One place the fall-out from the opioid crisis continues to escalate is in newborn nurseries. Data gathered from hospitals across the country show that the number of babies born to opioid-addicted mothers quadrupled in the past 15 years.
The Centers for Disease Control puts it this way: every 25 minutes in the United States a baby in the United States is born suffering from opioid withdrawal. Among those babies is 23-year-old Jessica Cardinal’s ten-month old son, Andrew.
"Every addict, every mother would love to say, 'Okay, I'm not going to use drugs anymore,' but it doesn't work like that," she said.
Like many people caught in the opioid epidemic, Cardinal started with prescription pills before graduating to heroin, a cheaper alternative. It took its toll. At one point she weighed just 90 pounds and lived in a tent. But when she learned she was pregnant with her first son, she said, she got clean.
"Every addict, every mother would love to say 'Okay, I'm not going to use drugs anymore,' but it doesn't work like that."
It’s one thing to give up drugs, another to stay off them. It was the stress of a second pregnancy that she said that led her back to using drugs.
"I ended up in a Home Depot parking lot, three-months pregnant, getting high with my eight-month-old in the back seat and, thank God, somebody called the police," said Cardinal.
She wound up in a half-way house in Lynn, run by the non-profit Bridgewell. It’s not jail, but its two dozen female residents must adhere to strict rules. Cell phones are banned, days start at 6 a.m. and support meetings are mandatory.
The goal is not just to get sober, but to understand what led to addiction in the first place and how to manage it moving forward.
"You have to remain vigilant, because it's just so powerful," said Cardinal.
Clues to better understanding the disease may come from its youngest victims: babies, like Cardinal’s son. During her pregnancy, Cardinal was put on methadone to prevent her from going into a withdrawal that could have endangered the baby. It’s a standard practice for treating opioid-addicted mothers, but it comes with a side effect — babies born in withdrawal.
“It breaks your heart,” said Jonathan Davis, chief of newborn medicine at Tufts Medical Center. As with adults, he said, opioid withdrawal is painful for infants. “A big part of it is crying inconsolably,” he said.
Yet, some newborns resist the impact of prenatal opioid exposure.
“Why, when you have two mothers who are getting prenatal care, who are taking methadone — one baby can have really significant withdrawal when they’re born and another baby may be very mild or none at all. What’s the difference?” asked Davis.
"Why, when you have two mothers who are getting prenatal care, who are taking methadone — one baby can have really significant withdrawal when they’re born and another baby may be very mild or none at all. What’s the difference?”
When mothers using opioids also smoke or take anti-anxiety medicine, he said, opioid withdrawal is worse for babies. But Davis’ research also shows genes — particularly ones involved in sleep — seem to play a role, too.
"And so, babies with certain genes tended to have worse withdrawal than babies who don't have that," said Davis.
The long-term prognosis is unclear. One of the largest studies of its kind tracked more than 2,000 Australian children born withdrawing from opioids. Standardized testing starting in third grade and continuing through 7th grade indicated those kids scored significantly lower than their peers. But Davis said it’s not clear if the findings reflect the impact of early drug exposure or the environment in which the children were raised.
“The problem is, doing these studies is so complicated that a lot of investigators haven’t gone that route,” he said.
Even in his own research, he said it’s difficult to enroll opioid exposed infants in studies because their mothers are often concerned about confidentiality.
Cardinal said, at 10-months, her son is hitting milestones. If he needs extra help down the road she said she’ll get it for him. Eventually, Cardinal hopes to become a nurse, but her overarching goal is to take care of her kids. She was 13 when her own mother died of an overdose.
“I don’t want my kids to have to go through what I went through as a child, losing my mom,” said Cardinal, “I want them to know they’re loved, no matter what.”