Author’s note: This series has explored questions about the opioid epidemic in Wilmington. It has focused on the basics: what are opioids, who are the people using them? Some questions remain: what is at the root of epidemic? Why is this epidemic hitting our area so hard – harder than nearly anywhere else in the nation? What can we do?
Those questions won’t have easy answers. But the picture will be clearer for those who understand the current efforts to address the epidemic. Again, a complicated picture emerges. Every group involved agrees our area is facing a crisis without parallel. Not everyone agrees on what to do about it.
This part of our series will show you the crisis through the eyes of the people fighting it. These are the many front lines against the opioid epidemic. By knowing where these groups stand now, we hope to provide a better sense of where the fight can go next.
Part VIII – Children of the opioid epidemic
When dealing with the opioid crisis, sometimes the numbers are complicated. When it comes to the children of the epidemic, the numbers are clear.
In 2016, 55 newborns were taken into temporary protective custody by the New Hanover County Department of Social Services (DSS) because of they were born with opioid-related issues. Since 2013, the number of number of children taken into permanent custody because of opioids has doubled.
According to Mary Beth Rubright, child protective services chief, DSS has seen an increase in a number of disturbing factors that point to the debilitating power of opioid addiction.
“We’ve seen an uptick in the number of children taken into custody, and the lion’s share of that is from substance abuse; about a third of the children come from families with opioid use,” Rubright said. “And we’ve seen an uptick in the number of parents relinquishing their custodial rights. Three years ago, we never would have seen those numbers.”
Judge Jay Corpening, chief district judge for the Fifth District, is in charge of all the family cases sent to the courts by DSS. Corpening said the opioid addiction is one of the most severe challenges to the court’s ability to keep families together.
“Nobody — nobody — wants to see a family torn apart. I want to see families put back together, to see children reunited with their parents,” Corpening said. “But once DSS gets involved, the state gives us about a year for the parent or parents to get clean, to make the home a safe place for a child. And for someone in the opioid world, that’s just not enough time.”
Like other demographics of opioid use, the families affected come from a broad range of backgrounds, according to Michelle Winstead, director of social services.
“I wish people could see it, but they don’t want to see it,” Winstead said. “This isn’t coming from ‘over there,’ from just a low-income neighborhood. People want to deny it because it’s coming from their neighborhood, from the place they chose to live.”
Corpening described the “changing face” of the families who appear in his court: “We see folks from low-income backgrounds with housing challenges, it’s true. But we’re also seeing professionals. We’re seeing parents with housing, with transportation, with good paying jobs. It affects families from everywhere, and children from everywhere. I’m not sure people understand this.”
Wilmington’s growing opioid treatment industry
Denial is big problem when it comes to the opioid crisis. Funding is a big problem when it comes to intervening.
DSS resources are stretched “dangerously thin,” according to Wanda Marino, assistant director at DSS.
“We don’t have the resources, we just don’t,” Marino said. “I’ve asked for another district attorney and another paralegal – we need help. We have 420 children in our system. We have a backlog of children. Think about that, not a backlog of cases, a backlog of children.”
But while DSS and the courts would benefit from an infusion of funding, there’s another issue. And it’s one that may come as surprise: the proliferation of private treatment centers.
For substance abuse cases, and especially for cases involving opioids, the centerpiece to DSS’s strategy is getting parents into therapy, according to Marino. But DSS can’t choose where a parent fighting addiction goes for treatment.
Rubright said the majority of private treatment centers that have opened recently worry her because of what she said includes minimal counseling, failure to drug-screen or monitor doses and unreliable reporting.
“This is a problem when, for example, we have a mother who tests positive. Is she at risk for nodding off and dropping her child, or is she legitimately using Subutex as part of medically assisted treatment program? A lot of these new places are just popping up – each one seems worse than the previous one – they aren’t treating them,” Rubright said. “These places are lining their pockets at the costs of the lives of mothers and children. I know that sounds dramatic but it’s what is happening.”
“We have 420 children in our system. We have a backlog of children. Think about that, not a backlog of cases, a backlog of children.”
Marino said the problem is disturbingly widespread, adding, “there are only two places in town I’d send someone if I cared about them. Coastal Horizons and Haven.”
Because parents under DSS supervision or in the court system are facing a ticking clock, ineffective treatment puts the family at risk for being separated permanently, according to Corpening.
“I have some concerns about some of these places, absolutely,” Corpening said. “The court has worked with Coastal Horizons for a long time, we trust them, we know they’ll do a good job. Some of these other places, they’ll send us a letter saying, ‘Jane Doe is going great, etc.’ and then when we check their paperwork, we’ll see the patient is missing meetings, we’ll see inaccurate pill counts.”
These “concerns” directly impact the lives of children, Corpening said.
“There’s just not enough time for those mistakes,” he said. “The quality of life of the child depends directly on whether the parents get clean – we’re talking about mothers losing their babies forever.”
‘(R)eunifying those babies with their mommies’
One partial but promising way to address these issues is what what Corpening calls “intensive reunification.” A pilot program in the Fifth District, it provides counseling and treatment for recent mothers addicted to opioids. Unlike mandatory treatment, intensive reunification allows the court to contract privately with the best-equipped treatment specialists, instead of working through managed care organizations (MCOs) like Trillium, or with potentially unreliable private treatment centers.
“I hate to be doom and gloom all the time, and this is good news,” Corpening said. “We’ve had 70 percent success. We’re reunifying those babies with their mommies. When those mothers walk into court, the whole attitude of the place changes.”
Corpening said the program is more expensive than traditional methods, but hopes it will become the standard for what’s known as “reasonable effort”; that is, the state’s expectations of what DSS and the courts will do to save families.
“Does this cost more? Absolutely. But when you think about the long terms costs of the adoption process, this is chump change,” he said.
The program is limited by funding to four mothers at a time, and it requires building networks between the courts and treatment specialists. But, if it became the state’s standard of care, state funding could help expand the program, Corpening said.
“I’ll be first in line for that funding, believe me.”
Read more from our opioid series (the whole series can be found here)
Part IV – Mental health and opioid abuse
Part V – The power and potential risk of harm reduction
Part VI – Opioid demand, the fear of detox and the path to treatment
Part VII- ‘Killing with kindness’ – where are prescription opioids coming from?