ll help; the bundled, limited time, price they’re offering for landline is more than what we’re paying our local telco.

  39. Heartbreaking topic. I don’t believe in cutting off contact between parents and their offspring, but kids obviously need to be able to rely on routine and on provision of life’s necessities. The possibility of a child’s desire to know their parents and know they please them should not be underestimated. Either a residential program for both or visitation while the child is in someone else’s care for years would make sense to me.

    Off-topic: many (most?) of you are more skilled at the art of the carpool than I. This year, I’d like the saacster to ride to school with a neighbor. I just can’t see driving him when there are busses available, and he doesn’t want to ride the bus. The girl’s mom is very willing for her daughter to take him. I am uncomfortable with the idea of them doing us a favor all year long. I’d like to offer to pay for her parking space at school, or at least half of it. Does that make sense?

  40. “Unfortunately, good treatments for chronic pain are not seen as all that important.”

    Yes. I had a friend with a chronic pain issue, and one complaint he had was that pain seemed to always be considered a symptom, and not a medical issue of its own.

    One ramification of this is that pain treatment was often given short shrift relative to the problems of abuse, and pain sufferers, especially those whose pain wasn’t definitively attached to some other condition, had difficulty getting appropriate meds.

    Another ramification is that there’s not a lot of research into treatment of pain directly.

  41. SM, IMO, paying for parking seems like a reasonable offer. I would also be uncomfortable with my kid just riding and us not contributing in some way.

  42. In my town, it is rare to reimburse other parents for driving even if they drive all of the time. I know the opposite is true when HS kids carpool with the older HS kids. Parking is free at our HS, so the kids or parents will offer some amount for gas or insurance. I think it is reasonable. Lots of HS kids do not like to take a bus, so they seem to grab rides with other kids. It seems to work better in the mornings since many kids stay late for sports or other activities.

  43. When I was the HS driver (no bus available) taking a younger student with me, they paid me gas money each week. I’d figure out if parking permit or weekly gas money is a better deal for the driver. Girl’s mom vs girl willing are two different things. Girl having more spending money can make it easier.

  44. So sad. Wow. As a recovering addict (seven months clean and counting every day) this really strikes a chord with me.
    Through my five year long battle with opioid addiction, I learned so so so much about addiction, withdrawal, relapse, rehab, drugs themselves, strategies for staying sober… the list goes on. Anyways I decided to put my knowledge to use and so I started a weekly podcast called Addictions on iTunes and googleplay.
    I feature valuable insight for anyone effected by addiction check it out if you get a chance. My WordPress site will lead the way to your listening pleasure.

  45. SM – the parking permit or gas money is reasonable.

    On a similar note if trying to repay neighbors for inviting my kids, now that we belong to a pool club, I have spent weekends taking groups of kids to the pool. It’s quite interesting. It is great to have kids that don’t need active supervision. They love the pool snack bar. This weekend I let the kids get things they would ordinarily not be allowed to eat.

    On pain, the home country dentists growing up used very little pain medication so going to the dentist was a very painful experience. I was pleasantly surprised when I couldn’t feel a thing in a typical U.S. dentist office.
    Same thing with labor & delivery, though now I think over there they give women pain medication.
    I had to suffer the pain from a kidney stone but luckily my GP in the home country administered pain medication. I wasn’t admitted to the hospital, was treated at home.

  46. I actually love talking about naming more than I like talking about opioid treatment and withdrawal. Here’s a good article on African American naming, http://www.salon.com/2008/08/25/creative_black_names/

    with an interesting factoid:

    “Then, in the 1960s, something changed, resulting in an unprecedented spike in black creative names, to the point where just a few years ago, “Freakonomics” authors Steven Levitt and Stephen Dubner noted that “nearly 30 percent of the black girls are given a name that is unique among the names of every baby, white and black, born that year in California.” “

  47. SM, when my daughter rode with a neighbor to HS, I estimated what had woukd be for a week (18 miles each way) and have her a little over half. When a boy asked my daughter to drive him, he did the same thing. A lot of high school kids have to pay their own gas, so I think it’s appropriate to have him pay her.

    On kids keeping in touch with addicted parents, I think it is very situation specific and is not possible to make a blanket statement for or against. My inlaws who ended up adopting their foster kids put a lot of effort into keeping the birth parents connected. However, for one of the kids it was awful. The mom was frequently a no show, was occasionally really bad-tempered, always made promises she couldn’t keep, and heaped tons of guilt on the little girl for ending up in nicer circumstances than she had left. It did such a number on the little girl. Then the mom got pregnant again and talked about her plans for keeping that baby. The therapist recommending reducing the visitation, and the mom just quit coming around. (They had another where they helped the teen dad get custody, and they are still his babysitter when he works nights, so great outcome.). I think the decision has to be based on what’s best for the child, and the desire of the parent has to take a lower priority if the instability is damaging to the child.

  48. Unfortunately, good treatments for chronic pain are not seen as all that important.

    I cocompletely disagree. The problem is they haven’t been able to develop good treatments for chronic pain. People in the medical field think this is incredible important, but we are very limited in what we can do. I have patients with chronic pain, and my options are painkillers/narcotics, refer them to a specialist depending on the type of pain (ortho for joint/back pain, Neuro for neurological pain, etc), or send them to a pain clinic.

  49. DD, do you disagree with the perception that pain is largely looked at as a symptom, and not its own medical condition?

  50. Chronic pain is certainly looked at as a it’s own medical condition. We give out discharge instructions all the time to patients that try to convince them as much.

    Recently heard a short lecture on innovations in back pain care. Basically the message was, “lower the patient’s expectations.” That’s what’s new in 2017. “Wow, that pain seems really severe. You are going to need to do heat, and ice and anti-inflammatories. Wow, you can’t work? That’s going to be really rough. Maybe more time for PT? One thing I want you to know is that half of all people who present to the ER with back pain will be still having pain 1 year from now. Yeah, wish we had something to do for that.

    Good luck!” P.S. Your copay is $500 and we will be billing you for $2500 later and we can’t give you narcotics for subjective complaints.

  51. Is a “subjective complaint” contrasted with something like a broken bone, where others can agree that there’s something wrong there?

  52. Yes. Many ERs are refusing narcotics for subjective complaints. These include back pain, dental pain, headache, endometriosis, irritable bowel syndrome, fibromyalgia. These are conditions which anyone can claim at any time and ask for narcotics. Contrast with broken bones, kidney stones, appendicitis, and abscesses.

  53. Ada – I think any type with nerve pain, that doesn’t show up on even advanced tests falls in this category. Family member was diagnosed with IBS. Pain was real and has subsided with both diet and pain medication but I could tell some physicians thought the pain was not real.

  54. Louise, do you mean Irritable Bowel Syndrome? Not Inflammatory Bowel Disease, I hope.

  55. “Yes. Many ERs are refusing narcotics for subjective complaints. . . . Contrast with broken bones, kidney stones, appendicitis, and abscesses. “

    My point exactly.

    A few years ago, my dad developed a severe back pain, the source of which his doctors could not determine, so his pain went largely untreated, and he was so miserable he pretty much stopped eating and started wasting away.

    When he became bedridden, he was moved into hospice, where the priority was making him comfortable, and his pain was treated more aggressively. Out of pain, he began eating again, and 6 months later he was kicked out of hospice.

    Socially, we seem to have prioritized keeping pain medications out of the hands of potential abusers over making them available to those in pain. The assumption seems to be that someone without a diagnosis that explains the pain is more likely to be wanting pain medication to get high or feed an addiction as opposed to treating real pain with an indeterminate cause.

    But that doesn’t seem to be working very well. I wonder how much worse things would get on the abuse side if things were allowed to get better on the treating of pain.

  56. Thanks, everybody! They’re buying parking permits this week. I like this better than gas money because it’s not tied to individual trips in any way, and because I can just be done with it, not have recurrent discussions about it. I’m giving her the money for the first semester, won’t think about it again until new years.

    On pain, the home country dentists growing up used very little pain medication so going to the dentist was a very painful experience. I was pleasantly surprised when I couldn’t feel a thing in a typical U.S. dentist office.
    I am so sick of arguing with my kid over brushing his teeth that I’ve told him I’m not paying for pain meds when he needs fillings. He has a cavity now, filling is in a few weeks. I’m curious how that will change his dental hygiene.

  57. Sorry, I missed this comment, but you’ll be hard pressed to find a dentist to do a filling without anesthesia. Do you mean lidocaine? Or general anesthesia? I think it would be considered malpractice at this stage to do fillings without lidocaine?

    Finn- I agree that is a problem. There is a difference, however, between denying pain medication from Emergency Departments, where staff have little familiarity with history, course of illness, etc. and a primary care provider who should work aggressively and with multiple modalities to diagnose and control subjective complaints.

  58. Yeah, S&M, I can’t imagine a dentist willing to skip anesthesia.

  59. “People that are transgender, they don’t choose to be transgender, they’re born that way, and why should we hold that against them?”

    Orin Hatch, R. Utah. It’s like we’re living in bizzaro world.

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