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Were you aware that Americans consume 99% of the world’s supply of the prescription drug hydrocodone (Vicodin)? Overall, we gobble up 80% of the world’s supply of all kinds of opioid pain medications such as oxycodone (Oxycontin, Percocet), morphine, and fentanyl.

An estimated 10.3 million Americans aged 12 and older misused opioids in 2018, including 9.9 million prescription pain reliever abusers and 808,000 heroin users. More than 130 people died every day from opioid-related drug overdoses in 2016 and 2017, according to the US Department of Health & Human Services.

This voracious cycle of addiction that manipulates our psyche into believing we can medicate away our physical and emotional pain has led to the deadliest drug epidemic in U.S. history, leaving virtually no community unscathed.

Well researched materials on the toll of opioid abuse can be found across the media spectrum. However, little is available when seeking to understand the impact on infants and children as a result of mothers and other caregivers who suffer from an Opioid Use Disorder (OUD). These helpless beings have suffered through no fault of their own. It has been thrust upon them.

In America, the number of infants born addicted to opioids tripled between 2004-2013 with 6.7 out of every 1,000 births linked to Neonatal Abstinence Syndrome (NAS). Infants born with NAS may experience a variety of symptoms ranging from a restless infant with high pitched cries, nausea, vomiting, tremors or seizures. These symptoms may appear immediately after birth or take several days to develop and the withdrawal symptoms they experience can be with them for as long as four to six months. Mother-child bonding is also compromised.

It may seem crass to bring up the financial cost to society for this public health crisis, but it can’t be avoided. Medicaid, the principal payer in this tragedy, is primarily a state budget line-item and state budgets need to be balanced. Federal budgets are not spared either. That means every dollar committed to prevention and treatment means that another public service goes wanting.

In 2016 alone, total hospital costs to treat NAS climbed to a new high of $572.7 million, with 83% paid by Medicaid, clearly placing a disproportionate burden on state and federal budgets. However, this is just the tip of the iceberg.

Infants grow into children, who face an unenviable childhood because of the bad luck of being born to an addicted mother or because a parent in the household has OUD. If current trends continue, the number of children affected nationwide by opioid use will rise from 2.2 million, i.e., 28 out of every 1000 kids, to an estimated 4.3 million by 2030. Sadly, the majority of these children are under the age of five.

Because of their special needs, many children with NAS will end up in the foster care system. In fact, in 2017 approximately 325,000 children were in foster care as a result of the opioid epidemic. With the increased rates of children being born to addicted mothers, it is expected that the number of children in foster care will continue to grow, increasing the strain on the already limited foster care system.

According to the United Hospital Fund’s Children’s Health Initiative (November 2019), The Ripple Effect: National and State Estimates of the U.S. Opioid Epidemic’s Impact on Children, the cumulative lifetime cost for this relatively small slice of our national population will reach $400 billion in additional spending on health care, special education, child welfare, and criminal justice. This figure does not include productivity losses or missed opportunities.

Of all the populations at risk, the least recognized and studied group includes children and teenagers who become caregivers for others in the family—parents, siblings, grandparents, and others. There was only one study done in 2005 but it did not carve out those impacted by OUD.

These young caregivers take care of household tasks like shopping and preparing meals and may take on more demanding responsibilities in a full role reversal where they become the parent to their parents and siblings.

In Appalachia, children as young as six years old are being taught to administer Narcan, a nasal spray used by first responders to reverse an opioid overdose. According to a report by N.Y. Times’ Dan Levin “It’s just like a little squirt gun,” drug prevention educator Jilian Reece told a group of children, before passing around the small plastic device for them to hold and squeeze. At the end of the session, each child received a blue zippered bag containing two doses of Narcan to take home.

All of this is disturbing enough, but realistically, as a nation, we must address not only the emotional and physical damage to individuals but also the damage to the bottom line. In a world of strained financial resources, where do infants and children fit into decisions about the allocation of resources? After all, they have no voice, no vote….

The media tout financial settlements with various pharmaceutical companies, namely, Purdue Pharma and the family primarily responsible for this catastrophic and chronic devastation, the Sacklers. It’s past due that some level of accountability is being metered out but what about the infants and children who are the future of this nation? They need the front-page headlines.

Admittedly, young adults, parents, and grandparents who are addicted need and deserve our care and attention…but so do infants and children. These innocent victims never popped a pill or put a needle in their arm.

Our infants and children are asked to bear too heavy a burden. We must be their voice and disrupt the silence. A heartbreaking call such as this should not be part of a child’s life. It happens all too often…and, once is one time too many.

“My mom is on the floor…No, she’s not awake. She’s changing color.”

“Keep talking to her.”

“Mom, wake up! Mom, wake up! Mom, wake up!”

—Conversation between 911 operator and nine-year-old child from “Heroin’s Children,” Top Documentary Films 2017

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