Newborn Abuse — the latest atrocity in our war on drugs

gallery_nrm_1416863230-tiffany — Another story of government overreach.

In 2003, the federal government began requiring states to develop strategies to deal with drug-dependent newborns. This came in response to an increasing number of babies born with opioid dependence. The government’s concern directly reflects the rise in opioid addiction nationwide.

“The number of prescriptions for opioids (hydrocodone and oxycodone products) have escalated from around 76 million in 1991 to nearly 207 million in 2013, with the United States their biggest consumer globally, accounting for almost 100 percent of the world total for hydrocodone (e.g., Vicodin) and 81 percent for oxycodone (e.g., Percocet).”[1] Most recently, tightening availability of prescription opioids has shifted abusers to heroin, an early pharmaceutical derived from the opium poppy and grandfather of the modern ‘codone’ products. Heroin is cheaper and in most cases more available than the pharmaceuticals.

No matter what form, opioids pose a real threat of addiction for many users. According to Wikipedia, “opioid addiction and opioid dependence, sometimes classified together as an opioid use disorder, are medical conditions characterized by the compulsive use of opioids (e.g., morphine, heroin, codeine, oxycodone, hydrocodone, etc.) in spite of consequences of continued use and the withdrawal syndrome that occurs when opioid use stops … The opioid dependence-withdrawal syndrome involves both psychological dependence and marked physical dependence upon opioid compounds. Opioid use disorders resulted in 51,000 deaths in 2013 up from 18,000 deaths in 1990.”[2]

It’s not like opioid-dependent pregnant women don’t know they’re sharing their addiction with their fetus. But like all addicts, these women are severely challenged in overcoming their need for the drug not only because of the nature of the drug but also because whatever led them to abuse drugs in the first place has not been addressed. After all, not everyone legitimately prescribed opiate drugs becomes an addict.

Within one to three days after birth, infants born addicted to opioids suffer neonatal abstinence syndrome (NAS). This withdrawal experience may require doctors to administer slowly decreasing doses of morphine or methadone to ease the process. Providing medical protocols to deal with this condition was the intent of the federal law.

Despite this initial specific focus on opioid withdrawal among newborns, states have begun implementing laws that target mothers who test positive for any illegal drug use. The National Institutes of Health agree that “Alcohol and other drugs used during pregnancy can also cause problems in the baby. Babies of mothers who use other addictive drugs (nicotine, amphetamines, barbiturates, cocaine, marijuana) may have long-term problems. However, there is no clear evidence of a neonatal abstinence syndrome for these drugs.”[3]

Notably, millions of American women have used and continue to use alcohol, marijuana, nicotine, and/or prescription drugs during pregnancy with no known ill effect to their offspring. Yet in many states, zealous, usually conservative lawmakers have seized on the situation as yet another way to attack illegal drug use. Newborns and mothers are profiled and drug tested without consent. Infants are separated from their mothers. Mothers are sent to jail.

The State of Arkansas is one of eighteen states which requires health care professionals to profile mothers and newborns to determine who should be drug tested. In 2014, Tennessee became the first state in the nation to pass a law allowing women to be charged with a crime if their babies are born with symptoms of drug withdrawal. Other states, such as Alabama and South Carolina, use interpretations of existing laws to prosecute pregnant women who use drugs.[4]

The potential penalties under Alabama law are especially stiff: one to 10 years in prison if a baby is exposed but suffers no ill effects; 10 to 20 years if a baby shows signs of exposure or harm; and 10 to 99 years if a baby dies.[5]

There is no known law which requires prosecution of fathers for their use of any substance which might have contributed to a newborn’s impairment.

The American College of Obstetricians and Gynecologists guidelines recommend that in cases where substance abuse is suspected, doctors use a separate form to seek consent for drug testing; women can opt out simply by not signing. These guidelines are widely ignored. In Arkansas, for example, if a health care provider or allied professional such as a social worker believe an infant might have been exposed to illegal substances in utero, a claim of probable cause meets the criteria of child abuse and federal laws protecting privacy don’t apply. Mothers are tested without consent and the case is turned over to authorities.

Such professionals employ a widely varying and undocumented set of criteria to identify newborns and mothers to be tested. Conspicuous symptoms such as premature delivery, low birth weight, seizures, fever, hyperactive reflexes, or rapid breathing are among the more obvious reasons to test the newborn. Yet hospitals also single out mothers who obtained little or no prenatal care even though this unfairly targets the poor or those who live far from medical facilities.

Persons who fit certain cultural stereotypes may also be at risk of greater scrutiny: compare the likelihood for suspicion of drug use in a young woman with dreadlocks and reeking of patchouli compared to that of a well-to-do woman with no counterculture identifiers. Racial profiling is also widespread in these cases as is suspicion of women who have engaged a midwife.

Aside from all the outrages involved in these policies, the fact is that they close the barn door after the horses are out. Once the child is born, whatever fetal harm might have occurred is already done. The rational approach would recognize that a few newborns may need intervention treatment and their mothers need access to counseling. End of story.

Instead, state lawmakers take whatever injury might have occurred to a fetus and explode that into the worst case scenario for the newborn infant by separating it from the mother—no cuddling at the breast for milk (one of NIH’s recommended treatments of NAS is breastfeeding), no mother’s heartbeat, no familiar voices. If we wanted to ensure that an already-challenged newborn suffer the greatest possible harm, we can rest assured that arrest of the mother fits the bill.

[I concede that in a very few cases, the mother’s behavior is so out of control that the infant is better off not in her custody. Very few.]

Legislators eager to punish mothers ignore the fact that the damage is already done. They justify punitive action in the belief that punishment serves as a deterrent. But—point of fact—if threat of punishment served as a deterrent, no one would use illegal drugs.

Marijuana use is not known to result in birth defects or NAS. One study even shows benefits to infants born to marijuana-using mothers.[6], [7] But according to a 12/18/15 report in the Arkansas Democrat-Gazette, of the 970 new Arkansas mothers referred to social services in 2014, 65% were for marijuana use.

Lawmakers also skim past the obvious hypocrisy in screening mothers only for illegal drugs when fetal alcohol syndrome has long been identified as a common cause of birth defects. Many of the distress symptoms in newborns can also result from the mother’s use of tobacco.

If punishment for theorized harm to the child is the state’s objective, then why aren’t alcohol and tobacco included in the screening? Why aren’t those mothers arrested and separated from the child?

I’ll tell you why. Because a driving purpose behind such laws is to punish mothers for illegal drug use.

If the real goal is to reduce the number of impaired newborns, a bureaucracy will need to be established which monitors all women of childbearing age with monthly testing for evidence of pregnancy. Once pregnant, women would be placed on 24-hour watch to ensure proper nutrition and adequate exercise. Prospective parents will undergo genetic testing and embryos will be screened for congenital defects and aborted when appropriate. Controlled environments for gestating women will need to eliminate potential stressors such as spousal abuse and financial troubles. Any possibly harmful substances such as alcohol, tobacco, or illegal drugs would not be allowed.

Ah, brave new world with our Alphas and Epsilons.[8]

There’s nothing wrong with states supporting protocols by which medical professionals can more adequately address NAS in compromised newborns. But compromised newborns should not be used to indict the mothers for real or imagined crimes. There’s no proof that illegal substance abuse alone is the cause of a particular newborn’s problems. A majority of distressed and/or premature newborns come from poor mothers and/or mother who use alcohol and nicotine and/or mothers who don’t exercise or eat properly.

Keep in mind there’s no scientific evidence that an addicted newborn suffers subsequent permanent damage.[9], [10]

The rush to prosecute illegal substance-using mothers of newborns does not assure that their future pregnancies will produce perfect children. Nor, in most cases, does it provide any benefit to the child.

Are women now fetus delivery systems answerable to the state?

Proactive encouragement toward good health and responsible behavior is as far as a free society can go to ensure the best possible outcome in any life pursuit of its citizenry, including parenthood. This approach involves all those abhorrent liberal ideas like sex education in the public schools and easy access to birth control. Access to abortion. Clean air and water. Greater public understanding of proper nutrition. Excellent education. Good job training and job opportunities. Community clinics with affordable, high quality mental and physical health care.

If we want to decrease the American trend toward ever greater substance abuse, we need to take immediate steps to stop commercial advertising of prescription drugs. There is not and never will be a magic pill for most of life’s troubles even if these ads insinuate otherwise.

We need to reorient our medical community toward prevention instead of pharmaceuticals.

We need to devote more resources toward understanding the factors that contribute to substance abuse and addiction and address these problems at their roots: disenfranchisement, poverty, lack of opportunity, low self-worth, racism, mental illness.

Have we done this before rushing to prosecute mothers?

No.

Learn more and offer your help at http://www.advocatesforpregnantwomen.org/

[1] http://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/americas-addiction-to-opioids-heroin-prescription-drug-abuse

[2] https://en.wikipedia.org/wiki/Opioid_addiction_and_dependence

[3] https://www.nlm.nih.gov/medlineplus/ency/article/007313.htm

[4] http://www.huffingtonpost.com/entry/pregnant-drugs-crime_5692ea9ee4b0cad15e653dd0?section=politics

[5] http://www.al.com/news/index.ssf/2015/09/covert_drug_tests_child_abuse.html

[6] http://www.ncbi.nlm.nih.gov/pubmed/1957518

[7] http://www.druglibrary.org/schaffer/hemp/medical/can-babies.htm

[8] https://en.wikipedia.org/wiki/Brave_New_World

[9] http://healthland.time.com/2012/05/01/number-of-babies-born-suffering-drug-withdrawal-triples/

[10] http://www.adoptivefamiliescircle.com/groups/topic/Baby_born_opiate_addicted….terrified/

The Report Is In

Initiated in early spring, a study of Arkansas’ Department of Human Services (DHS) is Governor Asa Hutchinson’s first step in addressing systemic problems within the agency. The driving force behind this initiative was the ‘rehoming’ and subsequent rape of a six-year-old girl originally adopted by Rep. Justin Harris and his wife Marsha of West Fork, owner and operator of a pre-school, Growing God’s Kingdom.

Harris’ excuse for their ‘rehoming’ of two already traumatized little girls was that he had asked DHS for help and they had refused. He stated that the girls had been “damaged by previous abuse and he couldn’t manage them,” according to Friday’s coverage by the Northwest Arkansas Democrat-Gazette (July 17, 2015).

Unfortunately, the governor failed to require this study to investigate whether Harris abused the power of his legislative position to coerce DHS approval of the adoption in the first place.

The couple fostering the two girls prior to the Harris adoption have voiced their belief that Harris had done exactly that. More than one observer cited local caseworkers’ opposition to the adoption. Harris was warned that the girls would not be suitable for his household. He pushed the adoption through anyway and immediately included the girls in a photograph used in his reelection campaign.

Less than a year later, when he and his wife decided the girls were too much to handle, Harris ‘rehomed’ them to a Benton County couple, Eric Francis and his wife.

Harris may have believed that the Francis household would serve as a suitable home. He cited the couple’s adoption of other children as evidence of their suitability. In hindsight, an observer might suspect that the couple’s eagerness to adopt had to do with the husband’s predilection for molesting children rather than any altruistic urge.

Prior to a stiff “I’m sorry for what happened to the girls” statement in June, Harris has admitted no wrongdoing. Now that the governor’s study is complete, it seems no blame will be assigned. We can take small comfort that Harris won’t run for another term.

State police investigating the extent of Francis’ abuse forced Harris to acknowledge to parents of his preschool students that a former employee had been convicted of sexually molesting children. Investigators found no specific evidence that Francis abused any children at the preschool, but several parents removed their children from the program anyway.

A year passed.

Without a reporter digging into the matter, the link between the conviction of Eric Francis and the role of Justin and Marsha Harris would never have been made public. Harris had reasons not to want any of this known. Not only was he holding elected office and operating a religious pre-school, he served as the co-chair of the House committee with control over the Department of Human Services. The whole debacle reflected poorly on his judgement.

Apparently none of this lit up on Gov. Hutchinson’s radar when he commissioned the study of DHS even though the trigger for the study was Harris’ accusation that he had to rehome the girls because DHS wouldn’t help. There has been nothing from the governor or in the report to criticize Harris for ignoring DHS advice and pressing for the adoption. There’s been no known follow-up on whether Harris held up the DHS budget request as part of his coercion as alleged by some observers. There’s been no statement by any of Harris’ Republican colleagues in the state legislature as to his ethics–or lack thereof.

Yes, DHS has problems and the report confirms just how bad they are. None of that excuses what Harris did.

Gov. Hutchinson brought in Paul Vincent to conduct the study, an experienced career man who formerly headed Alabama’s social services department. Vincent has conducted similar studies in numerous states. His analysis reveals a state agency in deep distress, understaffed and suffering long-term problems, all of which fell under Harris’ purview as Vice Chair of the House Committee on Aging, Children and Youth and as a member of the Joint Budget, a powerful committee which approves all appropriations for state agencies.

The study found that caseworkers in Arkansas are expected to handle twice as many cases as the national average (29 versus 15). The state has only two foster homes for every three children who need them which results in one of every five children in need being placed in a non-family living situation. Some caseworkers are forced to hold the child overnight at the office or at their own home.

The problem gets worse by the day. The number of children in foster care increased in just the last two months from 3,875 to 4,323. Fifty-five percent of fostered children are placed outside their home county because adequate arrangements aren’t available locally. With this kind of pressure within the system, the default option for caseworkers is to ignore cases where abuse is not clear cut.

The outcome is horrific. In 2011, 23 children died in families where social services had been in contact but had not taken the child out of the home. By 2014, the number jumped to 40. Most recently, a six year old boy died of intestinal rupture after being raped by his father. Social services had previously visited the home twice and found nothing to justify removing the child from the home.

The six-year-old raped after being rehomed by Justin and Marsha Harris came from an extremely troubled home situation. According to reports, this middle child of three daughters had already been through hell.

The girls had been taken into DHS custody in early 2011 after suffering through a staggering sequence of chaos and abuse. First, [the mother Sarah] Young discovered her husband sexually assaulting Jeannette, the oldest of the three girls, and turned him in; he is now in prison. (Other sources claim Young waited for days to turn the husband over to the police.) Young then became involved with a man who cooked and sold methamphetamine; a fire started by his meth lab provoked a police investigation that sent that man, too, to prison. The child abuse hotline soon thereafter received a call from an individual concerned for the girls’ safety, and investigators found the children in the care of a woman in a house with multiple adults who tested positive for meth; one man at the home had been sexually abusing both Jeannette and Mary, and he is now serving a 120-year sentence. When DHS collected the children, the eldest was 5, the middle girl was 3 and the youngest was under a year old. (More here)

Vincent pointed out the frustration experienced by caseworkers who want to help children and yet are left without sufficient resources and methods by which to do so. In response to the report, Gov. Hutchinson estimates it will mean hiring an additional 200 caseworkers at a cost of at least $8 million. No one knows where that money will come from.

Price tags remain unknown for the report’s recommendation for better and more accessible mental health care for foster children and others in the state’s care. For years, law enforcement and prison administrators have called for better mental health interventions for troubled offenders who end up incarcerated. The death toll among mentally ill prisoners continues to climb along with deaths of abused children while to date the state legislature has made no real strides in addressing this need.

Meanwhile, in their 2015 sessions Harris and fellow legislators spent countless hours fomenting unconstitutional laws to restrict abortion rights and to allow a Ten Commandments monument to be erected on state capitol grounds. And they’ve given themselves a pay increase from $15,869 to $39,400 per year.

If the Justin Harris case hadn’t been brought before the public by a reporter at the Arkansas Times, it’s questionable whether this study would have occurred. Because that’s how things are done in Arkansas. We don’t want to go looking for trouble.

We know trouble is out there. We know we are among the poorest states but other than appropriating scarce tax dollars to bribe companies to locate here, we can’t figure out how to do better.

Nearly 17% of Arkansans never graduate high school and less than 14% obtain a college degree. We have the next to lowest per capita income in the nation. Our crime rate is significantly higher than the national average and our prison population is growing accordingly. We also rank high in poor health, obesity, and use of tobacco and other dangerous drugs.

Despite the continuing lousy achievement levels in Arkansas, we seem incapable of trying to change anything. The conservative voters of this state loathe national standards in education; they want local control and tax dollars for programs such the Harris preschool where children are taught that their misbehavior is the result of demon possession.

Conservatives are outraged by the Affordable Care Act and legislators promise to end the state’s participation despite its progressive reforms including increased coverage for mental health care.

The governor says he will take the DHS problems to the faith-based community to increase foster care resources and improve care. Because religion helped Justin and Marsha Harris make good choices? Because religion guided Eric Francis? Because religion saved those little girls?

Why am I not reassured?