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The Honolulu Advertiser
Posted on: Tuesday, September 16, 2003

Meth-exposed babies studied

The ice epidemic has touched tens of thousands of lives in Hawai'i. It has an impact on our families, our children, our schools, our crime rate, our prisons, our businesses. Our community has never faced a problem quite like this, and we are still searching for the right responses.

During the next year, The Advertiser will probe different aspects of the problem, and our responses to it.

By Karen Blakeman
Advertiser Staff Writer

Chris Derauf, a pediatrician at Kapiolani Medical Center for Women & Children, conducted a study in 1999 to find out how many babies in Hawai'i were born with crystal methamphetamine in their systems.

Kaiser nurse Paulette Nakamura works with pregnant women whose fetuses are endangered because of drugs.

Gregory Yamamoto • The Honolulu Advertiser

He collected infants' first stool samples, tested them and estimated that more than 850 babies are born each year exposed to ice.

But Derauf did not match the names of the babies with the samples he collected. Had he known which babies were born to mothers who had exposed them to ice during pregnancy, state law would have required that he report the women to Child Protective Services.

Derauf thus faced a conundrum for doctors who are studying the effects of crystal methamphetamine and other drugs: how to collect much-needed information that will help others without asking women to face losing their children to state authorities.

"There was a lot of talk about the extent of the crystal methamphetamine problem and its impact on children," he said, "but that is all it was: talk. There was very little data to back it up."

Derauf and researchers in four sites across the country are about to change that. The group has recently been granted $6 million by the National Institute on Drug Abuse to conduct a five-year study on the long-term effects of crystal methamphetamine exposure in the womb. After that, they plan to request financing renewals that will allow them to follow the children — about 500 of them — through their school years.

Just over 100 of the children — half of them born to mothers who used ice, the other half born to drug-free mothers — will be recruited in Hawai'i.

Overriding state laws


While the state increasingly focuses on the thefts, burglaries and violent crime associated with methamphetamine addiction, experts say the harm to children of addicts is often overlooked.

 •  Drug's youngest victims see families torn apart
 •  Trauma of ice both physical, emotional
 •  Crystal meth Q&A
 •  Chart: The crystal methamphetamine crisis
 •  Chart: Indicators of a worsening ice problem in Hawai'i
 •  Chart: How methamphetamine works in the body


When state Child Protective Services removes children from a home because of drug use, it becomes a powerful tool to pressure the parents into treatment.


Losing children can break addiction

 •  Tragedy leads to change


Mother reflects on heavy price of her addiction to meth


Doctors desperately need information about babies born each year with ice in their systems, but some drug-addicted mothers fear taking part in such research could cost them their children.

 •  Prosecutor wants pre-birth intervention

The researchers will not only examine the babies at regular intervals, they will also conduct lengthy interviews with the mothers, including some in the homes where the children are being raised.

To allow them to secure the cooperation of the mothers, the NIDA, part of the government's National Institutes of Health, has given the researchers what Derauf says is proving an invaluable tool.

The federal agencies have granted a waiver that allows researchers to override state laws requiring physicians to report the mothers of drug-exposed babies to CPS.

Derauf said he sees the waiver as a means of opening doors not only for the researchers to gain information, but also for mothers and babies to gain access to treatment and medical care. The women will get referrals to treatment centers and researchers will keep track of the women and their babies for the five years of the study.

"We see this study as something friendly, not something that will drive people away," Derauf said. "If it will allow them to access the care and evaluation they need, and also help us in the analysis of the problem, then it is a win-win situation."

Barry Lester, a researcher at Brown University Medical School in Rhode Island who will lead the national methamphetamine project, said he considers the waiver essential for recruiting the mothers.

"That's the way it gets done," he said. "Otherwise, who the hell would do it?"

Lester agreed with Derauf that long-term, well-controlled research concerning the effects of methamphetamine use on children has been nearly nonexistent until now, and part of the reason may be roadblocks erected by state reporting laws similar to those in Hawai'i.

Lester, who led a landmark, long-term research project debunking much of the information that led to a national panic over "crack babies" in the late 1980s and early 1990s, and who has recently completed a study of societal attitudes toward mothers who are addicted to drugs, said physicians and scientists are unable to effectively function as researchers when they are seen as arms of law enforcement.

The physicians are also hobbled in their ability to function as doctors when they are required to act as detectives for the state, he said.

Requiring medical professionals to report their patients to authorities can cause pregnant drug users to avoid prenatal care to avoid losing custody of their children, Lester said, causing even more problems for the child the state laws seek to protect.

Doctors who are uncomfortable with reporting regulations may be less likely to test a child who may have been exposed prenatally to methamphetamine, he said, and obstetricians who suspect drug use by pregnant women may be more reluctant to ask.

Still, he said, legislators in 16 states have passed laws requiring doctors, when confronted with test results that show newborns were exposed to illegal drugs in the womb, to report the mothers to child protective services.

'Red flag' behaviors

"We see this study as something friendly, not something that will drive people away," said Chris Derauf, a pediatrician at Kapiolani Medical Center for Women & Children.
Like Hawai'i's mandatory reporting law, most were initiated after a nationwide scare just over a decade ago, when small studies — some of which had flawed control factors — led the public to believe that babies born to women who used crack cocaine would be irreparably damaged by exposure in the womb.

In Hawai'i, reporting becomes mandatory after tests on a baby show positive results, said Amy Tsark of the Department of Human Services, which oversees CPS.

Tests are usually taken after medical authorities notice "red flag" behaviors by the mother, including a reluctance to show up for prenatal care, or problems during pregnancy or childbirth that could indicate drug use.

The doctors perform the tests as part of providing adequate care for the infant, Tsark said. The tests are not mandated by law.

Once the positive test has been reported to CPS, state social workers initiate an investigation while the baby is held in the hospital, Tsark said. They examine the parents' home situation, the support available from extended family members, the mother's history of previous child abuse or neglect and other factors.

A court case is initiated, and a judge determines whether the child should be removed from the home, she said. Older children are also subject to removal and placement in foster care.

If you want to participate

Pregnant women 18 years and older who plan to deliver at Kapiolani and are interested in participating in the infant development study may call Dr. Chris Derauf at 983-6097. Women who use heroin or psychedelics during their pregnancies and those who are expecting twins will be unable to participate. A small stipend will be paid to the participants.

Lillian Koller, head of Human Services and Tsark's boss, said that in recent years, 80 percent of children who were reported to CPS by medical authorities have gone to foster homes, a situation that painfully stretched state resources. Although specific figures on ice have not been collected, most of those referrals are thought to be connected to its use.

"There just aren't enough foster homes," Koller said.

If the mother has not agreed to cooperate when state officials take custody of the child, police are called in to remove the children without her permission. The mother is then expected to seek treatment for her problem, stop using drugs and rehabilitate her environment at home.

Many fail, Koller said. State figures show 61 percent of children are eventually reunified with their mothers. The other 39 percent may never have their families reunited.

Sherry Loo, a pediatrician at Kapiolani, said she is happy with the mandatory reporting system.

A lot of thought went into developing the policy during the late 1980s and early 1990s, she said, with input from the Department of Justice and from the state Health Department. Because the state does not attempt to criminally prosecute the mother for endangering the baby before it is born, she thinks the current regulations, which deal only with the custody of the child, are a reasonable compromise.

Promise of treatment

Nurse Paulette Nakamura says she would like to see every baby born at Kaiser be tested for ice and supports reporting mothers on drugs.

Gregory Yamamoto • The Honolulu Advertiser

Loo said mothers who provide medical histories of drug abuse, tobacco abuse or alcohol abuse should be screened for drugs whenever possible. When the toxicology screen of the mother shows illegal drugs are being used, the doctor should always test the baby when it is born, she said.

"To screen the mother, we must have consent," she said. "We can screen babies without getting maternal consent."

Loo said that she reports positive infant screenings to a hospital social worker, who reports them to CPS.

Liz Claybaugh, who heads up a child safety program for the Hawaii Department of Health, said she sees mandatory reporting regulations as a punitive measure against the mothers who provide little or no means of correcting the addiction and do little to serve the family.

"Drug addiction is a mental illness," Claybaugh said. "We need to concentrate on providing treatment."

There are not enough openings in existing drug treatment programs for Hawai'i's ice addict population, she said, and treatment programs that care for addicts who are also mothers are even more rare: limited to a single program run by the Salvation Army on O'ahu.

Paulette Nakamura, a nurse at Kaiser Permanente who works with pregnant women whose fetuses are endangered by factors including drugs, alcohol or cigarettes, said too often the women are so helplessly addicted to ice that they cannot be helped by other than coercive measures.

Methamphetamine-addicted women, among the most serious and numerous threatened-pregnancy cases Nakamura sees, don't show up for prenatal care, she said, and many of the mothers do not seem to care.

"Their priorities change," Nakamura said. "Good prenatal care is no longer what is most upfront for them. Their life focuses around something different: the drug."

Nakamura said she supports the reporting regulations, and would like to see every child born at Kaiser tested for methamphetamine to make sure that specific ethnic or economic groups are not being singled out for screening.

Derauf said the pregnant women at Kapiolani who he and his interviewers have contacted for the methamphetamine study seem interested.

"Lots and lots of them are more than willing to participate," Derauf said. "Both the subjects and the controls. They are moms who see this as looking out for the best interests of the children."

The waiver, he said, will provide opportunities for the women to talk openly to medical professionals about their addictions and the effects of their drug use on their babies. He said he thought the same openness could be used by medical authorities in general to help their patients — if they were allowed to decide when and whether state authorities should be contacted.

"I think most doctors would draw the line at overt negligence or abuse," Derauf said. "Obviously, you would report that. But if you believe in the medical model, addiction is a disease. You don't improve it by reporting it to authorities."

Lester said Derauf's recruiting experiences are typical in research involving drug-addicted women who have just given birth.

"Even for the most hard-core user, having a baby is magical," he said. "They (the mothers) feel remorse. They worry: 'Did I do anything to harm this kid? Is there anything I can do to make up for it?' "

That's where the promise of treatment comes in, Lester said.

"Motherhood can be a powerful incentive," he said. "We unabashedly take advantage of that."

Reach Karen Blakeman at 535-2430 or kblakeman@honoluluadvertiser.com.