Opioid abuse has destroyed the lives of countless Indiana residents.
But increasingly, the state’s smallest and most vulnerable people are left in its wake.
Tiny newborn babies wail, tremble and fidget in the neonatal intensive care unit of local hospitals, their bodies yearning for the drugs that had formerly coursed through their systems.
More and more babies born dependent on opioids or other drugs are coming into Indiana hospitals. Helping these infants — as well as supporting their mothers in addiction recovery — has become an urgent priority.
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As the opioid epidemic continues to ravage Indiana communities, health officials and hospitals are focusing on women and children impacted by the crisis. Unique recovery programs have been created specifically for pregnant women and new mothers struggling with addiction, as well as for infants born dependent on opioids.
Programs ensure mothers find recovery treatment, get rides to appointments, access financial resources to help pay bills and have people to ask questions of or just find support.
"Having a newborn baby is a very stressful time for every woman," said Brooke Schaefer, obstetrician and gynecologist for Community Hospital East. "These women don’t necessarily have coping skills that have developed very well yet, because they’re new to recovery. While they were using, they didn’t develop those coping skills. So we’re kind of giving them a fast-track to those skills, and making sure they continue to get treatment."
Hospitals continue to be on the front line of the battle against opioid addiction. In 2017, Johnson County emergency rooms treated 559 people for non-fatal drug overdoses, including 160 for heroin. The county reported 34 deaths from overdose or drug poisoning that year.
One of the most troubling developments has been the increase in pregnant women caught in addiction, and babies suffering from neonatal abstinence syndrome, or withdrawal.
In 2016, the Indiana Department of Health’s Maternal and Child Health Division started working with hospitals throughout the state to test the umbilical cords of babies for drugs and other substances. The program was expanded in 2017 to include more hospitals, including Franciscan Health Indianapolis and Community Hospital South.
Nearly 3,000 umbilical cords were tested. The screenings found that 14.4 percent of the babies tested positive for opiates.
Exasperated by these babies impacted by opioid addiction, state officials started a pilot program at four hospitals around the state addressing neonatal abstinence syndrome. Community East Hospital in Indianapolis was one of those hospitals.
The Neonatal Opioid Addiction Project was created through the pilot program in 2015, envisioned by Community Health physician Dr. Anthony Sanders and addictions specialist Dr. Tim Kelly. The program was a comprehensive approach to help women caught in addiction who were pregnant or had just given birth. Aspects also addressed specialized care for newborn babies exposed to addictive drugs.
Through Community Hospital East, mothers are provided wrap-around support in their recovery. Counselors and staff members work with participants to get resources such as housing, food, utility help and access to addiction treatment.
"We try hard to fortify these women with resources," Schaefer said. "We want their lives to be resilient to the stressors of life. If they don’t have safe housing, if they don’t have transportation, if they’re living in dangerous situations, it’s really hard for them to focus on parenting and recovery."
Some women sign up for the program as soon as they find out they’re pregnant. Others don’t start until they have already given birth. Whichever approach participants want to take to start recovery, the hospital will support them, Schaefer said.
"When they’re ready for help, we’re going to help them," she said. "We’re coming at them from this non-judgemental place. We’re making sure our inpatient team, the nurses and doctors who care for these women when they’re in delivery, are treating these women with a lot of care and dignity."
Helping pregnant women and new moms through recovery comes with its own unique challenges.
Often, these women are filled with shame; not only are they carrying the stigma of addiction, but they’re have the added burden of using substance while carrying their baby.
"They’re so afraid to ask for help. They’re so afraid of being judged, of people thinking, ‘How dare you, you’re a mother.’ ‘How dare you, how can you do this to your child?’ So the main challenge is just getting them here, so we can help them," said Erin Neu, a nurse navigator in obstetrics at Franciscan Health Indianapolis.
Franciscan Health’s signature approaches for pregnant women in addiction is the Grace Project. The program was started as a way to provide financial aid to families coming to the hospital who were struggling with substance abuse.
The program is for families who have a history with substance abuse disorder, either in the past or currently. Assistance provided by the Grace Project has helped these families with costs such as transportation, diapers and formula, utility bills and recovery treatment.
The cornerstone of the program is providing support without judgement, Neu said. Staff members have gone to training on working with patients in need of recovery treatment, so that they can approach those who come to the hospital in need.
"We want to show them that compassion and what we call a graceful heart, getting them in here and letting the know we’re not going to judge them. That we’re here to help them and support them as long as they need it," Neu said.
Franciscan Health Indianapolis also wanted to address the increase in babies being born dependent to opioids or other drugs. Newborn babies going through withdrawal or neonatal abstinence syndrome can suffer from a number of problems, including poor sleeping habits, poor feeding habits, irritability, tremors and stiffness.
The accepted protocol for babies with neonatal abstinence syndrome throughout the U.S. was to give the babies low doses of morphine or morphine-type medications, to calm them when they were in a withdrawal-fueled frenzy so they could eat and rest.
But giving newborns such a strong medication is not ideal, said Paula Stanfill, manager of the neonatal intensive care unit at Franciscan Health Indianapolis.
"Many of us were always concerned when we were using that — what the long-term effect of giving a newborn morphine. But it was for comfort and to help them, but if it’s not needed, that’s best," she said.
In addition, that treatment can lead to a greater length of stay in intensive care. So in September, officials in Franciscan Health Indianapolis’ women’s and children center implemented a program using comfort care to treat these infants, a concept known as Eat, Sleep, Console.
The idea is to keep babies and moms together so that newborns can feed on demand and be held, rocked, craddled and cuddled as much as possible.
The results have been encouraging. Since starting Eat, Sleep, Console, the hospital has noticed a significant reduction in the amount of time infants stay in intensive care.
From January to September 2018, the average length of stay for infants with withdrawal was 12.9 days. But since the comfort care program has been put in place, the average stay for those patients is 7.2 days.
"Moms and babies get to stay together more, and literature has shown pretty consistently that the most significant thing is the presence of mom with baby, and I feel like that’s what we’re facilitating now," Stanfill said.
Community’s Neonatal Opioid Addiction Project, which also utilizes this type of non-pharmaceutical approach, has seen impressive results as well. Community officials have found that babies are spending less time in the NICU, while participating mothers are finding more success in their recovery.
In 2016, 46 percent of expectant mothers who came to Community Hospital East were testing positive for drug use. By the time those women returned to give birth, 55 percent were testing negative.
"That really speaks to what is happening within that practice that is helping women not only see the value of themselves as individuals, but the fact that they can make a difference and they have the strength to get on the road to recovery for themselves and their babies," said Amy Wire, registered nurse and vice president of women’s and children’s product line for Community Health Network.
The success of the project led to Community Health Network getting a $570,516 grant from the Indiana Family and Social Services Administration in 2017 to expand the program.
A new bill introduced during this legislative session is aimed at expanding the program even more. The hope is to save the lives of more moms, as well as their babies, by making the program permanent.
"We wanted to allow for women, who are more than likely pregnant and more than likely using, to come into these facilities and see how we can treat them and get them away from the addiction, along with saving their baby," said state Sen. Jim Merritt, who has been one of the leading voices in the statehouse addressing the opioid problem.
Senate Bill 274 would establish the Neonatal Opioid Addiction Project and appropriate $1 million for each the next two years to continue funding it. Merritt authored the bill because he had seen the previous programs working.
Not only are the health of newborn infants improving, and more people are getting into recovery, but fewer children are winding up taken from their parents. He felt that it could benefit other communities and other women and children throughout the state.
"Saving lives is the core of it. But I think what has come out of these successful stories of healthy babies and healthy new mothers is the fact that we’re preventing kids from going to (the department of child services.) That is something that is kind of an unsung situation," Merritt said. "
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The incidence of neonatal abstinence syndrome has increased significantly in the U.S., in cases per 1,000 births:
2000: 1.2
2004: 1.5
2006: 2.2
2008: 2.7
2010: 4.8
2012: 5.9
2014: 8.0
An increased rate of mothers with opioid use disorder has also been recorded, in cases per 1,000 births:
2004: 1.4
2006: 2.1
2008: 2.4
2010: 3.9
2012: 4.9
2014: 6.5
As a result, hospital costs associated with treating neonatal abstinence syndrome have increased more than five-fold
2004: $90.9 million
2006: $145 million
2008: $171 million
2010: $329 million
2012: $438 million
2014: $563 million
— Information from the National Institute of Drug Abuse
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In 2016, the Indiana Department of Health started working with hospitals to test the umbilical cords of babies for drugs and other substances. The program was expanded in 2017 to include more hospitals, including Franciscan Health Indianapolis and Community Hospital South.
Nearly 3,000 umbilical cords were tested. The screenings found that 14.4 percent of the babies tested positive for opiates.
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