Infant addicts are now kindergarten aged. Are we ready?

Our schools are straining to serve young students whose childhoods have been scarred by the long-running opioid addiction crisis on Cape Cod. We originally published the article below a year ago, and reprint it today in response to recent attention to the subject in local media.

“Sally” came out of the womb in pain. She cried inconsolably for hours, her body rigid. She needed to be rocked and held almost constantly at Cape Cod Hospital, where her 2011 birth marked the early stages of a drug-addicted infant epidemic across the Cape, which has only worsened locally, statewide and nationally. “Sally” suffered long periods of withdrawal because she had absorbed opioid drugs while in the womb. Her mom, like many others here, had been battling an opioid addiction for years. She followed her doctor's recommendation and took a substitute drug to treat the addiction while pregnant. Inevitably, "Sally" was taking the drug along with her mother. "Sally" was born opioid-addicted; among the 60-80% of addicted babies who begin life in similar scenarios. After weeks of injections with powerful drugs like morphine and phenobarbital, the tiny infant went home, free of addiction, but at risk for future social and behavioral disorders. Infant addicts now school age Fast forward five years to 2016. “Sally” is age-ready for kindergarten in Cape Cod public schools this September. She and hundreds of other opioid-addicted and exposed infants born here since 2011 will be entering our schools these next few years, potentially with greater needs for special education services than any population in past years. How can we prepare? Many of these children have received Early Intervention services, but many have not, because related disabilities may not show up until later in life. Perhaps the disabilities don't fall under the neat categories of occupational therapy, physical therapy or speech. As an 11-year education advocate for special needs students in Cape Cod, I urge our community to start the conversation about whether our existing framework will be adequate to meet the potentially growing need for increased special education services in primary grades. Possible effects Although research is inconclusive on the long-term cognitive effects of babies born with prenatal opiate exposure, many studies suggest behavioral and social disorders can be an after-effect. Typical disorders include attention problems, hyperactivity, aggressiveness and lack of social inhibition. These children are three times more at risk for ADHD and eight times more at risk of suffering depressive disorders. Even babies placed in foster or adoptive homes due to Mom's continued or resumed addiction show greater signs of hyperactivity, depression and other disabilities. One research article describes a study in which nearly 40% of older heroin-exposed children required special education classes, and 25% needed to repeat one or more grade levels. Environmental factors Some experts are quick to add that home environmental factors may be just as powerful as prenatal drug exposure in contributing to poor educational outcomes. The drugs predispose a baby's vulnerabilities. However, if raised in a good environment, it is possible the young child will have better educational outcomes. Recent studies of the long-term effects of infant opioid exposure on children as they age are unavailable, as the epidemic surfaced just about five years ago. But it has definitely impacted many other public services in Cape Cod and Massachusetts. Hospitals, DCF deal with explosive growth The opioid crisis among pregnant women caused our hospital maternity and infant wards to revamp procedures and increase staffing. It has also led to challenges statewide for the Department of Children and Families (DCF), which is “feeling the impact across the system” with increasing numbers of families needing services, and cases of children being removed from the home. In fact, our state's DCF determined that 75% of the 2,265 children born exposed to drugs required additional services or placement in foster care. Logic leads us to surmise the impact is going to be felt next in the primary grades of our public school systems, specifically special education services. Despite the lack of hard evidence that long-term effects are possible, I would like to urge us all to start now becoming aware and outspoken about the potential impacts on our public education system. On Cape Cod, no one escapes the heartbreaking effect heroin or other opioid addictions have on families and friends we love. Let's work together to find out how and if we need to help our schools prepare. It may mean increasing school budgets for special education services and adding specialized staff. Whatever the remedies, we should all be willing to help our schools prepare to effectively serve our youngest Cape Cod students.