Leah Rozie knew it had to stop.
The daily snorting of powdered heroin. The early-morning dry heaves in sweat-soaked clothes. The late-night parties and the afternoons wandering Franklin Avenue and Lake Street, searching for a fix.
Rozie, 21, of Minneapolis, knew she had to get treatment or lose her baby to a miscarriage. “I was scared,” said Rozie, who began abusing opioids after the death of her older brother. “Once I discovered that I had a life in my hands, I didn’t want to screw it up.”
Seven months later, Rozie is healthy and sober and her big-eyed baby, whose name means “Thundering Heart” in Ojibwe, is just learning to crawl. Her turnaround is a testament to a remarkably successful Hennepin County treatment program that may soon become the model for intensified state efforts to stem a sharp rise in newborns exposed to opioids before they were born. New data show that the number of Medicaid-covered babies born in Minnesota with neonatal abstinence syndrome — symptoms of drug withdrawal — has more than doubled over the past four years, to 9.8 per 1,000 births in 2014.
Alarmed, state Department of Human Services (DHS) officials are preparing to launch a program to target pregnant women in high-risk areas across the state, from inner-city Minneapolis to counties with high populations of American Indians. The goal is to help nearly 1,200 pregnant women who are at risk of giving birth to opioid-exposed infants by the end of 2019.
“Think of the symptoms of withdrawal that adults have, and that’s going to be magnified in babies,” said Human Services Commissioner Lucinda Jesson. “We want kids to get off to the best start possible, and this is one of the worst starts possible.”
The plan is modeled on a longstanding Hennepin County program known as Project CHILD, with a strong track record in keeping pregnant women sober through a combination of early intervention, group therapy and peer support. Since 2010, 301 women have completed the program, and 90 percent delivered drug-free babies.
Last year, as DHS officials searched for antidotes to the surge of opioid abuse among pregnant women, they toured the Project CHILD office on Chicago Avenue S. There, expectant mothers can attend classes on everything from breast-feeding to how to bond with their newborns through therapeutic touch. Colorful photos of newborns and their proud mothers fill six bulletin boards.
“We’d like to achieve on a state level what Project CHILD achieved” in Hennepin County, said Dr. Jeff Schiff, medical director for Minnesota Health Care Programs.
State officials estimate that offering a similar program in targeted areas would cost $272,000 in the first two years. However, it would generate at least $1.3 million in savings in the ensuing two years by eliminating prolonged state-funded hospital stays for infants suffering from opiate exposure.
Newborns with opioids in their systems can suffer from slower growth, seizures and developmental delays, among other health problems. In 2013, state-funded hospital claims for nearly 350 infants identified as opioid-exposed at birth totaled $10.5 million. These babies spent an average of 15 days in neonatal intensive care, with average paid claims of $30,125, according to DHS data.
The department also is looking to address one of the root causes of the problem: a surge in narcotic prescriptions for pregnant women. The state estimates that about 50 percent of opioid-dependent pregnant women who are enrolled in Minnesota’s public programs are actually being prescribed opioids, thereby contributing to their addictions. Gov. Mark Dayton’s budget proposal includes money to reduce the inappropriate prescribing of painkillers in the state’s Medicaid program through closer monitoring.
At first, she lied
Expanding chemical dependency treatment for pregnant women poses special challenges. Mothers using illicit drugs are often reluctant to seek help out of fear that they will be reported to child protection authorities and have their babies taken away after birth. Others are too ashamed to seek help, say county social workers.
“A lot of times, [mothers] … see us as part of child protection,” said Cindy Fleming, a senior counselor at Project CHILD. “We try to show them that we’re here to help them keep their babies … but that can be challenging.”
Rozie was no exception.
When a midwife at the Indian Health Board clinic initially asked her if she was abusing opioids, Rozie lied and said she was sober. “In my mind, I was going to quit cold turkey,” she said. “I was really afraid they were going to take my baby.”
But after the midwife explained that drug withdrawal can harm the baby and lead to a miscarriage, Rozie admitted her addiction and signed up for Project CHILD.
In group therapy with other pregnant women, Rozie said she learned what she calls “riding the wave,” or how to handle short-term drug cravings. The “waves” typically last just 30 to 90 seconds, she said, and dealing with them involves acknowledging the pain and focusing on a positive activity.
When Thundering Heart was born without drugs in her system, Rozie was so ecstatic that she called her case manager at Project CHILD, who showed up at the hospital with a pink blanket and a large hug.
“Now, my baby is enough to not want to use,” Rozie said. “I take one look at her and the urge just goes away.”