Tully: Meet heroin's tiniest, youngest victims

He was 5 days old and less than 5 pounds. He wiggled inside the white blanket that hugged him tight. He stopped moving for a moment and opened his eyes. Then he wiggled again.

Morphine raced through the newborn's tiny body. He had been given a dose earlier that morning to fight off his opiate cravings and would soon receive more.

Without the drug, nurses told me, the baby's pain would be overwhelming. His body would shake and he would be racked with diarrhea so bad that it could eat at his skin. His loud cries and screams would pierce the halls here at Franciscan St. Francis Health on the city's Southside.

"They feel the pain of the withdrawal so intensely," Neonatal Intensive Care Unit nurse Kelly Butler said. "You can just see how uncomfortable they are. When we wean them sometimes it gets so bad. They can't eat. You can't comfort them. They're just miserable."

That's how life begins for babies born dependent on opiates. Long before their first steps or first words, before they can leave the hospital, these infants have experienced a drug withdrawal so powerful it would send most adults to their knees in pain.

As I stood in the hospital room that morning, looking at a child enduring all of this agony during the first days of his life, it struck me that in a world in which so many children are given too little, I had possibly stumbled into the epicenter of unfairness.

I can't adequately describe how beautiful this tiny baby is. On the day I visited him, his parents standing nearby, I fought back tears as I looked at his tousled mess of black hair and at his eyes, their color still hard to make out. His lips were a dark shade of red. His nose was maybe the size of a jelly bean. An orange feeding tube dangled from it.

Medical staffers here said it would take six to eight weeks to wean the child off the drugs that polluted his body in utero. That's an estimate based on far too much experience; the hospital in recent years, like many others, has seen a flood of babies born dependent on the drugs their mothers passed to them through the use of heroin, pain pills or methadone. An infant care unit that a few years ago saw Neonatal Abstinence Syndrome cases a handful of times a year, now has two or three babies suffering through withdrawal on any given day. Sometimes more.

"Think of this like the spread of the plague or Ebola," Dr. Paul Winchester, who heads the St. Francis NICU, said as we talked in his office. "Nobody had it, and then all of a sudden everybody had it."

The story of heroin and other opiate addictions is playing out all across Indiana. It's filling courtrooms with men and women whose lives have been crushed by their addictions. It's ravaging neighborhoods where the drug trade has grown more violent. It's fueling an HIV epidemic in one Southern Indiana county. It's destroying families and robbing parents of the children they raised.

And at hospitals such as St. Francis, it's taken its cruelest path — torturing infants in the first weeks of their lives.

'Guilty; that's how I feel'

I met the mother of the black-haired newborn that Wednesday morning. She is 35, has six children and grew up in rural Johnson County. She seems tortured herself, haunted by the mistakes she has made and by fear for her baby's future. She wanted to talk to me because she hoped her story would help someone else. Her middle name is Nicole, and that's what we'll call her here.

Nicole, with her auburn hair pulled back, nervously twisted in her seat and occasionally wiped away tears as she talked about her fierce addiction to prescription painkillers. I couldn't understand why she had given birth to another child, and she seemed puzzled by that, too, vowing not to have another. She quietly laughed at herself, almost mockingly, when she told me about her unrealistic, shattered hope that her son would not be born dependent on the methadone she takes.

"I thought that maybe he'd go to a regular nursery, which was so exciting," Nicole said. "But then the withdrawal symptoms set in. He started the shaking. He was jumpy. Real jittery. A super high-pitched cry."

Tests would confirm what his behavior indicated: His body craved the opioids he'd grown dependent on in the womb. Before the end of the second day of his life, he'd had his first dose of morphine.

"Guilty," Nicole told me as we talked in a hospital conference room. "That's how I feel."

Painkillers to methadone

Her story is common.

Although the state Department of Health currently has no data on the issue, a study published in April in the New England Journal of Medicine found the rate of NICU admissions for babies suffering from drug dependency nearly quadrupled between 2004 and 2013. They now make up 27 of every 1,000 admissions.

At Eskenazi Health in Downtown Indianapolis, officials say the hospital is on track to see a 22 percent increase this year in the number of newborns experiencing narcotic withdrawal.

For Nicole, the hell of addiction stretches back a decade, to a painkiller prescription that followed bariatric surgery, the birth of her third child and severe back pains. The pills helped her sleep. They made everything a bit easier. Until they destroyed her.

Before long, she was taking an extra pill at bedtime, and then another. She received more prescriptions, including several after emergency gall bladder surgery, and raced through them. She once devoured a three-month prescription in a week and at one point was downing a dozen pills at a time. But, she said, at least she didn't turn to heroin when the prescriptions ran out, as many others have.

Instead, she spent every dollar she could find on illegally purchased pills, and suffered nasty withdrawals when those ran out.

After years of drug abuse she finally sought help. And, now, she visits a methadone clinic every day — weekends, holidays, every single day — for a legal dose of a chemical opioid that essentially replaces an addicted brain's demand for heroin or prescription drugs such as Vicodin and OxyContin. The methadone treatments have kept her away from prescription painkillers and the dangers tied to scoring drugs illegally.

But she's still held hostage — only now to methadone.

'Oh, God, if I could go back'

She continued the methadone treatments during her pregnancy. There was no safe alternative, doctors said. But it's why, as her 5-day-old son wiggled in his hospital room that morning, he would soon have another dose of morphine dripping into his body.

"In hindsight, when you think about the number of people who have been affected by this — well, my back didn't hurt that bad." Nicole said. "If I just could go back and change everything. Oh, God, if I could go back."

At St. Francis, the ravages of dependency on heroin and painkillers have made such fantasies as common as they are unattainable. Dr. Winchester said between 20 and 30 percent of the babies admitted to the Newborn Infant Care Unit suffer from drug dependency.

The problem has grown worse as the region's heroin epidemic has spread, snaring three of 11 babies in the unit on the most recent day I visited. Most children leave the hospital within two months — sometimes with their mothers and sometimes placed elsewhere by child services. But Winchester said it will be years or even decades before we know the full extent of the damage.

"We can treat the addiction," he said. "But that is trivial compared to what has gone on in their brains. These are brains that were exposed to dangerous drugs during a most critical period."

'I know, baby, I know'

Kelly Butler, the nurse I mentioned earlier, remembers a time not long ago when it was rare to have one baby a month suffering from narcotic withdrawal. Now, it's hard to remember a day when the unit didn't have at least one. She talked about the cries and the shrieks filled with pain that sometimes fill the air.

"It's so hard," she said. "Sometimes we will be with other patients, very critical patients who were born very prematurely and who need our attention, but you'll hear that baby and that crying and you want to do something."

Such cries poured from two rooms in the unit on a Monday in early May. In one, a 26-day-old boy in a baby swing sucked hard on a pacifier and rubbed his face, signs that he was hurting from withdrawal. He'd had a rough night, nurse Kathy Anderson said as the baby cried. She picked him up and tried to calm him.

"I know, baby," she said. "I know."

Less than an hour later, Anderson kneeled beside the boy and slowly pushed .08 milligrams of morphine from a plastic syringe into his mouth. That moment, more than anything I've seen, made clear the tragedy of an opiate addiction epidemic that experts insist will get worse in the coming months.

The nurses at St. Francis tell other stories that are just as hard to comprehend. Like the multiple instances of pregnant women who have shot up heroin in the hospital parking lot before coming in to deliver.

Or those who throw away their newborn's bodily waste so it cannot be tested for drugs, as if they can hide their addiction.

Or the times when nurses such as Anderson and Butler hear news reports about children they have treated who became victims of abuse and neglect months or years later.

One morning several weeks ago, I walked through the unit and spotted Butler holding one of the young patients, a 2-week-old boy, as she worked at a computer terminal. The infant's mother had passed a dependency on Vicodin to him; that day, he was nearly halfway through the process of weaning from the drugs. The baby sucked on a green pacifier. Minutes earlier he'd been crying, but now he looked peaceful. He was beautiful.

"It doesn't always work," Butler said later. "But a lot of times they just need some love, a cuddle, someone to show them some tenderness."

They need it today. And they'll need it in the years to come. From all of us.

You can reach me at matthew.tully@indystar.com or on Twitter: @matthewltully.