Best views, weather, etc. How to test them 👓 SC, Ala. sites look back Betty Ford honored
NEWS
Drug addiction

Born addicted: Drug-screening pushed for pregnant women

Laura Ungar
USA TODAY
"I love the Freedom House." Ashley Kirchhubel of Louisville said.  "I come back all the time to visit. I care about the staff and if it wasn't for the Freedom House I don't know where I'd be." Sylvia Simpson, a staff member with the Freedom House, takes a look at young Isaiah.

They are the tiniest victims of the nation's opioid epidemic, born into agony — trembling, sweating and crying inconsolably from the pain of drug withdrawal.

And as their numbers soar, doctors, health officials and drug-control professionals are pushing to screen all pregnant women for substance abuse.

"When a child's first days in this world are in agony, that certainly should be a concern to all of us," says Van Ingram, executive director of the Kentucky Office of Drug Control Policy. "We need to do all we can to prevent this."

Growing support for universal screening is a sign of how big the problem has become. One drug-dependent baby is born every hour in the USA, according to the latest national statistics from a 2012 study in the Journal of the American Medical Association, which showed the numbers nearly tripled between 2000 and 2009.

Recent state data paint an even more disturbing picture. Hospitalizations for the condition in Kentucky skyrocketed from 28 in 2000 to 955 in 2013, while those in Tennessee rose tenfold, to 672, between 1999 and 2011 — and already exceed 700 this year. Vermont saw its rate of drug-dependent infants rise from three to 26 per 1,000 deliveries in nine years, while Florida's rate more than tripled in five years.

To help stem the tide, the American Congress of Obstetricians and Gynecologists and the Association of State and Territorial Health Officials are calling for verbal drug screening followed by a urine test if necessary and agreed upon. The American Medical Association also endorses universal screening.

Not everyone welcomes the idea. Some pregnancy rights advocates argue that screening may lead to punishment or loss of custody rather than treatment and sobriety.

But recovering opioid addict Ashley Kirchhubel, 31, of Louisville, disagrees. She abused pain pills while pregnant with her now-3-year-old son, Johnny, hiding her addiction from her obstetrician even when asked about drug use. It raged on, and she briefly turned to heroin before entering drug treatment early in her pregnancy with Isaiah, born Sept. 27. She says only by the grace of God was neither born dependent.

If the mother of four had undergone a urine screen, she suspects she would have gotten into treatment much sooner to avoid losing her children.

"That would've been a good enough reason to stop," she says as her newborn's tiny fingers curl around hers. "They should screen everybody."

PREVENTIVE MEASURE

"A lot of girls want help, but are scared to ask for help, because they don't want their babies taken from them," Ashley Kirchhubel of Louisville said. Throughout her journey of getting clean, Kirchhubel temporarily lost custody of her children.

Doctors routinely screen pregnant women for diseases such as HIV and hepatitis, and some say adding drug abuse to the list would reduce the stigma of addiction and keep women from being singled out by race, income or appearance.

The obstetricians' group recommends screening first with a questionnaire. Those whose answers warrant, or who on examination have signs such as needle marks from intravenous drug use, would undergo a urine screening if they consented. Doctors would have to make them aware of any legal consequences of a positive screen, such as the need to notify child services.

"Substance abuse screening is critically important in pregnancy," said Jessica Young of Vanderbilt University, a fellow with the obstetricians' group. "It's a time for the physician to educate the patient and help them get into treatment, which can lead to better outcomes."

Today, outcomes are often grim.

Many drug-dependent infants suffer diarrhea, vomiting, low-grade fevers, even seizures. They're extra-sensitive to noise and light. Those born prematurely may experience respiratory distress and go on ventilators.

First-line therapy for severely affected babies is morphine, although babies with milder cases may not need medicine. All require swaddling, rocking and cuddling.

"In the short term, they may have problems feeding or growing," said Michael Warren, maternal and child health director for the Tennessee Department of Health. "There's not a lot known about the long-term effects."

Screening could save babies from such suffering and works best when doctors are non-judgmental, so moms feel safe enough to be honest about drug use, says Paul Jarvis, executive director of the health officials' association. His group also suggests removing financial obstacles to screening by covering it under Medicaid.

"We've got to keep the babies in mind here," Jarvis says.

CONCERNS LINGER

But Kylee Sunderlin, staff attorney with the New York-based National Advocates for Pregnant Women, says it's unlikely that universal screening will genuinely improve moms' and babies' health.

"Instead, what we see over and over again is that screening is used as a tool for reporting mothers to child welfare services and police enforcement," she said. "So even if the screening is universal, the reporting is not, which means that low-income women and women of color will continue to be vastly overrepresented in punitive child welfare interventions and, in some states, arrests."

The Guttmacher Institute, which researches reproductive health issues, says 18 states consider abusing substances during pregnancy to be child abuse under civil child welfare laws, and Tennessee allows assault charges in certain cases. But supporters of universal drug screening say punitive policies need to change.

"If you make it criminal, women will hide it, and they'll avoid prenatal care," Jarvis says.

Doctors also point out that urine tests aren't always accurate, and sometimes pick up drugs legitimately prescribed to pregnant addicts to treat them, such as methadone.

Even if screening correctly identifies addiction, doctors say there's too little drug treatment available, particularly for pregnant women. Kirchhubel was on a waiting list for two months before getting into Louisville's Freedom House, where she was treated for about three months.

Sober since January, she never lost custody of Isaiah and expects to soon regain custody of Johnny, now cared for by a family friend.

"I'm really lucky. There's a lot of girls who want treatment," she says. "I feel very blessed."

Ungar also reports for The (Louisville) Courier-Journal

Featured Weekly Ad