In a symposium in Lebanon last week organized by Indiana Farm Bureau and the Indiana Agriculture Leadership Institute, Lt.. Gov. Suzanne Crouch spoke on Indiana's opioid addiction crisis, along with others who explained its various impacts—one being the crisis' impact on children.
Ranked 17th in the nation for opioid overdose mortality, Indiana is considered well into the clutches of the crisis. Across the country, an average of 175 people die from substance abuse overdoses per day—that's seven per hour. Panelist Kevin Moore, director of the Division of Mental Health and Addiction, said that many are first exposed to opiates by their doctors after a surgery or accident which requires pain management. However, when the addiction escalates, individuals may go elsewhere to satisfy cravings.
"Prior use and addiction to prescription drugs is one of the greatest risk factors to eventually using heroin," Moore said. "And I don't think the crisis has necessarily reached its peak."
Crouch said the governor's office has deployed many efforts to fight overdose mortality in the state so far, including syringe exchange programs, tighter regulations on opioid prescribing, enhanced penalties for pharmacy robbery, creating an executive director of drug prevention, treatment and enforcement position, and launching a website to disperse information and resources.
"This enemy has visited far too many homes, and it knows no demographic bounds," Crouch said. "It is affecting every age and socioeconomic group. Rural Indiana is particularly at risk because we have lower levels of income, higher levels of pain prescriptions and a lack of appropriate treatment facilities."
An overlooked result of the opioid addiction epidemic is the impact it's had on children. Another panelist, Cassie Frazier, director of Boone County's Sylvia's Child Advocacy Center, said she and other child advocates have seen a change in the cases reported to them.
"In the last year I have seen most of my interviews move from just looking for disclosure regarding sexual abuse, to investigating what the home is also looking like," Frazier said. "We've had a lot of reports of drug use during acts of physical and sexual abuse. We have also done a lot of investigations recently over neglect situations where the parents may have been intoxicated when something bad has happened to their child or a baby death. We've seen a huge increase in those things."
Across the state in 2016, 53 percent of children removed from their parents were dealing with drug abuse in their homes, Frazier said. Frazier's agency is working with other agencies to ensure affected children get the help they need.
"The trauma aspect behind drug abuse—seeing their parents need Narcan several times, seeing police at their house several times, being removed from their home—it's very traumatic," she said. "So at our center, we try to get the investigation done as soon as possible, and then get services started for therapy as soon as possible. We know that if we intervene as soon as possible, kids will have a better shot."
Once removed from a harmful environment, Frazier said affected children are not yet out of the woods. Every time a child moves foster can homes or schools, they fall six months behind in school work.
"And every time they are put behind, the more likely they are not to graduate high school," Frazier said. "Which then again adds to this cycle we're going through."
But the challenges a child faces due to drug use can start much earlier than school age. Frazier said babies who are born addicted due to their mothers' drug abuse during pregnancy may suffer mental consequences later in life.
"Currently we are seeing some increases in behavioral problems at school—you'll hear things on the news about oppositional defiant disorder, ADHD, things along those lines," she said. "Those will probably slowly increase as these children who are born addicted start entering the school systems, and there might need to be extra help for those children or special services for those children, because we do not know what the exact effect of being born addicted has on the brain."
Lisa Suttle, director of strategic initiatives and community psychiatric services at Reid Hospital in Richmond, was another panelist who had first-hand experience with the affect that drug-addicted parents can have on a child. Her hospital takes in numerous cases of neonatal abstinence syndrome (NAS) per year—that is, the symptoms caused when a baby withdraws from drugs that were exposed to them in the womb.
"There are effects on a baby, and those are things that we watch very closely," Suttle said. "There are very, very patient people that work with these babies when they are born. There are a lot of things that we do that is not medication-focused. It's really about holding the baby, calming the baby, those kinds of things."
Symptoms of NAS include a high-pitched cry, yawning, frantic sucking, nervousness and seizures in some cases. Though normal babies experience some of these symptoms, they are extreme in NAS cases.
"One thing we see is a very high-pitched cry, and I don't know if anybody's ever heard that before, but it's something that you don't forget," she said. "When these babies are born into withdrawal, they stay in the hospital the whole time through that process. There are times when we give them opioids and sometimes that is morphine, and then we wean them off that in a safe manner."
NAS babies must be weaned off opioids slowly because cutting them off all at once is inhumane. Much like addicted adults, babies can be in great pain during withdrawal. Suttle said in 2016, Reid treated 58 mothers who tested positive for opioids at delivery. In 2017, those numbers rose to 101. But there are signs of hope, she said.
"The good news is in the last six months of 2017, we only had two mothers test positive for heroin. They are testing positive for medication-assisted treatment medications like methadone, which is an indication to us that they are in treatment."
Methadone, commonly used to treat heroin addiction, must be withdrawn from slowly and can be bought off the streets, which is why Suttle said Reid is going to start a program where mothers can be transitioned to methadone under the care of a physician. Like all other panelists, Suttle said awareness is and will be the key to ameliorating the opioid addiction crisis in Indiana.
"Awareness is huge for us in our area—some people think they know what's happening, but when you start talking to them, they really don't," she said. "So it's important we educate our hospitals and our communities."