Number of drug-addicted babies on the rise in Sonoma County

Monday. Wake up. Text your dealer. Oxycodone if he has it, but hydrocodone works, too. No money? Figure it out.

Tuesday. Wake up. Text him again.

Wednesday. More.

Thursday. More. You’re smart; you’re young. You can control this.

Friday. Again.

Saturday. Again.

Sunday. You hide it all. You black out. You steal from your family if you have to.

Then, one day you’re 24.

And you’re pregnant.

Pause.

“I was shocked,” said Anni McAnallan of the discovery that she was expecting a child.

That was her life. She’s clean now and has been for six months, ever since she gave birth to her son. She asked that he be referred to by his middle name: Valentino.

“It means strength, survivor,” McAnallan said.

Valentino is one of a rapidly growing number of children in Sonoma County who are born addicted to drugs.

Every year, an average of 25 babies are born with drug addictions in Sonoma County, according to data from 2012 to 2014, the most recent available from the county. The numbers have nearly tripled from a decade ago, when the average was nine drug-addicted babies per year.

The problem is significant in Sonoma County, where the rate of drug-addicted babies - 5.3 babies for every 1,000 born - is now twice the state average. In California, about 1,190 babies were born addicted to drugs in 2014, according to data from the Office of Statewide Health Planning and Development.

Valentino was born on July 15, 2015, about three weeks early, and weighed 5 pounds, 6 ounces.

“A healthy, opiate-addicted baby boy,” McAnallan said.

He was, though, symptomatic: irritable, restless and stiff. He shook uncontrollably. Both he and McAnallan, who was in withdrawal at the time, were given drug tests. Both tested positive.

At the time of her son’s birth, McAnallan’s tolerance for painkillers was so high, the morphine that doctors gave her barely did anything to numb the pain of childbirth.

She only saw a doctor for her pregnancy two times before that July day.

“It wasn’t even because I was trying to avoid it,” she said. “I was just too busy trying to get high.”

Both times she went to the Vista Family Health Center, and neither time was she put through the county’s mandated “universal screening,” she said. The screening is a simple question that all pregnant women visiting a public clinic are supposed to be asked: Do you use drugs?

When McAnallan first found out she was pregnant, she knew her alcohol abuse had to end. “I don’t know - for some reason in my mind, I just thought that, like, there was a drastic difference between alcohol use while being pregnant and smoking Oxy while being pregnant,” she said referring to oxycodone, an opioid pain medication. “It made sense in my mind at the time.”

She never told anyone that she was using drugs while she was pregnant. Not her husband, not her parents, not a doctor.

“I used a lot during my pregnancy,” she said. “Hydrocodone, oxycodone. When I couldn’t get that, I would use Xanax to counteract the withdrawal. Marijuana I used my whole pregnancy. It was the same vicious cycle of trying to get the drug, spending all day getting the drug, and I kept telling myself, ‘Tomorrow I’m going to stop. Tomorrow I’m going to stop.’ But I could not stop for the life of me. Even knowing I was growing another life, I could not stop. I didn’t know how.”

She did take prenatal vitamins occasionally, but they made her sick.

The universal screening was developed as part of the county’s Drug Free Babies program, and was meant to be a way for health care providers to talk to mothers about healthy pregnancy, something that can be achieved even while using drugs. For example, for women addicted to opioids, like McAnallan, it’s actually healthier for them to be given an opioid prescription while pregnant, to maintain a constant level of opioids in their system, rather than put the mother’s body into any kind of shock from withdrawal, which could then risk the pregnancy.

The Drug Free Babies program, which was founded six years ago to help clients get into treatment, serves about 30 women every year, said Marena Koukis, the county’s perinatal placement specialist. That number, though, she said, is actually half the total number of women who are referred to the program by health care providers.

But that only shows part of the problem, explained Dr. Erin Lunde, with the Vista Family Health Center. In California, because hospitals aren’t required to give newborns or mothers toxicology tests, many babies with Neonatal Abstinence Syndrome (NAS) - the term for a group of problems for newborns exposed to addictive narcotics before birth - go undetected.

Most NAS babies don’t show any symptoms during their two- to three-day hospital stays. In fact, many won’t show signs until they’re back at home, sometimes as late as a week later, depending on the mother’s drug of choice.

From 2006 to 2008, the rate of Sonoma County babies diagnosed with NAS was 1.7 for every 1,000. For the years 2012 to 2014, that average increased to 5.3 for every 1,000 born. The state average is half that: about 2.5 babies for every 1,000 born.

“Women who are active users and who become pregnant - a large portion of them avoid prenatal care because they don’t want the medical facility to know that they’re using,” said Cheryle Stanley, executive director of Women’s Recovery Services. “And, of course, if it’s found out that they are using, there can be consequences.”

Women’s Recovery Services is an in-\patient treatment facility in Santa Rosa where many drug-addicted mothers go at the recommendation of local care providers, the Drug Free Babies program or Child Protective Services.

McAnallan found it through CPS. Her history of substance abuse is long and checkered: A DUI arrest, a history of depression, abuse of alcohol, cocaine, pain pills, benzos - a class of psychoactive drugs - and an occasional dalliance with heroin, though she said she never shot up. That was her limit.

Not all mothers who test positive for drugs at their child’s birth end up being contacted by CPS, said Nick Honey, Sonoma County’s director of Family, Youth and Children’s Services.

In fact, his directive to local hospital administrators and social workers is that a positive toxicology finding for a newborn or their mother is not sufficient for determining an existence of risk to the child. According to his most recent memo to hospitals, dated December 2012, a positive toxicology test must also be paired with “an indication that the mother will continue to use substances, rendering her unable to fulfill the basic needs of the infant upon discharge from the hospital.”

It goes on to say that a number of indicators could exist, including “the type of drug (the more addictive the drug, the more likely there will be continued use), pattern of past use, behavior during hospitalization, statements by the mother or others regarding use, and willingness/ability to care for an infant.”

After McAnallan and Valentino tested positive for opioids, because of her past, she was referred to CPS.

“The CPS worker at the hospital was like, ‘You have a problem. You have a problem.’ ... At the time I didn’t really realize how serious my drug use was. But there I was, sitting there, they’re about to take my son away, and all I could think was, ‘How am I going to get high when I get home?’?”

She didn’t get high when she got home, though.

She thought about it, but she couldn’t afford it. During the lowest depth of her addiction, McAnallan spent $350 to buy 25 pills, a two- or three-day supply.

She did drink, though, after leaving the hospital. It was her first time since getting pregnant - not that avoiding alcohol was a real challenge.

“If I had (opioids), I didn’t drink,” she said. “I didn’t want to drink. … It was like I was on top of the world.”

McAnallan got home from the hospital on July 18, three days after Valentino’s birth. He would stay in the hospital, detoxing, for another week and a half before being placed in emergency foster care.

Not all babies who test positive for drugs are as lucky as Valentino, who was able to receive specialized attention in a hospital setting.

He was given small doses of phenobarbital through a baby bottle, and today, at 6 months old, he is almost fully weaned from his opioid addiction.

McAnallan entered Women’s Recovery Services on July 29. She didn’t get to see Valentino for three weeks, but once she did, their visits were weekly - starting out for just an hour in her residential unit at the facility, where the baby would be shielded from any bright light or sounds that would be painful for him during his withdrawal. Then, eventually, she was allowed two-hour visits. Then three.

To be admitted to Women’s Recovery Services, a woman must be on public aid and also be a mother, either already with small children, or with one on the way.

Seventy women are admitted every year for the 120-day program, but only 20 can be housed at a time. The numbers don’t always line up because some women don’t graduate, said Stanley, the executive director.

About half of the women in the program are pregnant when they’re admitted, she said, and more than half of the women are opioid users. That number is a significant increase from even five years ago.

“I’ve been here 20 years,” Stanley said. “We didn’t have any of this 20 years ago. Yes, we had women who gave birth to babies, but they used meth. … For the first 15 years, it was clearly meth. … We saw heroin, but we saw very few up until recently.

“It’s worse now by far. Opioid (use is) at more epidemic levels than meth ever was.”

Dr. Karen Milman, the county’s health officer, was hesitant to put that label on the county’s heroin problem, though.

“I would say it’s certainly a concern,” she said. “But there are a couple of things that are contributing to this.”

Opioid abuse is increasing across the United States, including in Sonoma County. Milman also said that it’s likely Sonoma County identifies more cases because of the universal screenings. When asked why McAnallan wasn’t screened, Milman said she likely was but just didn’t know it was happening.

In the fall, the county launched an opioid work group to assess the way local doctors prescribe pain medications. Recommendations will be complete by the end of 2016, she said.

“We’re really looking to start to tackle this,” she said.

According to Lund, the doctor who works at the Vista Family Health Center, opioid-addicted newborns go through some of the worst withdrawals of any tox-positive babies.

“It can (mean) increased heart rate, increased temperature, increased respiratory rate,” she said. “It affects their gastrointestinal tract, so they don’t want to feed well, or they’ll vomit or have diarrhea. It can affect their nervous systems, so we see jitteriness. They’re hypertonic so their muscle tone increases. They can be really hard to calm. In more severe cases, they can actually have seizures, but that’s rare.”

Withdrawal symptoms for opioid-addicted newborns can be difficult, lasting anywhere from a week to two months, she said. Once those babies are weaned from the opioids, though, doctors don’t think there are any major long-term consequences.

On the other hand, for mothers who use stimulants like cocaine or methamphetamine, the withdrawal is easier but the infants can suffer long-term problems. Pregnant women using those substances, unlike women on opioids, are encouraged to quit immediately.

“We think that meth has other effects, more long-term effects,” Lund said. “But in the short term, the heroin addict’s baby is going to be much worse off.”

In March 2015, because of the increase in the number of women she was seeing at Vista who were showing signs of opioid addiction, Lund started the New Beginnings Clinic.

“I just thought the regular model of care wasn’t working for this population,” she said. “We’d have appointments scheduled with the mothers, and they’d frequently miss them, and when they came back, there wasn’t always the continuity of care.”

Because of a lack of continuity, Lund said, a lot of times clients’ substance use was getting missed.

The New Beginnings Clinic is staffed by a limited number of providers, all of whom are used to treating patients with substance abuse problems, and who operate with a nonjudgmental approach, Lund said.

By the time the clinic opened, McAnallan was too far along in her pregnancy to take advantage of its programs.

She’s been out of Women’s Recovery Services for about three months now, though she still attends outpatient classes for women with children. Next, she’ll be getting in touch with Dependency Drug Court and will head to night school at Empire College to complete her medical assistant certificate.

“One of my biggest dreams after coming into treatment is to open a treatment facility specifically for the Hispanic community. I feel like there are a lot of addicts in that community, and it would be really nice to have a treatment center targeted specifically for the Latino and Latina community, so I really want to do that. Especially for women. I feel like women forget what power they hold and that they can be somebody. That they don’t have to revolve around a man. That there’s more to them than just playing the role of wife and mother.”

After a few months in the care of a foster parent, Valentino’s custody was transferred to his paternal grandmother, who lives in The Sea Ranch.

McAnallan and her husband go up on weekends to see him.

They hope to get custody back by his first birthday.

You can reach Staff Writer Christi Warren at 521-5205 or christi.warren@pressdemocrat.com. On Twitter @SeaWarren.