Playing Hot Potato With Pregnant Drug Addicts

Oct 26, 2015

  Xavier Francesco Medlin is only 11-days-old and detoxing from prescription drugs. His mother Hillary Medlin gazes down on him as she gives him a bottle, and baby Xavier starts to scream.

“I know your tummy hurts,” Medlin says to her baby. A trio of wires poke out from under his onesie and connect to a screen monitoring Xavier’s heart rhythm and heartbeat. A cuff on his tiny foot measures Xavier’s oxygen level.

Xavier’s screams are heartbreaking.

“This is new,” Medlin says. “This is part of the withdrawal.”

Medlin, 25, was an opiate addict when she got pregnant. Withdrawal during pregnancy is dangerous, in part because the baby goes through withdrawal, and in part because detoxing mothers will sometimes turn to dangerous street drugs.

So her doctor prescribed oxycodone, and now mom and baby are detoxing together after birth.

“It definitely sucks seeing them go through withdrawal because that’s the first thing they go through when they’re born,” Medlin said. “And they don’t know what’s going on. Us when we go through withdrawal, we know why.”

Medlin’s story isn’t unique, in Florida or the nation. At Halifax Hospital in Volusia County, Xavier is one of six newborn babies detoxing on the same day. Things have gotten so bad, the hospital is expanding its neonatal intensive care unit, or NICU.

Nationwide, the rate of babies born addicted to opiates has tripled in the last two decades. But in Florida, the state formerly known as the Oxy Express, the rate of addicted babies grew ten fold.

And that has leaders trying to figure out what to do with pregnant addicts, even as county health departments get out of prenatal care statewide.

Health News Florida is highlighting details of its Pregnant and Poor investigation all week. See the series here.

A complex problem

Medlin wears a black T-shirt with the picture of a wolf emblazoned above word 'Survivors'. She has freckles, a wide smile and big brown eyes that can’t hide her pain.

Her road to addiction started with two slipped disks and two bulging disks. She has piriformis syndrome, a condition where the muscles around her sciatic nerve weaken, causing low back pain. She was on a legal prescription to control the pain, but then she lost her insurance.

“Once my insurance got cut off, that’s when I went to the street with my dependency,” Medlin said. “I didn’t know what to do and I just took everything I found to feel better.”

She took any opiate she could get her hands on: morphine, oxycodone, roxycodone, loratab, percoset.
Medlin takes a deep breath.

“I do feel guilty putting him through this,” Medlin said. “But I feel if I wasn’t on something we both probably wouldn’t be here.”

She’s referring to last November when she had an overdose, right before she got pregnant.

“It was whatever I could find in the cabinet,” Medlin said.

Medlin’s problems are complex. She has a legitimate medical problem that causes her pain. But she’s an addict as well.

Medlin’s doctor Pamela Carbiener said it’s hard to sift through what is acute and chronic pain from withdrawal and dependency on opioids.

Carbiener is one of the few doctors who will treat pregnant drug addicts in Volusia County, and she risks her own medical license by doing it.

Her job has recently been complicated as the Volusia County Health Department stopped offering prenatal care. Statewide, more and more health departments are getting out of prenatal care.

If a doctor saw patients through the Volusia County Health Department, they couldn’t be sued. But the health department stopped offering prenatal care in the last two years, leaving doctors wary of seeing pregnant addicts for fear of being sued.

Carbiener told a panel working on solutions to the problem of pregnant addicts that doctors are overwhelmed, under-educated and don’t want to deal with this population when they have no resources to help.

“If there’s a bad outcome, (doctors) fear liability,” Carbiener said. “And that’s one of their biggest fears because too often there will be a bad outcome. It’s hard to get good outcomes in these circumstances.”

What’s next

Xavier doesn’t know it yet, but he’s got a big task in life: Saving his mother. Medlin calls Xavier her second chance.

“With my first son, he got taken away because I was in another rough patch with the dependency,” Medlin said. “His father found out. I would drink and drive with him. I would snort anything I could find while he was in the room. You know he could walk then. And I knew he knew something was going on if he had seen. … I finally went to detox.”

In the intensive care unit hospital room, Medlin and her doctor start talking treatment. Medlin can’t keep the prescription-strength ibuprofen down. She’s getting a steroid pack to help with the pain.

Carbiener promises to work with the pharmacist in the morning.

“There’s no way to do it today? Just asking, just asking,” Medlin said.

Carbiener asks if her mom is coming to pick her up. No, Medlin says, she has the car.

“If I were to give you a script today, would you give it to your parents when you get home?” her doctor asks.

“Yeah,” Medlin says. “I’m going home after we’re done here for a couple hours to chill out.”

Carbiener nods.

“I’ll give your mom a call and make sure she knows you have a script that needs to be handed to her when you get home,” Carbiener says.

Medlin also received a steroid shot for her back pain. If those don’t work, she may get the nerve endings in her back burned so she doesn’t feel pain.

Once Hillary Medlin is weaned off opioids, she can go into a residential treatment program called WARM: Women Assisting Recovering Mothers.

WARM was originally founded to help snow babies, babies born to mothers addicted to cocaine and crack. The program has evolved to treat women addicted to pills.

Participation in WARM ballooned alongside the state's prescription drug crisis. The program that started with 16 beds now has 80. Alicia Vincent is the program director for WARM. She says it’s scary how many women are afraid to seek help.

“The thought process is there if I or my baby test positive at birth the state is gonna step in and remove my baby,” Vincent said. “Not always the case, but still that fear factor is there, so a lot of women remain over in the shadow because they don’t want to run that risk.”

Rhonda Harvey and Alicia Vincent  work with WARM. They flip through a box of photos of women who have been though the program. One photo stops them.

Some come through the program successfully, Vincent said. And some don’t make it.

“This young lady here didn’t make it, is not currently parenting that baby,” Harvey said. “You can tell him where she is now.”

“This current lady here, in heaven,” Vincent said. “She died.”

Harvey tears up at the photo. Harvey said the staff at WARM finds strength in those tragedies. Every day, the goal is to not let it happen again.

“Sorry,” Harvey says, her voice wavering.

“It’s OK,” Vincent says. “This, oh. We gotta put the box away.”

Abe Aboraya is a reporter with WMFE in Orlando. WMFE is a partner with Health News Florida, which receives support from the Corporation for Public Broadcasting.