“By the time she was 15 months old, her behavior was so bizarre,” Wozniak said. “We couldn’t get her to stop laying in front of the dog dish and eating out of the dog dish and drinking out of the water. If she’d catch the bathroom door, she’d go in and dump her head in the toilet.”
Wozniak knows of another local foster child born addicted to heroin who died in her sleep. She was 3 months old.
Nazareth Home in East Chicago was founded in the early 1990s to care for babies born with AIDS in Lake County. Now the foster home for medically challenged infants and toddlers mostly sees newborns dependent on drugs, mostly heroin.
“Babies being born drug-addicted is a huge problem and huge issue right now,” said Jean Bowman, director of Nazareth Home. “I don’t know what’s going on that we have such a big crisis with the drugs.”
Treatment does look to be expanding in Indiana. The federal government recently awarded the state $10.9 million to combat the opioid epidemic, 80 percent of which has to be spent on treatment.
The state Legislature also has allocated $5 million over each of the next two fiscal years for substance abuse treatment, prevention and enforcement, and passed more than a dozen bills during this year’s session to fight the opioid crisis.
Two of them included pilot projects to expand treatment for pregnant women. One will test the best ways to pay for training for OB/GYN doctors to prescribe drugs such as buprenorphine for medication-assisted treatment, and to detect and treat neonatal-abstinence syndrome in babies and provide drug treatment to moms.
Another pilot project will set up residential drug treatment facilities for pregnant women and mothers of newborns in Indianapolis, Winchester and southern Indiana.
The latter program is modeled after the Fresh Start Recovery Center in the state capital, run by Volunteer Services of America Indiana. That center is believed to be the only in the state to treat pregnant women and new mothers, who are allowed to keep their newborns with them. The women also are taught parenting skills.
“If we can get pregnant women in, they can have babies while staying with us and can bring the babies after,” said Shannon Schumacher, executive vice president of Volunteers of America Indiana. “Then we can have babies born without drugs in their system, avoiding all the NICU stays.”
That program, however, has a waitlist of about nine to 10 months and roughly 140 women. The facility is expanding, though: It recently doubled its bed size, to 30 from 15, and is adding another 30 beds by the end of the year.
In addition, the managed care companies in charge of the state’s Medicaid programs have joined with community mental health centers across the state on a pilot project, called MOMentum, to reduce neonatal abstinence syndrome. Eight facilities — including Valparaiso-based Porter-Starke Services and Swanson Center in LaPorte — have expanded their medication-assisted treatment offerings, including buprenorphine and methadone, and promised to get pregnant women and their partners into immediate treatment.
So far, though, all these programs are only being tested and available in certain parts of the state.
The state Department of Health just recently started trying to determine the extent of the perinatal drug use in Indiana. The initial pilot project, in 2016, scored four hospitals, which had a neonatal abstinence syndrome rate of twice the national average. The screening initiative has since expanded to 26 hospitals across the state, including, in Northwest Indiana, the Franciscan health hospitals in Crown Point, Dyer, Hammond and Michigan City.
Only a handful of states mandate drug testing for new moms and infants; Indiana isn’t one of them. That could change once the health department is done collecting its data.
“We will likely request universal screening based on the results,” said Martha Allen, director of maternal and child health for the Indiana State Department of Health. “We want to increase our sample size first so we have confidence in the prevalence.”
Hospitals now have to be equipped to treat neonatal abstinence syndrome. They first determine whether the baby is dependent on drugs and needs to be transferred to the NICU by using the Finnegan scoring system, which quantifies withdrawal symptoms.
Treatment is done by giving the baby opioids, such as morphine and methadone, eventually weaning them off, as well as fluids and high-calorie formula. NICU staff also provides comfort measures to the newborns.
“The aim is really to have a child be less stimulated,” said Dr. Kemi Mascoll-Robertson, a neonatologist with Methodist Hospitals in Gary and Merrillville, which saw its cases of neonatal abstinence syndrome increase to 22 in 2016 from 14 the year before, with an average NICU stay of 31 days.
“You want to minimize light and sound: a quiet room, dim light. You also want to swaddle that infant, mimic how they feel inside the womb, gently rocking and cuddling them.”
Community Health Network hospitals in Indianapolis has perhaps the most comprehensive approach to treating drug addiction in pregnant women. They are tested for drugs at their first prenatal appointment. Women who are addicted to opioids are prescribed Subutex, or buprenorphine, an opioid replacement medication (Suboxone generally isn’t used because the ingredient naloxone is believed to be harmful to the fetus). A behavioral health specialist counsels the women on their addiction through their delivery. Care coordinators hook up the moms with social supports in the community.
Not all those services are reimbursable by insurance. “We’re doing it because it’s the right thing for the patient, who, in the long run, has better outcomes,” said Donetta Gee-Weiler, vice president for women’s and children’s services for Community Health Network.
In the first year of the program, she said, the hospital system saw a $4 million savings and cut the number of pregnant women who tested positive for drugs at their first prenatal visit in half by the time of their delivery.
Five years later and having regained custody, the Valparaiso couple’s child is healthy and entering kindergarten. He hasn’t had any developmental delays as a result of his neonatal abstinence syndrome.
“I thank God,” said his father, who would only speak to The Times if the newspaper didn’t identify him. “He’s advanced in every way. He’s quick-witted, smart, asks questions.”
The father said there simply aren’t enough treatment options in Indiana for opioid-addicted people, pregnant or not. Even if there were, he said, the stigma surrounding addiction often prevents parents from telling their doctors the truth.
“We were guilty, ashamed, to reach out for help when she was pregnant,” he said, “because of judgment, because we were afraid of getting our child taken away.
“It’s a difficult thing to go into a doctor’s office and say, ‘I’m addicted to heroin.’ For any rational person, that’s what you should do to save the baby. But when there’s that much guilt and shame, it makes it very hard.
“You’re essentially asking somebody to say, ‘You think I’m the biggest piece of s*** in the world, and you’re going to talk about me when I get out of here and say what a horrible person I am — but can you help me?’ ”