Amanda Hensley started abusing prescription painkillers when she was just a teenager. For years, she managed to function and hold down jobs. She even quit opioids for a while when she was pregnant with her now 4-year-old son. But she relapsed.
Hensley says she preferred drugs like Percocet and morphine, but opted for heroin when she was short on cash.
By the time she discovered she was pregnant last year, she couldn't quit.
"It was just one thing after another, you know — I was sick with morning sickness or sick from using," says Hensley, who is 25 and lives in Cleveland. "Either I was puking from morning sickness or I was puking from being high. That's kind of how I was able to hide it for a while."
Hensley says she was ashamed and hurt, and she wanted to stop using but didn't know how. She had friends who would help her find drugs — even after they found out she was pregnant.
Finding help to get clean and protect her child proved much more difficult.
The number of people dependent on opioids is increasing, and that includes women of child-bearing age, like Hensley. Researchers estimate that a baby was born dependent on opioids every 25 minutes in 2012, the most recent year for which data are available.
By the time Hensley was about six months pregnant, she was living on couches, estranged from her mother and her baby's father, Tyrell Shepherd. Her son went to live with her mother.
That's when Hensley reached out for help. One moment, she dialed to get her fix. The next, she called hospitals and clinics.
"Nobody wants to touch a pregnant woman with an addiction issue," she says.
Shepherd wasn't happy when he realized Hensley was taking opioids while pregnant. "If you don't care about yourself," he says, "have enough common decency to care about the baby you're carrying. Be adult. Own up to what it is you're doing and take care of business. Regardless of how bad you're going to feel, there's a baby that didn't ask to be there."
After she was rejected by two hospitals and several clinics, Hensley let herself go into withdrawal and then went to the emergency department of MetroHealth System, Cleveland's safety-net hospital.
Under the auspices of a state-supported program, Hensley was prescribed Subutex — an opioid-replacement drug that has helped her recover.
Her baby girl, Valencia, was born three months later. Mom and baby had their own room at the hospital, where nurses encouraged snuggling and breastfeeding. The nurses were also on hand to drop liquid morphine into Valencia's mouth if needed. The baby, too, had to be slowly weaned off of opioids.
Hensley cries as she remembers those early days: "She wouldn't latch on — we couldn't get her to feed. I couldn't get her to stop crying. She was very fussy, and I realized, I did that to her. I took her choice away. And that's one thing I still need to work through, because I haven't forgiven myself for that."
Hensley hasn't used opioids in nine months, and Valencia is now about 6 months old. She has chubby baby cheeks and clear brown eyes as big as saucers.
During a recent visit, Valencia kept cooing and smiling — especially when her mother was nearby.
"She started saying mama," Hensley says. "So now, at night when she wakes up, that's what I hear: 'Mama, ma, ma, mama.' "
It's been a journey. Hensley says only within the past few months has she stopped having dreams about using opioids.
Most physicians who specialize in addiction treatment agree that Hensley and her baby received the appropriate care. According to the American Congress of Obstetricians and Gynecologists, women who are pregnant should have medically assisted therapy that at least temporarily replaces the opioids they are using with drugs that are more stable, like methadone. Withdrawal should be discouraged during pregnancy if medically assisted therapy is available.
Quitting opioids cold turkey is dangerous for the infant and could increase the risk of preterm labor or fetal death.
Dr. Stephen Patrick, a neonatologist at Vanderbilt University's School of Medicine, says the medical community really needs to focus on providing access to medically assisted care for substance abuse.
"I think it's time for us to reshape how we view addiction in the United States," he says. "It is a medical condition — it is not a moral failing."
Patrick has seen firsthand how difficult it is for women to find this medical help. At Vanderbilt and in other communities he has visited around the U.S., he says, he's seen women travel for hours to receive treatments for opioid-use disorder. It's particularly a problem in rural communities.
"These are difficult patients. They are complicated and they have complex social needs," Bailit says. "Many practitioners are just not equipped to deal with the breadth and depth of the kind of issues that come with them."
In the past few years, MetroHealth has become a go-to place for pregnant women in Northeast Ohio, treating more and more patients. The hospital cared for a handful of pregnant women with opioid addiction in 2002. Last year, it saw 160 women, and many of them traveled some distance to reach the facility.
In addition to the sort of opioid replacement therapy that Hensley received, the hospital has a whole package of services to support mothers before and after the baby is born. The hospital assigned Hensley a social worker, and set her up with intense outpatient therapy — three days a week for six months. Hensley still checks in with a doctor at the hospital once a month to get her medications.
The support has helped the whole family recover. Valencia is hitting all her developmental milestones — like rolling over. And Shepherd has really taken to being a dad, regularly feeding the baby, changing diapers and creating silly noises to make her laugh.
Hensley and Shepherd have picked out their wedding rings and have begun discussing where to have the ceremony. Hensley has also gone back to cosmetology school, and the couple is talking about when they can bring Hensley's older son home.
RENEE MONTAGNE, HOST:
The nation's struggle with opioid addiction is producing babies born to mothers who can't quit. Some people in the medical community want to focus on those mothers while they're pregnant. Here's the third in our series about babies born dependent on opioids. Today, in Your Health, I'm joined by WCPN's Sarah Jane Tribble in Cleveland, Ohio. She spent time with a mother who wanted to quit after discovering she was pregnant. Welcome.
SARAH JANE TRIBBLE, BYLINE: Good to be here, Renee.
MONTAGNE: We know that the number of people dependent on opioids is increasing, and that does include lots of women of childbearing age. Researchers estimated that by 2012, a baby was born every 25 minutes dependent. And you've gotten to know this mother and her baby. Tell us more about that.
TRIBBLE: I met Amanda Hensley about three months after her baby, Valencia, was born. And she's part of a M.O.M.S. program at Cleveland's big safety net hospital, MetroHealth. Amanda is 25 years old and began abusing prescription painkillers in her teens. For years, she held down jobs and even stopped for a bit when her now 4-year-old son came along. But by the time she discovered she was unexpectedly pregnant last year, she couldn't quit.
AMANDA HENSLEY: It was just one thing after another. You know, I was sick with morning sickness, and then I was also sick from using. So it was either, you know, I was puking from morning sickness, or I was puking from being high. I mean, which was kind of - that's kind of how I was able to hide it for a while.
TRIBBLE: Amanda told me that she was ashamed and hurt, and she wanted to stop but didn't know how. She even had friends who would help her find the drugs after they found out she was pregnant.
MONTAGNE: And what exactly were the drugs that her friends were finding her and giving her to take?
TRIBBLE: She told me that she preferred Percocet and morphine, but she would opt for heroin when she was short on cash.
MONTAGNE: So the baby has arrived. You met her after the baby was born. How is she coping?
TRIBBLE: Well, Amanda hasn't abused opioids in nine months, and Valencia is now about 6 months old. When I visited recently, Valencia kept cooing and smiling, especially when her mother was nearby.
HENSLEY: She started saying mama. So now at night, when she wakes up, that's what I hear - ma, ma, ma, ma.
TRIBBLE: Amanda says only within the past few months has she stopped having using dreams. She and Valencia now live with the baby's father, Tyrell Shepherd, but he wasn't happy when he realized Hensley was taking opioids while pregnant.
TYRELL SHEPHERD: If you don't care about yourself, have enough common decency to care about the baby you're carrying. Like, be an adult. Own up to what it is you're doing. And take care of business.
TRIBBLE: When we talked, Amanda was looking back on when she was pregnant. And she recalled that when she was nearly six months pregnant, it was a really tough time. She was living on couches, estranged from her son, her mother and her boyfriend, Tyrell. That's when she reached out for help. One moment she dialed to get her fix, the next she called hospitals and clinics.
HENSLEY: Nobody wants to touch a pregnant woman with an addiction issue.
TRIBBLE: As it turned out, she was rejected by two hospitals she called and several clinics. Amanda then let herself go into withdrawal and went to MetroHealth's emergency department. The hospital used a state-supported program, and staff members prescribed Subutex, an opioid replacement drug. And when Valencia was born, mom and baby had their own room. Nurses encouraged smuggling and breast-feeding, and they were on hand to drop liquid morphine into Valencia's mouth when the baby's legs started shaking and her screams turned frantically high-pitched because she, the baby, was going into withdrawal.
HENSLEY: She wouldn't latch on. We couldn't get her to feed. I couldn't get her to stop crying. You know, she was very fussy. And I realized, you know, I did that to her. Like, I took her choice away. And that's - that's one thing that I need to work through because I still haven't forgiven myself for that.
MONTAGNE: Just listening to this family's story - clearly it's difficult to overcome opioid addiction, even when you want to. And as we have heard before, detox just isn't enough.
TRIBBLE: That's right. It really takes a sort of medical team effort to help a pregnant woman and her baby. The problem I learned while reporting this story is that it's really difficult for women to find help.
MONTAGNE: Exactly. Is there a standard for the type of help mothers-to-be should get?
TRIBBLE: So most doctors agree that women who are pregnant should have medically assisted opioid therapy. That means at least temporarily replacing the drugs they are accusing with opioids that are more stable. Quitting opioids cold-turkey is said to be dangerous for the baby and could increase the risk of preterm labor or even fetal death. Dr. Stephen Patrick is with Vanderbilt University School of Medicine in Tennessee. When I talked with him, he said the medical community really needs to focus on providing access to that medically assisted care for pregnant women.
STEPHEN PATRICK: I think it's time for us to reshape how we view addiction in the United States. It is a medical condition. It is not a moral failing.
TRIBBLE: I asked Dr. Jennifer Bailit at MetroHealth about why it it's so challenging for women to find help. She was Hensley's obstetrician, and she runs the M.O.M.S. program at MetroHealth.
JENNIFER BAILIT: These are difficult patients, and they are complicated. And they have complex social needs. And many practitioners are just not equipped to deal with the depth and breadth of kinds of issues that they bring with them.
TRIBBLE: In the past few years, MetroHealth has become a go-to place for pregnant women in this part of Ohio. And they keep seeing more and more patients. The hospital treated about five pregnant women with opioid addiction in 2002. By last year, it saw 160 women.
MONTAGNE: What do they do for these women?
TRIBBLE: The hospital has a whole package of services before and after the baby is born. For Amanda, they started putting her on Subutex right away. They assigned her a social worker and set her up with intense outpatient therapy that was three days a week for six months. Even now she still checks in with a doctor at the hospital once a month for her medications.
MONTAGNE: What about the baby, Valencia?
TRIBBLE: Valencia is gorgeous. And she's hitting all her milestones, like rolling over. Amanda and Tyrell live together now with Valencia. And Tyrell has really taken to being a dad.
MONTAGNE: That's very sweet.
TRIBBLE: When I last visited, they were very excited. The couple showed me their wedding band sets. And Amanda was going back to cosmetology school and doing well. And they were even talking about when they could bring Amanda's older son home to live with them.
MONTAGNE: Sarah, thank you for joining us.
TRIBBLE: Thank you very much for having me, Renee.
MONTAGNE: Sarah Jane Tribble joins us as part of a reporting partnership with NPR, WCPN and Kaiser Health News. Later today, on All Things Considered, why tracking the numbers behind the opioid problem is such a struggle and a priority. Transcript provided by NPR, Copyright NPR.