Pubdate: Thu, 13 Aug 2015
Source: Washington Post (DC)
Copyright: 2015 The Washington Post Company
Author: Lenny Bernstein


A Pregnant Heroin Addict Passes on Her Struggle

After a month of painful withdrawal that bunched her body into a 
tight ball, after tremors and diarrhea and sleeplessness and 
difficulty eating, Makenzee Kennedy went home to her bed in a drug 
rehab facility to celebrate a milestone: turning 2 months old.  She 
lives there for now with her mother, 31-year-old Ashley Kennedy, who 
is 11 years into her on-again, off-again struggle with heroin 
addiction. If all goes well, Makenzee will never again see the inside 
of Mount Washington Pediatric Hospital, where she was weaned off 
drugs through intensive, round-the-clock care.  "It's not my first 
time trying to stop," Ashley Kennedy acknowledged as she bottle-fed 
Makenzee. "It's my last time now. I don't want to touch another drug 
after putting my baby through this."  In communities across the 
nation, the collateral damage of the heroin epidemic is rippling 
through the health-care system. The rate of hepatitis C is 
skyrocketing, fueled by needle sharing among addicts. Experts worry 
that an upturn in HIV rates may not be far behind. And the rate of 
fatal heroin overdoses has quadrupled over the past 10 years. In 
Baltimore, nearly two-thirds of the 302 overdose deaths last year 
were caused by heroin. "We have a very serious issue in the U.S. 
right now in terms of the use of heroin and other opiate agents," 
said Alan Spitzer, senior vice president at Mednax, which provides 
maternal and newborn medical services to hospitals.

Among the most heartbreaking developments: a sharp rise in the number 
of drug-exposed newborns like Makenzee. The incidence of "neonatal 
abstinence syndrome" has quadrupled over nine years, to 2.7 percent 
of all neonatal intensive care (NICU) admissions, according to a 
study published in May by Spitzer and others.

The cost to care for each child has also soared, to an average of 
$53,000 in 2009, according to other research.

With a bag of heroin now cheaper than a pack cigarettes, people once 
addicted to costly prescription opioids are turning to the cheaper 
street drug in alarming numbers, according to the Centers for Disease 
Control and Prevention. As a result, heroin has invaded suburban and 
rural America, places such as Elkton, a small town of 15,000 in 
northern Maryland where Ashley Kennedy grew up.

At 17, Kennedy suffered facial injuries in a car accident and was 
prescribed Percocet for pain. The pills were easy to obtain after her 
injuries healed, and she became hooked.

At 20, she began selling heroin. "But then I wanted to know what was 
the big fuss about this whole thing that I was selling. So it just 
took one bag and there it went," she said.

"It was just a good high. Better than Percocets."

Over the next decade, she gave birth to a disabled son, lived in a 
car and was jailed five times for theft, credit-card fraud and other 
crimes she said she committed for drug money. Released from jail last 
September, she was using heroin again by the end of the month. In 
October, she discovered she was pregnant with Makenzee.

But Kennedy kept using, eventually injecting 30 five-dollar bags of 
heroin a day. When she wasn't shooting heroin, she was out searching for it.

"Stay high all day. Wake up and do the whole process over again 
because I wouldn't have nothing left in the morning," she said.

She found a doctor who prescribed Subutex, a medication designed to 
replace the craving for heroin, but it didn't work. Kennedy wound up 
taking both drugs, or traded her Subutex for heroin on the street. 
Then she turned to methadone, which didn't fully satisfy her cravings either.

In March, a judge threatened to take her children away. Kennedy 
finally quit using heroin and was admitted to a residential rehab 
program. She finished her pregnancy on methadone; giving up drugs 
entirely could have killed her unborn child.

As extensive as it was, Kennedy's drug history is relatively 
uncomplicated, compared with the habits of most pregnant drug users 
treated at the Center for Addiction and Pregnancy, an intensive 
outpatient program at Johns Hopkins, not far from the hospital where 
Makenzee Kennedy went through withdrawal.

More than three-quarters of the women in the program have some form 
of mental illness; take medication for depression, anxiety, 
schizophrenia, bipolar disorder or post-traumatic stress syndrome, 
said Lauren Jansson, the center's director of pediatrics.

Most have hepatitis C. Opiates are now the favored drug for about 75 
percent of the women, Jansson said, but they are often mixed with 
cocaine, marijuana and alcohol. Virtually every woman smokes 
throughout her pregnancy.

Like Kennedy, some women seek help when they realize they're 
pregnant. Others deny taking drugs until after their child is born 
and begins suffering from tremors or other symptoms of withdrawal, 
said Monique Satpute, director of the Center for Neonatal 
Transitional Care at Mount Washington, where Makenzee was treated.

"We have to go back and say, 'Is there something you didn't tell us?' 
" Satpute said.

Doctors used to think a baby's withdrawal was related to the quantity 
of heroin a mother used or the number of months the child was exposed 
in utero. But studies have found that not to be true, Jansson said. 
Some newborns experience only mild symptoms. Researchers are 
searching for a genetic link to withdrawal.

Caregivers today assume that no two children will go through 
withdrawal in quite the same way. That makes the process tricky and 
laborintensive. Each newborn must be weaned slowly and monitored 
carefully around the clock, with one paramount goal: avoiding a 
devastating seizure that could have lifelong consequences.

Although doctors and nurses have become adept at that, the sad truth 
is they can't do much to lessen the misery of a baby in withdrawal. 
Makenzee, for example, arrived from the University of Maryland 
Medical Center already started on tiny amounts of morphine and 
clonidine, a bloodpressure medication that helps in the weaning process.

Every three hours, she was assigned a "Finnegan score" based on 21 
factors observed by nurses, including tremors, hyperactivity, fever, 
difficulty sleeping, sweating and her ability to suck, which often is 
compromised in infants going through withdrawal. Those scores are 
averaged and used to determine the next day's dose of morphine.

Makenzee was a difficult case: Healthy newborns sleep most of the 
day; she was awake all the time. Healthy newborns relax and begin to 
stretch their limbs; Makenzee clenched her arms and legs tightly and 
cried constantly as she adjusted to minuscule reductions in the 
opiates she had been receiving in the womb. She had acidic diarrhea 
and sweated heavily.

Nurses dimmed the lights in her room, played soft music and spoke in 
low voices. They swaddled and held her. They changed her diaper often 
and patiently fed her.

"It hurts," said Kay Mathias, the nurse practitioner who runs the 
unit where Makenzee was treated. "If you [go through] withdrawal, it hurts."

Of the 97 drug-dependent infants Mount Washington has discharged over 
the past year, most were ready to go home after about two weeks. 
Makenzee's withdrawal took 31 days and cost Medicaid $32,777.

Research has not found devastating long-term consequences for 
newborns who go through withdrawal. Such children tend to fare poorly 
by most health and socioeconomic measures, but it's not clear whether 
that's the result of the drugs in their systems at birth or their 
subsequent upbringing in often terrible homes by parents prone to drug use.

"We don't think that they have any neurodevelopmental delays just 
from going through withdrawal," said Leslie Kerzner, associate 
medical director of the Special Care Nursery at Massachusetts General 
Hospital in Boston, who tracks such children for years after birth. 
"In most kids, the brain is very plastic and they kind of rewire."

At the rehab facility, Ashley Kennedy prepared for her baby's release 
from the hospital by taking herself off methadone. After rehab, she 
plans to return to her mother's house in Elkton, where she hopes to 
raise her children far from her drug-seeking friends.

For nine days, she went cold turkey, a brutal experience she hoped 
would leave her sufficiently clear-headed for the more difficult journey ahead.

"So we went through it together this last week," Kennedy said. "It 
was painful. [ Your] body's aching. Your bones hurt. You can't stay 
still. You can't sleep. You can't eat. You're having diarrhea. ... My 
body still hurts. My back still hurts. My legs sometimes. My knees.

"But it's worth it. Thoroughly worth getting off everything to be 
with my child."
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MAP posted-by: Jay Bergstrom