Pubdate: Wed, 26 Feb 2003
Source: Herald, The (UK)
Copyright: 2003 The Herald
Contact:  http://www.theherald.co.uk/
Details: http://www.mapinc.org/media/189
Author: Rebecca McQuillan
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)

THE BABIES BORN TO JUNKIES

What should we do about parents hooked on heroin? Should they be allowed to 
raise their own children? REBECCA McQUILLAN investigates the controversial 
policy of leaving babies born to drug-abusers in their custody

WHEN Clare walks into the room holding her three-month old son, Riley, the 
impression is the force of her smile. Frozen as a snapshot in time, the 
sight of mother and smiling baby is as perfect an image of motherhood as 
you could find.

Yet just last summer, when she discovered she was pregnant, Clare was in 
despair, struggling to care for herself, let alone a child. At 38, she had 
been a heroin addict for more than half her life and had had to give up two 
children for adoption already. Her body was so ravaged by heroin, cocaine, 
sleeping tablets, and illness that she had no symptoms of pregnancy. It was 
when she was being treated for an infection in Glasgow Royal Infirmary that 
doctors discovered her condition and by that time she was around five 
months gone.

She had one thought: adoption. "I was totally crazy on drugs," she says. 
She was living in a hostel, her parents had died, she had no partner and no 
relatives to support her. In the midst of such swirling uncertainty, 
keeping the baby seemed inconceivable.

Clare's perspective changed when she was referred to the ward run by Dr 
Mary Hepburn of the Women's Reproductive Health Service at Glasgow Royal 
Infirmary. Dr Hepburn's team has been supporting drug-addicted women 
through pregnancy for more than 17 years and now deals with 200 such women 
annually. A multi-disciplinary group of midwives, social workers, health 
visitors, and addiction workers assess each mother's ability to care for a 
child and provide her with ongoing support after she is discharged.

Clare was no stranger to the ward; she had given birth there before and had 
given up her other two children because of her chaotic lifestyle. Yet, as 
she chatted to her support worker, she started to think that she might be 
able to manage motherhood after all.

She was put on methadone instead of heroin and found supported 
accommodation. The perpetual twilight of before had given way to a normal 
cycle of day and night, meals and outings, duties and responsibilities. 
"It's great getting up every morning, going out, and doing things without 
having to stick a needle into yourself or get the tinfoil out." Three 
months after the birth, she is clear that staying off drugs is down to her 
now, and is deeply grateful for the support she is still receiving from the 
hospital.

But should drug users be caring for children? It is a controversial 
question, and not one that is often aired in public, but many nurses, 
doctors, social workers, and drug treatment professionals are seriously 
concerned about such children's welfare. Research shows that exposure to 
parental drug use can be profoundly damaging to a child, leading some to 
conclude that the babies of drug users should be sent to foster carers 
until their parents are drug free. Others believe drug users are victims of 
prejudice and argue they can be highly effective parents, given the chance.

Today, the Scottish Executive publishes guidance for a range of agencies 
who share responsibility for protecting the welfare of such children. It 
comes at a time when child protection is high in the public consciousness. 
Yet no-one actually knows how many such children there are in Scotland. The 
only firm statistic, from the Scottish Drugs Misuse Database, shows that 
around 19% of 11,000 drugs users who sought treatment last year had 
dependent children, but the Scottish Executive believes the real total is 
somewhere between 40,000 and 60,000.

What is for sure is that these children require to be carefully monitored. 
Every so often, a high-profile case of serious abuse throws the issue into 
sharp relief. Last year, a 29-year-old drug user called Mark Connelly was 
sentenced to a minimum of 16 years in jail for the murder of 33-month old 
Scott Saunders, his girlfriend's child, who died after being beaten, 
starved, and locked in an unheated room while his mother and Connelly fed 
their heroin habit.

Such extreme cases are rare. Children of drug users are not automatically 
put on the at-risk register and, indeed, most experts make a distinction 
between stable drug users, who can provide a stable environment for their 
children, and chaotic users. However, addiction professionals are in no 
doubt that in many cases drug abuse compromises parenting.

The Scottish Executive recently reviewed international literature on the 
subject and concluded that, while abuse and neglect do not follow 
automatically when parents use drugs, substance misuse greatly increases 
the risk of family problems. Problem drug use which is the central focus of 
an adult's life reduces the time and emotional energy available for 
children. Children may be at higher risk of maltreatment and emotional or 
physical neglect or abuse. They are also at greater risk of mental illness 
and behavioural problems, experiencing social isolation and misusing 
substances themselves when older.

Of 111 Child Protection Orders made on children in 62 families in Glasgow 
between 1998 and 1999, 40% cited drug-related risk.

Drugs like heroin or tranquillisers that induce sleep can result in 
unsupervised children swallowing drugs or having accidents, while cocaine 
is implicated in higher levels of domestic violence. Children of drug users 
may be made homeless if a parent is sent to prison or admitted to hospital, 
and two in every 100 problem drug users in Scotland die.

Sandy Cameron, executive director of social work at South Lanarkshire 
Council, describes the plight of children living with chaotic drug users as 
"one of the most worrying situations I have seen in 30 years". He and 
Professor Neil McKeganey, of the Centre for Drug Misuse Research at Glasgow 
University, highlight a need for much more research. "The main worry is: 
how quickly is enduring damage done to a child in those early months? Some 
of them come to be looked after by us with very disruptive and sometimes 
sexualised behaviour," says Cameron. "We're caught in the dilemma of trying 
to keep them in the family and I think the question is, do we keep them in 
the families for too long before damage is done? Resources for looking 
after children are also under considerable strain."

The anti-drugs campaigner, Maxie Richards, believes the best solution is to 
put such children into foster care until their parents are able to give up 
drugs, citing the example of Norway and Sweden, where such a system is in 
place.

Having a baby can and does act as an incentive to give up in some cases, 
but the difficult truth is that many mothers lapse back into using drugs 
afterwards. "Naively, people think that the motivation of looking after a 
child will change people. It doesn't," says Dr David Lloyd, who runs the 
neonatal unit at Aberdeen Royal Infirmary. He says that although some women 
manage "remarkably well" as parents, he has seen many stay clean during 
pregnancy only to go back to using afterwards. "They are, in a way, 
selfish, and it's not their fault. After you've been hooked on drugs it's 
very difficult. The only way to come off drugs is if you want to, and if 
you don't, you come back again and again."

However, Dr Hepburn believes a parent's drug use should not prejudice views 
about their suitability as parents. "Fifteen years ago, drug use per se was 
seen as a child protection concern and it isn't. It may become a child 
protection concern, but just like a middle-class person having half a 
bottle of red wine and a couple of gin and tonics could become one.

"If they're not good mothers, it's very often nothing to do with their drug 
use, it's something incidental, like coming from a broken home or not 
having experienced good parenting themselves."

Dr Hepburn regards stability as more important than enforced abstention. 
For heroin users, this means putting them on methadone.

The Glasgow-based public health consultant and architect of Glasgow's 
methadone programme, Dr Laurence Gruer, agrees this can improve stability, 
but says it does not work in a unified way. Where doctors underprescribe, 
or when a patient is under stress, they may top up their methadone with 
other drugs.

The danger that even stable drug users might fall off the wagon poses a 
major challenge to social workers. There are simply not the resources to 
take huge numbers of children into care and even if there were, 
intervention by social workers must be justifiable and proportionate to the 
difficulties a child is facing.

Prof McKeganey is concerned that addiction workers, who have regular 
contact with drug users, may be "too hesitant about inquiring into the 
circumstances of clients' children".

The new guidelines seek to make such judgments easier, but another problem 
is the shortage of suitably skilled social work staff.

There are some encouraging signs. Schemes like the Harbour Project in north 
Edinburgh, launched by the Family Support Unit (FSU) a year ago, have shown 
what can be achieved. Staff help parents to stabilise their drug use, 
establish structured mealtimes and playtimes, manage budgets, and 
prioritise their children's schooling. Above all, they make parents shield 
their children from their drug-using activity. "We give people hard 
choices," says Brian Cavanagh, development manager of the unit Scotland. He 
believes some children they have worked with would otherwise have been in care.

Liz Whyte, headteacher of Royston Primary School, has seen "a dramatic 
improvement" in the attendance of all children referred.

Other more general parenting schemes, like Starting Well, also support the 
families of drug addicts on the basis that good adult health depends on a 
strong parent-child relationship in the earliest years.

Alongside such work, however, Cameron believes there is a need to start 
thinking radically, perhaps by encouraging drug-using women to use 
contraception. "Part of the harm-reduction approach is to say to a drug 
user, 'think about the potential consequences of children coming into your 
life'," he says. "We need to think about helping them in terms of 
contraception. It may be controversial but I think we need to look at that."

When it comes to protecting the most vulnerable members of the most 
vulnerable households, today's guidance may only be the beginning.

How babies born to drug-using mothers are affected

Q. Which drugs are we talking about?

A. The most common are opiates, such as heroin or methadone, and 
benzodiazepines, such as temazapam and valium. Combining both is common. 
Cannabis is used almost universally; cocaine, amphetamines, and ecstasy 
occasionally.

Q. What effect do they have in the womb?

A. Heroin can cause muscle spasms. Spasms in the womb can cause miscarriage 
or pre-term labour. Blood vessel spasms in the placenta can cut down the 
blood, and therefore nutrition, reaching a baby. Pregnant heroin users are 
offered methadone which acts on a 24-hour cycle without fluctuations. 
Cocaine constricts blood vessels which can cause placental separation, 
reduced brain growth, even foetal death.

Q. How serious are withdrawals in the newly born baby?

A. Some babies have none. Others are irritable and snuffly. Moderate to 
severe withdrawals create difficulty feeding, painful diaorrhea, and 
incessant crying which can last for months. Convulsions are possible but 
extremely rare. Methadone withdrawals last longer than with heroin; 
benzodiazepine withdrawals are worse than both; and the worst of all are 
withdrawals caused by a combination of both.

Q. Do withdrawals have long-term consequences?

A. Mary Hepburn, of the Women's Reproductive Health Service at Glasgow 
Royal Maternity Hospital, says there is no evidence they affect babies' 
health in the long run. Laurence Gruer, a Glasgow-based public health 
consultant, however, fears that long lasting withdrawals, making a baby 
difficult to care for, can compromise bonding. Babies can also 
"rewithdraw", having to return to hospital after they have been discharged.

Q. Shouldn't pregnant heroin users be encouraged to come off drugs instead 
of taking methadone?

A. Acute heroin withdrawals are thought to be more dangerous to an unborn 
child than taking methadone. Besides, if a women cannot cope with being 
drug free and goes back to illicit drugs, it will be worse for her baby.

My kids love me Case study

* Lisa, five, and Harry, seven, live with their father Hugh, 40, a 
recovering heroin addict who is stable on a prescription for methadone and 
valium. Hugh has had custody of his children since they were removed from 
their mother, a heroin addict. He is in touch with a parenting support project.

"I was very fearful the kids would be taken into care. My dad was always 
there to warn me what was going to happen and he was the one who was going 
to do it if I didn't buck up my ideas. I managed to get myself a good GP 
and get sorted out with methadone.

"Then I got a prison sentence in 2000. They stayed with mum and dad for 
nearly five months, then they went into foster care. When I came out of 
prison, Harry, all he wanted was to get back home to his dad again. I don't 
think the foster carers realised just how close the kids were to their dad.

"If I say, kidding on, 'I'm leaving' and go out and shut the door, it's 
pandemonium. One day I was going from the park 100 yards to my mum's house. 
The kids were playing in the park and they asked me where I was going. I 
said I was going to the house, 'I won't be a minute'. But for some reason 
they didn't believe me and they started screaming. That insecurity's still 
there, but that's down to me. I let them down when they ended up in foster 
care.

"Both kids are doing great at school, but outside school . . . Harry was 
enticed to go stealing. He was pushed into doing it. He's been harassed and 
bullied.

"I'm determined to get a new house. They won't sleep in the bedroom. We all 
sleep through in the living room on mattresses, because they're frightened. 
The house below us and the house opposite us, the windows were getting smashed.

"I met our parenting support worker last summer and she started coming down 
round the house. The kids got to know her and they started summer trips. 
She got me involved and it was something that, yeh, I enjoyed.

"They are definitely much happier with me than in foster care. I know that 
they love me. I keep telling them to listen to what I say - 'I don't want 
you going down the same road I went down'. If I'm in the toilet for any 
more than five minutes, Lisa will want to know what I'm doing. I can't have 
tinfoil in the house or anything like that because they'll think I'm going 
down that road again.

"I feel like if I can get out of the rat hole we're in I can start to work 
on reducing what I'm getting from the doctor.

"People like their headmaster, our home support worker, my mum and dad have 
been great. If it wasn't for all them, possibly the kids wouldn't be with me."

Names have been changed.
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