No one had to tell Cassie Manning that using drugswhile pregnant was wrong.
"I was still in my addictive behavior," she said. "It becomes something that takes over. You're overwhelmed."
Manningknew she needed help.
A doctor helped Manning gradually wean off Suboxen and Subutex, prescription opiates.BabyLiam was born healthy and drug-free. Manning, who has been clean for 17 months, faced no criminal charges for using opiates while pregnant.
Earlier this week, asMissouri lawmakers considered a bill that would criminalize prenatal drug use,14-month-old Liam toddledhappily around the living room.
"I'm so blessed," Manning said, watching her son babble to the News-Leader photographer. "(Liam) isso kind. He's so nice."
The bill was proposed by Rep. Jered Taylor, R-Nixa, who saidhe knew of a similar law passed in Tennessee in recent years.
"I think it's a big issue and it's only increasing," Taylor said. "Something needs to be done to make sure we have healthy babies and get these women the help they need."
Under the proposed bill, it would be a misdemeanor to use drugs while pregnant, and if a child died as a result of the drug use, the mother could face a felony charge, according to the bill's language.
In an interview, Taylor noted that his bill would allow women who face criminal charges for using drugs while pregnant to avoid prison sentences by completing a drug court treatment program "to hopefully get off these drugs."
While many in the local medical and drug treatment field agree the problem is growing, some say criminalizing prenatal drug use is not the answer.
Dr. Patricia Dix has been a perinatologist at CoxHealth for nearly 28 years, caring for women with at-risk pregnancies.
Dix walks fast, has a gripping handshake and doesn't mince words when asked about the bill.
"Bad idea," she said, shaking her head. "It's another example of our legislature trying to practice medicine, which they know nothing about."
Dix believes addicted women won't seek prenatal care if there is a threat of criminal charges.
"I don't care who you are, that is never good," she said. "Whether you are using drugs or not, no prenatal care is dangerous for both the mother and the baby."
And these pregnancies are certainly considered high risk, she said.
Dix said legislatures need to focus on two things: dramatically increase spending for drug treatment and call for better training for physicians who prescribe opiates.
"We probably have 10 times more people addicted to chronically using opioids during pregnancy now thanwe did 15 years ago. It's just astounding," she said. "We get people addicted and then we blame them for being drug seekers. That doesn't help anybody."
Missouri is the only state in the country that does not have a prescription drug monitoring program, but lawmakers are considering bills regarding this issue. One creates a database and monitoring program. Anotherwould create a monitoring program for only drug offenders. Taylor said he supports the latter.
Greene County Prosecutor Dan Patterson said he is "encouraged" that the legislature is looking at the issue again. Patterson's comments were less direct.
"I believe there is a role for the criminal justice system and, in particular, treatment courts, in addressing this problem in the worst cases in which a mother knowingly endangers the life, health or body of her unborn child by abusing illegal drugs," Patterson said in an email. "That said, I also believe the drafting of any criminal law regarding this topic must be carefully crafted to avoid discouraging women dealing with addiction from seeking prenatal care."
Opiate epidemic
Taylor, the lawmaker who created the bill, said he became interested in the issue after reading a 2015News-Leader storyabout the "epidemic" of babies born addicted to opiates. The story detailed the painful and dangerous withdrawals many of these babies experience once they are born.
Not all babies exposed to opiates in the womb present withdrawal symptoms. Some can be treated with environmental modifications such as providing a quiet environment, low light and swaddling.
But roughly 60 percent of babiesborn to a drug-addicted mother do require medication (typically methadone or morphine) to wean them, as well as a stay in the NICU for an average of 18 days.
In 2010,CoxHealth had 5 babies requiring pharmacological treatment for what isknown as neonatal abstinence syndrome— or opiate withdrawals. In 2015, there were 33.
Mercy NICU had 11 babies requiring pharmacological treatment for withdrawalsin 2010. In 2015, that number rose to 33.
These babies are described as inconsolable. They appear to be in painand exhibit high-pitch and excessive crying.Babies are often agitated and overstimulated with no way to self-soothe and calm down.
They might have diarrhea, vomiting and be unable to eat, which can quickly cause an infant to become dehydrated. Some babies have seizures during the withdrawal process.
There are also dangers associated with sending a baby home with a mother who continues to use drugs, including neglect and abuse.
Dr. Joseph Eccher, MC, neonatologist, has been themedical director at CoxHealth NICU for more than 30 years.
Eccher estimated the cost of care for a baby requiring pharmacological treatment in the NICU to be about $3,300 a day. He figured the overall cost of care is anywhere from $160,000 to $238,000 greater than that of a healthy newborn.
"Obviously this is a problem. It's a problem in people and it's a problem in health care costs," Eccher said.
Eccher said he believes criminalizing prenatal drug use is a bad idea.
"Most women, they've gotten addicted (to opiates) under medical care," Eccher said, adding that a 2013 study found illicit use of opiates without a prescription only accounted for 28 percent of babies with neonatal abstinence syndrome.
"There is always a facet of the population who thinks the answer is just to punish it. If we beat them with a stick hard enough, they will quit doing it, which I think generally shows a lack of understanding of the problem."
Eccher said he believes more should be done to control the prescribing of opioids in the first place as well as having more drug treatment options.
"The hope lies in trying to help women care for their babies and be the caretaker instead of finding a foster home," he continued. "You better walk in their shoes for a while before you start telling them they are a criminal. They are not. They deserve to have an opportunity to take care of their baby, and they deserve an opportunity to turn their life around."
Mercy NICU staff would not comment for this report.
Few treatment options
Taylorsaid thegoal of his bill is not to put women in jail but to get addicts into treatment. He said he would be in favor of adding more funding for treatment centers.
"I spoke with some recovering addicts yesterday, so I know there are good programs out there," Taylor said.
Those who work in the field say there aren't nearly enough.
And ifa pregnant addicttries to quit opiatescold turkey, the baby might withdrawal in utero and be at risk for stillbirth, Eccher said.
Of the 184 adult substance use treatment programs in Missouri listed with the Department of Mental Health, only 32 can accommodate women with babies. In the southwest region of the state, there are three: Family Self Help Center in Joplin and Neosho, and Preferred Family Healthcare in Springfield.
Rhonda Ferguson, clinical supervisor at Preferred Family Healthcare, said there are 16 spots for women in the residential facility, with a few more beds to accommodate their children.
At any given time, about 200 women will be receiving outpatient care, she said.
According to Ferguson, there is almost always a wait list for the residential facility, but pregnant women and IV drug users go to the top of the wait list.
LifeHouse Crisis Maternity Home in Springfield is not a treatment facility, but it provides safe shelter and comprehensive services for homeless pregnant women and their children up to the age of 5. Women can live there throughout the pregnancy and then a year after birth. Beyond that, LifeHouse has a 2-year aftercare program.
LifeHouse director Michele Marsh said over half of the women who come to LifeHouse have a substance abuse history.
LifeHouse randomly drug screens the women living there. If someone tests positive for drugs, LifeHouse staffworks to get her into an inpatient treatment facility.
"We need more treatment centers. They need to be accessible,"Marsh said. "They are not accessible to everyone. Some of them cost too much for most to afford."
According to Marsh, women are often motivated to get clean when they find out they are pregnant.
"Those in the midst of addiction are not looking at consequences the same as you and I would," Marsh said. "Their disease is often stronger than concerns for any consequence, so we need to make sure that we utilize every opportunity that we have to get them into treatment."
Marsh said she believes the proposed legislation is based on good intentions for both mother and baby, but she has concerns that fewer women, who are already at high risk for complications, will seek prenatal care and drug treatment.
"We have to be careful not to do more harm. The idea would be that these individuals would receive treatment, be able to care for their children positively, and be able to continue with productive lives," she said. "If they lose everything while serving time in jail, including their employment and homes, it may make it even harder to rebuild their lives."
A second chance
For Cassie Manning, treatment has changed her life.
Two years ago Manning had no ID, no job, a warrant for her arrest and a heroin addiction.She was trying to get clean and living at a faith-based transitional home for womenwhen she discovered she was pregnant.
Manning then moved into LifeHouse Crisis Maternity Home andswitched from heroin to Suboxone and Subutex — opiates often prescribed to help addicts get clean.She felt those drugswould be safer to her unborn child thanheroin.
"I was struggling and hiding it from people. Eventually LifeHouse (saw) some red flags,"she said. "I admitted I was doing it. I went and did a two-week stay (at Preferred Family Healthcare)."
There, a doctor helped Manning gradually wean off the opiates.
"It was hard for me. I felt depressed," she said. "Somehow I got through it. I kept myself away from anybody that would try to talk to me about it or offer me (drugs). I changed my people, place and things I was doing."
Manning has a job and a place to call home now.
She joined the Prince of Peace Lutheran Church.
"I can actually trust them. My pastor is there to counsel me and work with me through the changes that come up," Manning said. "It's like a family I've never had. But it's a huge family.
"I wake up every day and I smile. I’m the happiest I’ve ever been."
It’s not always easy though. Manning said when thoughts of drugs cross her mind, she thinks of Liam.
"I have his little face in my head. And the last thing I want is for him to ever know that side of me."
Manning was apprehensive about sharing her story, but said she feels it's the rightthing to do.
"If I can help one person with my story, then that is exactly what I want to do,"she said. "It’s the best way I know how to give back to God for working in my life and changing me the way He did."
Drug Court JudgePeggy Davisinvited Manning to the Annual Treatment Court Conference in April at Lake of the Ozarks. Her counselors at Preferred Family Healthcare have also invited Manning to come along on their next Jefferson City trip.
When asked if she thought moms should be punished for using drugs while pregnant, Manning said no. Those women should be given treatment options, she said.
"People think it's just so easy to stop doing it," Manning said. "It's really hard to rewire your brain, to not think like an addict. But it can be done. It starts when you change everybody in your life and just focus on your child and your new life.
"Everybody deserves a second chance and a chance to rebuild their life."
Status of proposed legislation
HB 1903, thebill that would create criminal penalties for prenatal drug use,is waiting for a committee hearing.It must get heard and passed by the committee. Then it will most likely then go to a second committee. At that point it will go to the House floor. House leadership would then have to call up the bill for debate. If it passed the House it would repeat the same process over again in the Senate. If the Senate amended the bill in any way, the two chambers would have to work out the differences.
News-Leader reporter Jon Swedien contributed to this report.
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