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This Rural Mission

Jan 7, 2020

This week we are taking a part-two look at the opioid crisis and talking about who opioid addiction really hurts: children. The foster care system in this state is flooded with children who have had their lives impacted and uprooted by opioid addiction. In this episode we will hear from CPS workers, foster care parents, family service professionals and addiction councilors. 

This Rural Mission is a podcast brought to you by Michigan State University College of Human Medicine. The podcast is produced with funds from the Herbert H. And Grace A. Dow Foundation and the Michigan State University College of Human Medicine family medicine department. Welcome to season two. I'm your host Julia Terhune and I hope you enjoy this episode.

This season I knew I had to address the opioid crisis that is affecting rural communities, but I really didn't want to do it in the traditional way. Truly because there is so much to unpack and in my opinion, I think that when we talk about the issue, we have a tendency to either focus on numbers or start blaming and pointing fingers as to why and who and when and who's not being considered and what the real root cause is. Really what I think is that isn't where any of the conversations should start because it doesn't matter. It doesn't matter how it all started. It's here and it's affecting real people and we have a problem.

We're going to talk about the real consequences and why we should care and why we all should care is because we're talking about children. When it all boils down, the people who are really affected the most and the longest in the midst of this crisis are kids. So in the efforts of impact and to contextualize this real issue, we are going to tell the story of the Brown family. The Browns adopted both of their children from foster care and the origin story for why they are together and a family today is because of opioids.

Back in 2010, Todd and I decided to go for foster care and in 2012 we were gifted with two wonderful children, their ages were nine months and four years at the time. They had been taken out of a home where they received trauma from abuse and neglect and they were placed in our home in a very short amount of time. From the call to the time they arrived in our driveway was about 45 minutes. They came to us, very malnourished. They were very dirty.

We believe they were under the influence of cannabis or second hand of cannabis because they were very dazed and confused. Our foster son at the time was very underdeveloped. We could tell that he had speech issues. He had gross motor skill issues and the little girl, our daughter now, which was nine months at the time, she weighed about 12 pounds and she wasn't able to crawl yet. She was just barely rolling over, so they were very much on the lower end of the scale of development.

Our children's mother had an opioid addiction and actually her mother overdosed on opioids in front of her and died when the mother was about 19 years old. With the opioids, we have all of our children's medical reports and our daughter, especially when she was born she was born at 31 and a half weeks, so she was very premature. She was less than three pounds. She was addicted to meth and cannabis and there was many things in her toxicology when they pulled it. So they had to put her on Suboxone and a bunch of different other medications to help her come off of that addiction along with trying to build her way up because she was so small and she was a premature.

Because of that, now she is a fully developed child. If you saw her, she's very small but she is fully developed mentally and physically and all that, but she does suffer from deteriorated vision in her left eye because of the opioids. So unfortunately she has a patch that's over her right eye right now trying to strengthen her left eye.

That's one thing. People will always say to me, "Those kids are so blessed to have you," and to me it's not that. We are blessed to have these kids. These are awesome kids and once you get to know them and once you see how many great things they can do in their life, it's such a treat. It's just such an awesome, awesome experience.

According to the Center for Disease Control adverse childhood experiences, or ACEs, are referred to as potentially traumatic events that occur in childhood zero to 17 years such as experiencing violence, abuse, or neglect, witnessing violence in the home and having a family member attempt or die by suicide. Also included are aspects of the child's environment that can undermine their sense of safety, stability, and bonding such as growing up in a household with substance misuse, mental health problems or instability due to parental separation or incarceration of a parent, sibling, or other member of the household. Adverse childhood experiences have been linked to risky health behaviors, chronic health conditions, low life potential, and early death.

So if we put some data behind all of this, according to the Institute on Drug abuse, babies being born addicted to opioids has gone from less than one baby per a thousand in 2014 to more than seven babies per thousand being born addicted in Michigan alone. That is an eight fold increase. That means that more than 125,000 children each year are being born either addicted to opioids or living in a situation where they are either removed from their families because of that circumstance or living in a family where there are real consequences of opioid use streaming in almost everything they do in Michigan alone.

So it's time to consider this and start talking about solutions. I spoke to five experts on the topic of children and opioids. We're going to start with Marnie Taylor from the Isabella County Child Advocacy Center. She is going to introduce us to ACEs and then we are going to jump right into talking about foster care with my friend Afton and my friend Doug Lewis.

Afton is now a child protective service worker and Doug Lewis is, well, he's everything. He's a biological foster and adoptive parent and he has been for more than 30 years. He was a child and teen advocate, a foster care worker, an addictions counselor, a community volunteer, a business person, a pride teacher. That's the class you have to take before you become a foster parent and now he takes care of the homeless in rural Michigan. He's also a light in a dark world.

[inaudible 00:08:02] has a high use of opioids and other drugs, but because that is an ACE that is going to increase the number of adverse childhood experiences that a child is going to have if they're exposed to a loved one, an adult who is their main caregiver if they are addicted to heroin or opioid prescription pills. But furthermore, an incarcerated parent causes an adverse childhood experience as well. So if that is happening within families, they have not only a parent who has a substance use disorder, they also more than likely will have a parent who becomes incarcerated at some point in time.

So ACEs are comorbid typically because when one adverse childhood experience happens, then it's highly likely that other adverse childhood experiences are going to happen because of the chaos that comes around that experience. Though, if a family is going through divorce for example, that in and of itself is an adverse childhood experience, but then when you start to look at the number of maybe domestic situations might be going out because of the divorce. So that child's being exposed to some kind of maybe abuse or neglect, even if it's emotional abuse or neglect, those kinds of circumstances increase substance use probably increases in terms of coping mechanisms and people dealing with a difficult time in their life. So it's very easy when one adverse childhood experience happens that others are happening along with that.

You can talk about it being the choices that their parents make in order to have the drugs or the choices they're making while on drugs. So in terms of neglect, children aren't removed from their families because of poverty. However, there is a lot of poverty associated with drug use because money isn't being spent on food, it's not being spent to pay bills and those create very unsafe situations for children.

So you get some of those cases being the reasons that children are removed and then the next broad area is of use and abuse of course gets broken down into the types of abuse. But anytime that you are dealing with someone who is trying to I'll say feed a habit, there may be unsavory characters around and then of course there are people who are caring for children while they are high. We know that part of being on drugs, part of being high is that it changes a person's personality, changes their ability to cope with things. So you have a small child in their terrible twos and you have a person who's high and can't handle that and now we have a situation where child abuse is opportune.

Prenatal trauma is that trauma that children will experience in utero while their mother's carrying them. What they're theorizing right now is that we have this genetic makeup, but that our environment can trigger certain genetic things to happen in us. So not only does our genetics determine who we are, but our environment can affect our genetics and in the process change who we are. So if we look at cortisol levels in the brain, those can be genetically triggered by a mother being exposed to domestic violence or having a lot of emotional experiences during her pregnancy that not only is that affect the genetics of the child, but if a woman is carrying a female child in her, it can affect her development of eggs in utero. So not only will it affect her genetically, it could affect her children genetically too, down to the second generation. So it's much more complicated than what we thought. Now, as an adoptive parent, I think we need to understand a little bit what families.

I think we need to understand a little bit what family systems may look like in a dysfunctional family. I go back to some training I had when I was young concerning a thing called Karpman's Triangle, where we talk about different roles that people play in an in a codependent family. One person plays the victim and another plays a rescuer, and then they both alternate between those two roles and the role of being an accuser or persecuted or because like how dare you do this? Why didn't you bail me out? Or why do I have to bail you out again?, People began to feel like victims who are rescuers and victims not the relationships to be a rescuer, or so it is just an unhealthy pattern that develop in these families, and you can take them out of that family and put them under other relationships and they tend to duplicate those types of relationships and other systems that you put them in.

I think it's important for us to begin to understand how family systems often look like in addictive behaviors. We know that there are some roles that people play. There's the role of the addict. There's often somebody in the family who will be an enabler. They will continue to cover for that addict and try to soften the blow on them. There's often the role of the hero in a family. This is the child who is trying to make everything perfect, organizing the chairs on the Titanic. They're constantly trying to make everything perfect in their lives. They become very stressed out people. Oftentimes as adults, they suffer from stress-related illnesses. We have the scapegoat or what we used to call the whipping boy in the family, is the child who gets blamed for everything that goes on because we're not going to blame the addict and we're not going to blame anyone else.

Oftentimes one person in that family will be that scapegoat for the family, and that relationship is really a difficult one because they grow up feeling the sense of guilt and shame for everything that somebody else has done. Oftentimes you will have the mascot in the family. They're the kinds of the clown of the family. They try to make everything smoothed over by being, everything's a joke kind of a thing and they will often self-medicate with alcohol or drugs themselves and does thus perpetrate the whole cycle of addiction. I think one of the sadness when is the lost child in the family, a child who just doesn't know who they are, and they just completely shut down. They'll have problems forming intimate relationships. They'll tend to isolate themselves as adults.

A number of my children have come who were born addicted to heroin. Back at the time I was adopting, they were not doing tests routinely in the hospital. I would, for instance, one of my children came to us was I'm two days old. We noticed right away she was almost impossible to soothe. It was because she was going through withdrawal. No one knew. It wasn't until July, we were doing a garage sale at our house and her grandmother came to the house and asked how she was doing. We said, "Well, she," we're both, my wife and are both dazed because we haven't slept in months. We said, "She's a lot to handle." She said, "Well as soon as she gets done going through withdrawal she'll do better." We both looked at it kind of with our heads tilted and said, "What withdrawal are you talking about?"

She said, "Well, my daughter was using heroin through her whole pregnancy, and so she was born addicted to heroin." That was an eye-opener. There are certain patterns that often exist in homes where addiction is the centerpiece of the family. We talk about codependent relationships that develop in those type of families, which often, those type of codependent relationships create a whole level of ACEs for kids that are raised in those homes. You take all the genetic things that have happened to these kids and then you take the prenatal things that have happened to him and now you include in that whole process, some really adverse childhood experiences, and you've got what we might consider a perfect storm for these kids growing up. Interestingly enough, I was talking to somebody just today. We were talking about a person who I'm working with who is in their twenties, has never had a birth certificate, never had a social security card, didn't know what their social security number was until a couple of weeks ago.

It's been almost an impossible task just to get that identifying information for foster care, adoption that went rough. The worker tells me at age 23, the reason he doesn't have these things is because he's done some things wrong along the way. It was one of those moments when I just, I had to quietly lose it because yeah, he's done some things that he probably shouldn't have done, but there is [inaudible 00:16:34] . He's part of that perfect storm. He's just part of a perfect storm. As adults, we have to take responsibility for our lives, but we also need to be given opportunities to take responsibility. But when you tell somebody you can't get a job where you earn a wage because you don't have even a social security number, so you're going to have to work under the table or do illegal activities, take responsibility? Let's give them the ability to have responsibility.

Dr. Julia Riddle is a family medicine doctor in Northern lower Michigan. She treats vulnerable women who are addicted to opioids and other drugs while pregnant. This is an important and controversial topic when it comes to rural health care because what we know is that medical-assisted therapy for drug addicts does help with cravings, withdrawal and the effects on developing fetuses. But the opinions on best practice regarding MAT or medical assisted therapy are endless. Dr. Riddle is making a difference in women's lives and taking care of rural women, rural babies, and helping to cut the impact of drugs before they stem and spread and continue this cycle of addiction.

Opiate dependence is a disease. Some people are already in treatment and managing their disease. They're already, maybe on Buprenorphine products and they become pregnant. Other people have been using Norcos or Percocets or shooting heroin and then they find out they're pregnant, and they realize that they have to quit and they can't. Then there's some people who aren't necessarily ready to quit. And despite the fact of being pregnant, not ready to move forward with treatment. Very few of those. Once women find out they're pregnant, they really want to get help and they want to do good. They want to be better. They want to not use during the pregnancy. I would say a vast majority of women are like that. So, if they've been using on the street and they find out they're pregnant and it's not a true dependency, a lot of women would quit.

Maybe they only take a few pills occasionally at a party once a month. They quit. They just don't pick it up anymore. I think the vast majority of women though, if they are using opiates, they have a real dependence on them, and they are unable to just stop taking the opiates because they get sick and they go through withdrawals. We don't recommend that women go through those withdrawals during pregnancy. There's all kinds of rehab centers or detox centers where people just go, and they go cold turkey, and they have sweats and vomiting and shakes and chills and they're real sick just to get off of the opiates. We don't recommend doing that during pregnancy because that's harmful to the fetus. I put them on Buprenorphine. That takes away their cravings and it controls their withdrawals. They don't withdraw so that helps them with their physical symptoms.

The next step is helping figure out their basic needs, trying to find them a place to live, potentially work if they need it, and then getting them into counseling to help deal with the reason they're using, whether it be anxiety, a history of trauma, which is really common. Relationships, getting out of bad relationships. All those things are really important to healing them and healing their brain, getting them off the street, hanging out with people that would get them into the situation of using again.

This is a disease and it is a very powerful disease, and it affects the brain in such a way that it can be really, really, really hard to not use drugs. That's why this medication, Buprenorphine is so important because it gets rid of those cravings, it gets rid of those urges to use and it doesn't make anyone high. If Buprenorphine doesn't work because I sometimes I think it isn't strong enough, that's where Methadone comes in. We don't have access to Methadone in Traverse City. This gets down to the whole rural health concern. We don't have access to send people to that higher level of care. That's sad because I have seen people trying. They're coming into extra appointments. They're taking their medication. They're going to counseling, but the urges are still there, and they need a higher level of care that we just don't have here. We see them and support their pregnancy as much as possible. Sometimes they deliver early because of the stress that puts on the infant, depending on what's going on.

It's tough, and it's sad because if we had more options for medications, we could potentially help them do better during their pregnancy. That's one of the reasons I started working in Gaylord, is so that even though it's an hour from Traverse City and two hours from Manistee, we still have that somewhat availability. Well, the greatest rise right now is the opioid epidemic, and a lot of the children are coming in because of the opioids. Not that they're addicted to them, but their parents are so addicted to them, they're being neglected and they're not being cared for in the manner that every child deserves. So we're, yes, physical abuse, sexual abuse, mental abuse, all that is still current as it was for many years. But the drug abuse has completely skyrocketed in our system to the point where we are having trouble as a society here in Northern Michigan to find placement for these foster kids because we don't have enough foster parents anymore. Unfortunately sometimes they have to be sent down state to open foster homes because there the need is so high and they just can't fulfill it.

I'm going to let you all in on my life for a moment. I am a foster parent. In 2018 my husband and I took care of five different children from four different families, all from a few days to more than six months. Our longest and first placement we love. Love like our own biological child. We got really attached and had to do the thing that we and everyone else says that they could never do, and that was to reunite. We dropped our foster child off with his biological parent at an inpatient rehabilitation center when it was time to bring everyone together, and you want to know something? It was the best thing that could've ever happened to that family. While there were adjustments, we saw both people-

While there were adjustments, we saw both people thrive. We saw our foster child's parents get and stay clean and we saw happiness and attachment and a sense of home for our foster child. Opioids cause so many problems, but we as a people are the ones who can fix them. We just have to be willing to have real hard, messy, beautiful relationships with people. And then the second ingredient is empathy.

First two kids, we get into care and at the nine month review hearing, mom and dad are saying, they're going to get the kids back, they're going to go on and pull some rabbit out of a hat and get their kids back. And so we're like freaked out. We're waiting out a lobby in the court system in the town we were in, and mom and dad are just around the corner and they're spewing off their mouth about we're going to get our kids back and you people will never see these girls again, blah, blah blah. And I'm sitting there thinking all the things that you shouldn't think about birth parents, about what rotten horrible people they are and how they don't have a right to have these kids and blah, blah, blah, blah, blah.

They go into the judges chambers to try to work out a deal before we go into court. They're in there about 20, 30 minutes and pretty soon the case worker comes out and says, "You're not going to believe this. They're in there signing off their parental rights right now. Would you be willing to adopt these two kids?" And my wife and I are both sitting there with our mouths hanging open going, huh?

We're at the elevator, at the courthouse sitting in a bench there. And pretty soon out come mom and dad with their backs to us and push the button to take the elevator down. And I'm looking at these two people thinking, what in the world did you just do? How could you possibly do this to your children? The elevator opens, they step on and they turn around. And in that moment I looked in mama's eyes and I saw something I didn't expect to see. This woman was broken. She had just lost her children. I never had seen so much pain in the eyes of somebody in my life. There was something else I saw in her eyes too. The eyes of those two girls that I had.

And in that moment I thought to myself, how can I love these children and hate their parents when the difference between mom and her kids are just time? These kids could very well end up like their mother and I love them dearly. How can I not love their mother just because life has taken her naturally where it was going to take her anyway. Not that she's not to blame for some of the things that happened, but as a Christian, I don't think my job is to judge people and that's difficult. What would I be like if I grew up in the world that she grew up in and I had the few options in life that she had. I mean, I was given lot in life and I made some really bad choices. So how much worse am I as a person than her who had very few options in her life and made some of the same bad decisions I made as a young person.

One of my best friends died because his doctor prescribed oxycodone and assured him that he could live a normal happy life for the rest of his life and be on oxycodone because of a back pain. And he dropped dead of a heart attack. And as he was dying, he didn't even wake him up from his sleep because he didn't feel any pain. Had no idea that when he went to bed that night, he would never wake up again. And the conversation I had with him a week before, so I told him, you are on a synthetic form of heroin, how are you going to get off of it? And he said, "Doug, my doctors assured me that I'll be fine with this and I can live like this the rest of my life." And then he died. That was about 10 years ago. He's still dead.

In a perfect world, I think foster parents would be considered honorary aunts, uncles, big brothers, big sisters, grandfather, grandmother types to a family who is struggling with a substance abuse. So yes, I might've been a stranger the first time you met me, but we're all going to work together. So that your family, that includes the foster child, the foster mother or the foster child, the biological mother, all of the children, we're all working together. So that little foster kiddo, you get to go home to a family that is safe, loving, nurturing, and we'll even stay in touch over the years. So that mom has a support system, so that mom doesn't feel shame, so that mom doesn't feel blame. So that mom is supported, so that you stay supported little foster kiddo. And it becomes a community effort. It becomes a family effort.

If we're going to address the whole idea of opioid addiction, I think there's two things we need to keep in mind. One is the earlier we intervene in people's lives with trauma informed care, whether it be as foster parents, or daycares, or in schools, the better we are. And then the other thing is, is we need to treat addiction as a family system issue rather than just an individual in a family system issue.

And I think that, that's part of what the great thing about ACEs is, is that the more we educate people on what adverse childhood experiences are. And so this really ties back to my love of parenting and that de-stigmatizing thing. Is this is something that's happened to you. Even as an adult, as a parent, and I'm raising my young children, there is a lot of guilt that comes into parenting. There just is. And some of that is by the poor choices that you make as a parent. Like you get upset because they knock over a ... Silly example, but knock over a glass of milk and then you feel guilty because you got upset and it was just spilled milk. But this really gives us a tool that we can talk with parents and say, it's not all about you being a bad parent. These are things that have happened to you that has impacted your ability to make decisions that's impacted your ability to be the best person that you could be.

And there's ways that we can work with you to move forward from that. And just taking away that guilt and that shame piece allows people to blossom and become a better person than what they were because they're not positively shaming themselves inside or [inaudible 00:31:15]. And so that's one thing we want to do is build that resilience and have that self talk be more a positive self-talk as opposed to a negative self talk.

Thank you to Dr. Riddle, the Brown family, Doug, Afton and Marnie. Not just for the interviews, but for everything, everything you do for families and children in rural communities around the state. Your service does not go unnoticed. A special thanks goes out to Ada, one of our mighty and noble leadership in rural medicine students who help to edit and produce this podcast. After two years of producing this on my own, I can tell you the help was immensely appreciated and all of us at Leadership in Rural Medicine programs love working with you, Ada. Thank you for everything. Thanks as always to our director, Dr. Andrea Wendling, and to all of you the listeners. We could not keep doing what we are doing with this project without you. So in return, we hope that this episode inspired you to make rural your mission and we will hear from you. Next time.

To learn more about the Rural Community Health Program, please visit our website at By joining our website, you can connect to us on Facebook, Instagram, and Twitter. You can also find out more about our musician. Music today was provided by Horton Creek and Brian Eggers, a local musician and Michigan native. We hope you tune in next time to hear more from This Rural Mission.