Securely swaddled in white blankets, one-day-old Aubrianna snoozed against her mother’s chest.
Maria Sandoval, 24, spoke softly as she described her tumultuous history with opioid addiction.
If Sandoval hadn’t found a path toward recovery, Aubrianna might not be nestled next to her mother – let alone have the middle name revealing Sandoval’s new outlook on life: Hope.
Sandoval hung out with the “wrong crowd” while she was growing up in Monte Vista, a rural town in Colorado’s San Luis Valley, with a population just shy of 5,000.
“It’s small. There’s not really much to do,” Sandoval said. “That’s why everyone’s out getting high, stealing from the stores to get high. But once you get clean there is so much more to that.”
The San Luis Valley, as well as towns in southeastern Colorado and the central mountains, were among the rural areas hardest hit as the state’s opioid and heroin overdose death rate nearly tripled between 2001 and 2015, according to the Colorado Department of Public Health and Environment.
Pueblo, Adams, and Denver Counties experienced the greatest increase in overdose deaths among urban areas.
As Sandoval cradled her infant, she recounted how her three-year heroin binge began with pills.
She was instantly hooked on Percocet and eventually switched to heroin. The drug snatched three years from her life.
“Your body just aches, and you do not feel good. You withdraw. You’re hot. You’re cold. You’re angry. You do anything to get money,” she remembered. “I’d be stealing from the stores – stealing from people trying to get money.”
When she started gaining weight and feeling ill, Sandoval wondered whether she had an infection or was experiencing withdrawal.
Instead, she discovered she was four months pregnant.
“I cried for days,” she recalled.
She had seen heroin’s ugly effects. She was in the delivery room when a cousin gave birth to a little boy, she remembered.
“He just kept crying and crying, shaking, you know. There wasn’t anything anyone could do.”
Babies born to opioid-addicted mothers are at risk of experiencing serious withdrawal symptoms such as shaking, seizures, trouble feeding, low birth weight, miscarriage or premature birth.
What the data showColorado does not consistently track where and how often drug-addicted mothers give birth to babies who suffer from withdrawal symptoms related to opioid use, also known as Neonatal Abstinence Syndrome. However, at the request of Rocky Mountain PBS, the Colorado Hospital Association evaluated five years of medical codes from birth records at its 100 hospitals statewide.
According to the data, the number of newborns experiencing opioid-related withdrawal symptoms increased nearly 2½ times between 2011 and 2015.
There were 109 diagnosed cases in 2011. In 2014, the number of documented cases increased to 221. Medical coding methods changed in 2015, but according to annualized data compiled by CHA, the number of cases increased to 268 that year.
University of Michigan researchers found the number of rural newborns experiencing opioid-related withdrawal symptoms increased by more than six times during a recent span of 10 years compared to nearly 3½ times for urban babies.
The road to recoverySandoval said she was terrified to tell the doctor about her addiction. But she knew she couldn’t get sober by herself.
“I was scared to get judged,” she said. “But after I told (the doctor), you know, she helped me with whatever she could.
“I had a long talk with my mom, and I had to get help somehow because it’s not (Aubrianna’s) fault, you know? She didn’t ask to be conceived to a mother that’s addicted to heroin.”
Dr. Barbara Troy, a jovial obstetrician, sees many pregnant addicts at her clinic in rural Alamosa, including Maria Sandoval.
When Troy arrived in town in 2014, she immediately recognized an opioid abuse problem in the community and few medical options for treatment.
She previously specialized in addiction treatment in Española, New Mexico, between 2009 and 2014, but she didn’t expect to use her expertise so quickly upon her arrival in southern Colorado.
Troy immediately joined a newly formed neonatal substance abuse task force to bring attention to the growing issue. She discovered her training and waiver to prescribe special medication for pregnant addicts would be an important step for helping them have pregnancies with fewer complications.
“Any time you have even one mom delivering and not being able to take her baby home…that’s a problem.”
Treatment optionsThe American College of Obstetricians and Gynecologists recommends two treatments for pregnant addicts: methadone – a liquid that is usually administered in a clinic – and buprenorphine, an under-the-tongue film or tablet, which requires a doctor to have special training to prescribe it.
Troy launched the community’s only methadone clinic in 2015. It is one of 19 in the state.
According to the federal government’s Substance Abuse and Mental Health Services Administration, methadone has been around for decades and helps prevent withdrawal symptoms and “helps pregnant women better manage their addiction while avoiding health risks to both mother and baby.”
Buprenorphine is a newer medication-assisted treatment that can cut an addict’s cravings while reducing withdrawal symptoms and the length of a hospital stay for newborns.
According to a 2010 National Institutes of Health study comparing the two treatments, “buprenorphine resulted in similar maternal and fetal outcomes, yet had lower severity of (Neonatal Abstinence Syndrome) symptoms, thus requiring less medication and less time in the hospital for their babies.”
Troy is the only doctor within at least 50 miles of her community with certification to treat patients with buprenorphine, according to federal records.
During her first year working for Valley-Wide Health Systems in Alamosa, Troy was only permitted to assist 30 patients, in accordance with the law.
“I went from zero to 30 quickly,” Troy said. “The goal was I wanted to take care of these mommies and babies. That was my main goal – was to protect the babies because when you protect a baby in utero, you’re protecting them for a lifetime – and a lifetime of public assistance if you don’t do it.”
The treatmentTroy required Sandoval to see her on a weekly basis and enter counseling for her addiction.
“Nothing is ever easy, but if you have the right support system, you get the help you need,” Sandoval said.
When Aubrianna was born, she suffered minimal withdrawal symptoms.
Sandoval had to cut contact with some friends and family.
“A lot of people were still trying to get me to use, and just being around it tempts you to want to use even though you don’t want to. So it’s better to stay away and surround yourself with people who want to help you.”
Not enough providersDr. Kathryn Wells, a Denver-based child abuse pediatrician and co-chairwoman of a Colorado task force on substance-exposed infants, said there are not enough providers in the state to help every pregnant patient.
According to SAMHSA, nearly half of the 64 counties in Colorado do not have a medical provider with training and certification to legally prescribe buprenorphine.
The Comprehensive Addiction and Recovery Act of 2016, increased the number of patients from 100 to 275 whom a specially trained physician can treat.
Nurse Practitioners and Physicians Assistants with proper training and licensing may be eligible to prescribe the drug as a result of the law, which took effect in July 2016.
A woman’s rightsTroy said many addicts do not seek help until late in their pregnancies. Sometimes, they’re unaware of their pregnancy, but other times, they are afraid of the legal implications.
“Their biggest fear is that they’re not going to get to keep their babies,” she said. “(Many pregnant addicts) don’t understand that in medical care, that’s not our job. Our job is to provide health care.”
Wells helped ensure pregnant addicts seeking prenatal care would receive protection from criminal prosecution by advocating for a Colorado law that went into effect in 2012.
She said a woman will not automatically have her child removed from the home because the mother used drugs during the pregnancy.
“Child welfare is going to make a decision based on safety and risk on each individual situation,” she said.
Wells’ task force is working with a select group of hospitals to develop a list of best practices when tracking and treating substance-exposed infants.
“We’re talking about a problem that’s one hundred percent preventable. One hundred percent,” she said. “Every single one of these babies that has to go through this would be one hundred percent preventable if we could address the issue around addiction.”
The Durango Herald brings you this report in partnership with Rocky Mountain PBS News. Learn more at rmpbs.org/news.