Six hours after Kemper Roach was born, it grew clear something was wrong.
Jitters took over his 6-pound body. Wails rose from his throat. Nothing could comfort him.
“It got horrific,” his father remembered.
It was the addiction taking hold. Less than a day old, Kemper was suffering from opioid withdrawal.
Doctors at Slidell Memorial Hospital diagnosed him with neonatal abstinence syndrome, which happens when babies are exposed to drugs in the womb and are dependent on them after they are born. They wrote in medical records that he was jittery and fussy, and had an elevated temperature and loose bowel movements.
Kemper’s agony has become more common among Louisiana newborns amid a national opioid addiction epidemic. The rate of Louisiana babies diagnosed with neonatal abstinence syndrome quadrupled between 2005 and 2015, the most recent year on state records.
In 2015, at least 384 newborns in the state were diagnosed with the condition, according to hospital discharge data. The national Centers for Disease Control and Prevention has estimated that every 25 minutes, an infant is born with neonatal abstinence syndrome in the United States.
They only represent a sliver of infants who have been exposed to drugs and alcohol in Louisiana. At least 1,681 newborns last year had valid allegations of this exposure, according to the state Department of Children and Family Services.
Compounding the problem, those who treat addiction say options for pregnant women trying to get clean in south Louisiana can be hard to come by. Some doctors fear the liability of treating an addict when birth defects could be involved, according to a former state medical examiner.
OB-GYNs and neonatologists also acknowledge that some prenatal care providers are hesitant to take on addicted patients. State health officials and hospital administrators have discouraged providers from cutting off prenatal care for pregnant addicts, worried that turning away mothers will result in more unhealthy children.
The shame for a pregnant woman who is also an addict can be overwhelming, said Lindsay Carrier, who was in that exact position one year ago. Before she found help, Carrier said she could hardly stomach the knowledge that she was pregnant but unable to stop using drugs. She started a medication-assisted treatment program that replaced her heroin habit with Suboxone, a prescription drug meant to temper the withdrawal. Her son, Liam, was born in November with no signs of addiction, and she has been clean for 10 months.
Suboxone, a combination of the opioid buprenorphine and the anti-overdose drug naloxone, is the same drug that Kemper’s mother told doctors she used during her pregnancy, according to his medical records.
Regardless of the type of drug being used, medical professionals say the increased numbers of neonatal abstinence syndrome should be preventable. The costs of treating the withdrawal are also skyrocketing, as a new study in the American Academy of Pediatrics estimated that hospital costs in 2014 for neonatal abstinence syndrome births covered by Medicaid reached $462 million.
"When we are having to treat a baby for withdrawal, that's a system failure,” said Dr. Steven Spedale, the chief of neonatology at both Woman's Hospital and Ochsner Health System in Baton Rouge.
“We are at the tail end of the process,” he added. “This isn't a disease we're treating; this is a byproduct of someone else's medical illness. These are unnecessary admissions. These babies should never be in this position to begin with."
'Uneasy about everything'
After he was born in 2014, Kemper spent 11 days in the hospital. Doctors documented “intrauterine drug exposure” and transferred him to the neonatal intensive care unit, according to his medical records.
During the height of his pain, NICU staff treated Kemper with morphine every three hours. Spedale said morphine is often used when babies score high on tests meant to measure neonatal abstinence syndrome. Not all babies who go through withdrawal need it.
"The babies just don't go from being this nice, calm kid to being out of control,” said Spedale about neonatal abstinence syndrome. “It's usually a graduated process. They're irritable and inconsolable.”
Using small doses of morphine can help newborns reach a steady plateau of comfort before doctors begin to wean them off, he said.
After Kemper finally was released from the hospital, his father said his troubles did not end.
“He was uneasy about everything,” said 31-year-old Tyler Roach. “He was really hard to get to sleep at night, just screaming and crying for no reason whatsoever.”
Now age 3, Kemper likes Hot Wheels and ice cream. He takes some time to warm up to new people but immediately takes to dogs. He likes to see the big trucks at the concrete crushing yard where his dad works, and he likes to go crabbing with his aunt who watches him during the day.
Kemper has two older siblings, but their mother is mostly out of their lives, Roach said. A lawsuit he filed in St. Tammany Parish on behalf of Kemper against prescription drug companies says she became addicted to opioid painkillers after being injured in a 2011 car crash. His filings in their 2015 divorce proceedings said she continued to use drugs around that time.
Kemper's mother, whom The Advocate interviewed for this story, asked not to be identified. She said it was horrifying to watch her son go through the pain of withdrawal after he was born.
She said she became hooked on oxycodone after the car crash but said she started going to the Addictions Counseling and Education Resources treatment clinic in Slidell and switched to taking Suboxone after she became pregnant. She said she did not understand until late in her pregnancy that her baby could go through withdrawal for the opioid replacement as well.
Morris Hawkins, the chief executive officer of ACER, said he could not confirm or deny that she was their patient without her written consent. But he did say the clinic has pregnant women sign consent forms confirming they understand their babies could go through withdrawal from Suboxone.
When Kemper came home from the hospital, his mother said they spent a few wonderful months together before she relapsed. Since then, she has been in and out of jail and said she has not been able to stop using drugs. Being isolated from her kids and her family has made it harder for her to want to get clean, she said.
“I just feel like I have nothing to live for," she said. But she said she dreams of “living a normal life with my kids, working a full-time job.”
Kemper has not seen his mother in months.
“Right now, on occasion, he’ll see another female and he’ll say, ‘Is that Mommy?’ ” Roach said about Kemper. “I try to change his thought, but there’s going to be a point in time where he’s going to ask me and I’m going to have to answer it.”
In some cases, state officials intervene to prevent parents who are drug users from taking home their babies diagnosed with neonatal abstinence syndrome. The state’s children’s code describes prenatal neglect as exposure to unlawful, dangerous substances that are present in a newborn. Realizing last year that some addicted infants were born to mothers legally using opioids as well, state laws were updated to include infants withdrawing from drugs that were used legally.
In cases that seem to fit prenatal neglect, child protective services workers usually investigate the safety of the child and create a “plan of safe care.” Last year, at least 935 newborns that had valid allegations of drug or alcohol exposure were overseen by state caseworkers within 60 days of their initial report, according to Louisiana's Department of Children and Family Services.
Kemper’s medical documents said his parents were both attentive and understanding of the importance of closely monitoring his health. His mother said caseworkers visited their house multiple times after Kemper was born.
When she was looking to kick heroin, Carrier also turned to ACER. The for-profit clinic has locations in Slidell, Metairie, and Chalmette, and plans to open one soon in Baton Rouge.
Around 70 percent of the clinic's patients are on Medicaid, and they accept private insurance as well, Hawkins said.
At the start of treatment, patients visit in three-hour timespans for four days a week over two to three months. They meet with doctors, go to group therapy and take Suboxone. They taper down the dose over time to help addicts to effectively quit, but it can be a lengthy process, said Hawkins, who is also a registered nurse.
"The one thing that almost everyone would agree to is it's certainly safer to have these women in a medically supervised narcotic replacement program than to have them acquiring drugs illicitly on the street,” said Ochsner’s Dr. Joseph Biggio about Suboxone use in pregnant women. Biggio oversees maternal-fetal medicine for Ochsner.
Biggio added that he has changed his mind over time about pregnant women quitting drug use completely during their pregnancies. Although doing so would mitigate the effects of neonatal abstinence syndrome, he also has learned that the short-term fix can increase their likelihood of relapsing. And he said doctors have been trained that the stress from a woman going through drug withdrawal while pregnant could result in a stillbirth, though new research may challenge that belief.
Carrier, 24, is one success story of medication-assisted treatment.
Depression and family problems fueled her addiction in high school in Kentwood. She said she started using Xanax, Lortabs, oxycodone and eventually heroin. She’d develop panic attacks when she wasn't high, and brief stints in rehab and jail did not help, she said.
Carrier said she was using heroin three times a week when she found out she was pregnant last year. She told herself she was going to stop doing drugs because she didn’t want to hurt her baby, but she felt lost, she said.
“The guilt I felt was so overwhelming,” she said. “I didn’t know how to quit; I didn’t know how to reach out. I was embarrassed, and getting high consumed my thoughts.”
Dr. Louis Cataldie, a Baton Rouge addiction specialist and former state medical examiner, said it’s important to understand that addiction is a brain disease. His clinic also treats pregnant women who are addicted to drugs and said it's better for them to go through a "controlled detox" rather than quit cold turkey. He prescribes them Subutex, which also has buprenorphine as its active ingredient but does not have naloxone in it.
“Mom is not choosing to pump opioids into her child,” Cataldie said. “It's much more complicated than that from a neuropsychological perspective."
When Carrier went to her first doctor’s appointment, her obstetrician asked if she had any addiction problems that could affect the baby. Carrier confessed that she needed help, and her doctor referred her to ACER.
Exactly how to find out if pregnant women have a drug problem that needs treatment is something obstetricians are still working through, said Dr. Dore Binder, the chief quality officer for Woman’s Hospital in Baton Rouge.
At Woman’s, hospital officials are trying to create a system where a nurse and social worker can help connect pregnant women to drug treatment. Although they discourage doctors from cutting off pregnant women who are drug users from prenatal care, Binder said Woman’s cannot control what their private physicians do in their office settings. He said they are trying to create an alternative to rejecting patients that doctors can choose to participate in.
Carrier said she worried about her baby going through drug withdrawal, but Liam, born in November, did not exhibit signs of neonatal abstinence syndrome. He has big blue eyes, likes the sound of women’s voices and smiles a lot.
As Carrier kissed his forehead and stood him up on her thighs inside of ACER, she said her baby boy has taken away her urge to use drugs and said other pregnant women need to know help is available. Hawkins said although ACER prescribes Suboxone to pregnant patients, their outcomes can differ. Some babies do withdraw, while others do not.
Carrier and her son live together at a sober house for women and children in Mandeville, and she regularly attends Alcoholics Anonymous meetings. She recently started a job at a gas station, and she hopes to go to college one day.
Researchers have not necessarily caught up to the national surge in neonatal abstinence syndrome diagnoses, and its long-term effects are still uncertain, said Dr. Tina Stefanski, a state Department of Health medical director for the Acadiana region. Spedale added that the lingering effects could depend on how late in a pregnancy a mother used drugs and how it affected brain development.
"We're learning as we go on this," he said.
Roach said Kemper did not speak until his was 2 years old and said the boy has had behavioral issues. He said he believes those are the long-term effects of Kemper’s neonatal abstinence syndrome.
He filed a lawsuit in February on behalf of Kemper, pinning the blame for his young son’s struggles on companies that manufacture and distribute opioids. He is asking the drugmakers and distributors to pay for Kemper’s medical expenses as well as his future medical needs. It was filed by his attorneys as a potential class-action suit.
Opioid companies have, for the most part, denied their responsibility in the many lawsuits being filed against them.
Asked about Roach's lawsuit, Janssen Pharmaceuticals, which is part of Johnson and Johnson, responded that its marketing and promotion of opioids has been appropriate and that "the allegations made against our company are baseless and unsubstantiated." Still, the company added that it is committed to finding ways to address the opioid crisis.
The McKesson Corp., which distributes pharmaceuticals, responded that it is "deeply concerned about the impact the opioid epidemic is having on families and communities across our nation." The company added that it maintains strong programs to prevent opioid misuse and said it is starting initiatives to help address the epidemic.
Drug manufacturer Teva said it is "committed to the appropriate use of opioid medicines" and said it recognizes "critical public health issues" that happened via both illegal and legally prescribed opioids. Purdue Pharma also added that it is "dedicated to being part of the solution" of the opioid crisis.
Ava’s blonde hair sticks straight up in the air after she whizzes down her favorite slide at the playground.
Roach wants to start Kemper at preschool this year but worries about how he will do around the other children. Aside from speech therapy and pediatrician visits, Roach said he has not been able to afford much more help for his son. He said they are all still trying to heal from what addiction has done to their family.
“It bothers me, still, on a daily basis,” Roach said. “But I learned to let go, and I moved on with life.”