‘The death just reverberates’
Homelessness. Incarceration. Death. What happens to children when their parents, and families, are torn apart by drugs? They are the silent victims of the opioid crisis.
AS SERENITY LAY MOTIONLESS on the bathroom floor, an employee at the fast food restaurant where she’d overdosed scrambled to get her naloxone — a lifesaving opioid antidote he had in his backpack — before the paramedics arrived.
When EMS got there, the 25-year-old was still unconscious. Serenity was rushed to hospital where she spent one more day on life support. She died the next day.
To the medical team that ultimately pulled the plug, it was fentanyl — a deadly opioid, 100 times stronger than morphine — that killed her. But her family knew it was the heartbreak of losing a child that drove her to it.
Just months earlier, her third child had been taken from her. Three kids, all in care.
Serenity had long struggled with addictions — demons that seemed to plague her entire family, mom Rachelle says. But it had seemed, at least briefly, that she was finally making strides during this last pregnancy.
When she realized she was expecting, four months into her pregnancy, she got onto a methadone program; even doing well enough to get “carries,” meaning she could take the medication home with her.
But when she learned she would not be taking her baby home from the hospital after the neonatal withdrawal treatment, her mom says, it all fell apart.
“She was hysterical,” Rachelle says now. “They never gave [her] a chance to prove herself … she was trying so [expletive] hard.”
Serenity is not her real name. Nor is Rachelle her mother’s. Because the children are in Children’s Aid Society custody, legislation protects them — and their family — from being identified in any way, even after the young mom’s death.
Rachelle is devastated that her grandkids are in care, separated from each other and with dwindling memories of their mother.
Her own kids had a tough go themselves, she acknowledges — generational trauma from her own childhood wrought with abuse and mental health issues and addictions. Rachelle herself fought addictions for much of her life, she says, and has been on methadone for eight years.
“I’m scared to relapse. I probably wouldn’t come back,” she says.
‘Losing a child, or having a child apprehended, is such a huge trauma in these women’s lives, who already have such layers of trauma.’ “It’s unbelievable. It is probably the worst thing that can happen to children, seeing their parents disappear and die.” DOMINIC VERTICCHIO EXECUTIVE DIRECTOR, CHILDREN’S AID SOCIETY OF HAMILTON “We see the tears. The motivation to get clean. The fear. We see that in our clinics — the death just reverberates in the whole community.” DR. JILL WIWCHARUK PHYSICIAN, MATERNITY CENTRE
WHETHER IT IS EXPOSURE to drugs in utero, or the collateral damage of addiction at home, babies and children are often the silent victims of the opioid crisis. Hundreds of lives are being lost each year, and many more are being ruined.
Since the fall, the Children’s Aid Society of Hamilton has had two parents overdose and die.
“It’s unbelievable — it is probably the worst thing that can happen to children, seeing their parents disappear and die,” Dominic Verticchio, executive director of the Children’s Aid Society, says. Because even if a child is in care, it is rare that their parents would be out of their lives entirely.
Despite these losses, Verticchio says the opioid crisis — a public health epidemic that is killing thousands of people across Canada every year, including more than 700 deaths in Ontario in 2015 — has not led to a marked increase in their caseload.
Rather, drugs have always been an issue for them.
“I can tell you it [drugs] is one of our major referral sources,” Verticchio says.
Rocco Gizzarelli, executive director of the Catholic Children’s Aid Society of Hamilton, says the opioid crisis is certainly on their radar as well.
DR. JILL WIWCHARUK, a physician at the downtown Maternity Centre which has a program for pregnant women with substance use issues, had worked with Serenity at the centre before her death. She knew her family, and how long she’d struggled — how hard she was working to beat her addictions and give her baby a shot.
She was devastated to learn of the young mom’s death — bad news she learned through the patient grapevine, as is often the case.
“It really does speak to how losing a child, or having a child apprehended, is such a huge trauma in these women’s lives, who already have such layers of trauma,” Wiwcharuk says.
Wiwcharuk says Serenity was the fourth patient of hers in the last few years to die of a drugrelated cause after having a child apprehended.
“I have family members, friends coming in to see me. We see the tears. The motivation to get clean. The fear. We see that in our clinics — the death just reverberates in the whole community,” she says.
“I just wish I could say it was less common. But it just happens way too much.”
ON A THURSDAY MORNING on the Mountain, Grandma Linda is settling into life raising her son’s newborn twin girls. At 46, this is not where she expected to be in life.
But this is the latest chapter in her “new normal,” she says, as a friend who has stopped by to help out swaps babies with her. One needs a bottle, one needs a change.
Linda’s son, Rick, and his girlfriend, the kids’ mom, are addicted to opioids.
In addition to the twins, Rick and his girlfriend also have a four-year-old son named Liam, who Linda is also raising as part of a “kinship” arrangement through the Children’s Aid Society. As a result of that arrangement, the family cannot be identified and these are not their real names.
Because their mom was using drugs during her pregnancy, the twins were born in opioid withdrawal and spent a month in the St. Joe’s NICU after they were born in January to be treated for neonatal abstinence syndrome (NAS).
For every 1,000 babies born across the province between April 2015 and March 2016, 5.9 were diagnosed with NAS. The national rate was 4.2 births per 1,000. Those figures are a stark increase from a decade earlier, when the provincial and national NAS birth rates were both 1.8 per 1,000. In Hamilton, there were roughly 45 NAS births in 2015 — a number that rose to roughly 62 last year.
When the twins were discharged from the hospital, they went home with Linda.
Her son and his girlfriend are homeless, she says, and in and out of jail. Linda doesn’t know how to reach them.
Rick is currently in jail. He calls home, promising this time will be different, and Linda is tempted to believe him.
“Those expectations are starting to creep back. Of course, he says he’s not going to use anymore, and I want to believe every word he says. As a mother, that’s your first instinct,” she says.
“But he wants me to bail him out … and have him reside here, and I can’t do that. I’m not doing it to be a [expletive]. It’s for these kids’ protection.
Since the fall, the Children’s Aid Society of Hamilton has had two parents overdose and die
You can’t just bounce in and bounce out.”
She has seen Liam’s face fall when his parents failed to show up to their supervised CAS visits — visits that don’t even happen anymore. She has seen his face as he gets a little older and starts to understand.
As a grandmother, she is fiercely protective. But as a mother, she worries.
“I still want to see him. I still want to know he’s OK. I want to hear his voice. I want to believe he’s OK,” she says of her son.
But she fears he will end up dead. He has overdosed multiple times. She tries to keep him and his girlfriend equipped with naloxone, a lifesaving opioid antidote.
Today, at three months old, the twins are meeting their development milestones. And friends and family pop in and out to help her juggle the demands of raising three kids for the second time in her life.
“These kids need to stay with family. I am hopeful that one day their mom and dad are going to be able to come through the door and see them, and maybe in a perfect world they can even go live with them,” she says.
In a phone call from the jail, Rick acknowledges the burden he has put on his mother.
He wants to be a dad, and his goal now is to have “more clean time” behind him when he gets out. He wishes he and his girlfriend could go for treatment simultaneously, to give them a better chance at success. They’ve tried it separately before, even completing residential rehab programs. But as soon as they reconnect in the real world, they relapse.
“You know, watching somebody use … it just triggers you,” he says.
At 30 years old, he’s struggled with addictions for close to half his life.
But opioids, he says, “are a way different kind of addiction.”
“It doesn’t give me any opportunity to even be a parent. It’s taken everything from me.”
IN BRANT COUNTY, CAS executive director Andrew Koster says they are in crisis mode.
“Our philosophy of the agency is not to bring kids into care unless you really can’t help it,” he said. “But the rise in fentanyl means we’re being forced on a crisis level to make decisions of care.”
He went to Ontario’s budget consultations in Hamilton last fall to plead for money to combat the fentanyl crisis. “We’ve had a lot of deaths,” he warned. He recalled one case earlier this year where CAS was called to a family’s house where one adult had overdosed and another was high. The home was littered with drugs and drug paraphernalia — all easily accessible to the kids in the house.
This is particularly alarming given the potency of some of the bootleg drugs increasingly popping up. Fentanyl — 100 times stronger than morphine — and carfentanil — 1,000 times stronger than morphine — are being mixed into other drugs, often unbeknownst to the user.
In high-risk cases, Koster says they no longer have the luxury of time — it’s a crisis that’s requiring quick thinking and decision making.
In addition to the immediate, tangible risk of ingestion or overdose, there are also risks of violence to children when parents are intoxicated, risks of growing poverty from parents spending all of their cash on drugs and a worry the kids will start using drugs themselves.
Sometimes it is for a child’s safety they are apprehended. But it can still be traumatic — not just for the parents, but the child as well.
“Even though we’re keeping the child safe, there’s an emotional toll,” Koster says.
And given the rollercoaster nature of addiction, he says these issues often linger throughout a childhood. In some cases, he says, it is the kid who grows up having to take care of the parent.
“They call it the ‘parentified child’,” he explains. “They feel a great need to be with their parent to continue looking after them, so when they’re taken into care there’s an emotional upheaval. There’s guilt.”
CAS is a necessary agency, but Verticchio acknowledges that it can be an intimidating one.
“I think [people are] nervous simply because of our role and authority,” he says.
“[Parents] automatically come to the conclusion that … we are going to apprehend the baby. But that may not be the situation. We look towards ensuring that the child is safe, and that they’re managing and providing the resources they need to take care of themselves and their children.”
If a mom is stable and doing well on a methadone or suboxone treatment program, Verticchio says there may be no reason to keep her file open.
SOME OF THESE STORIES do have happy
Kate — a fake name, in order to protect her family’s identity under child protection laws — spent the last year working to get her kids back.
She is clean. She has an apartment. A healthy relationship — her first. She takes every parenting course or personal development workshop that she can.
On a Tuesday afternoon in March, she speaks with a reporter at her home while preparing dinner for her children during a visit. Her girls are young; both under two years old; happy and bubbly and curious about their visitors.
The carpet of the living room is covered in toys. More overflow from a stuffed animal hammock hanging from the ceiling. Family photos and kids’ artwork are collaged across the fridge.
“We look like normal people, don’t we?” she says.
Kate struggled for years with addiction. She had been homeless and using crack cocaine when she first met Dr. Jill Wiwcharuk at the Wesley Centre on Ferguson Avenue North, where she would often stop for a hot meal.
Wiwcharuk — the executive director of the Shelter Health Network — ran a clinic there, and it was the first time Kate had been to a doctor in years. But more than a physician, Wiwcharuk was the first person to have faith in her — to push her to do more with her life.
“She was very friendly and warm and caring and her door was always open,” Kate remembers.
Slowly but surely, she started to cut back on her drug use. She got on disability. She found housing. And then she got pregnant. “My first trimester I found out I was pregnant, so I completely stopped using,” she says.
Wiwcharuk linked her up at that time with the Maternity Centre, where Kate diligently attended her prenatal appointments. Although crack cocaine use results in a less severe withdrawal for babies than opioids, there can still be adverse affects.
Kate was nervous, but she was excited about being a mom, and the chance to start fresh.
She attended programs like Healthy Moms Healthy Babies, to learn about breastfeeding and baby food and prenatal vitamins. When her first daughter was born, she was excited to take her home from the hospital. But it was tough, and she eventually relapsed.
Pregnant at the time, she was not able to take her second baby home from the hospital when she was born. Both girls went into foster care.
Kate was devastated. Lonely. Bored. She’d had to cut out virtually her entire social network when she left her old life behind, and without her kids, the house was silent. And with silence comes temptation. But she did not unravel, instead leaning on support programs to get her through it.
On May 1, she got the good news at her latest family court hearing that her children would return to her care. They are now back living with her full-time.
“The Society always has as its goal the reunification of children with their parents. This is one example of the many cases in which this happens,” Rocco Gizzarelli, executive director of the CCAS, says.
“I’ve had a lot of ups and downs,” Kate admits — but she is elated. She did it.
She credits Wiwcharuk with giving her the confidence to try.
With her support, she is clean today and says she has been out of jail for two years. She is working on getting her high school diploma and her driver’s license.
“I studied. I bought the book from the Ministry of Transportation for like $16. And then my boyfriend was like ‘what do you want for Christmas?’ and I said ‘my driver’s licence.’ So he paid for the test and I passed the first time,” Kate says proudly.
“There is light at the end of the tunnel. I have my small goals and then I have my long term goals. Where do I see myself in five years? A pretty good place — a lot better than where I was. I’m willing to try.”
The first step, she says, was admitting she needed help.
“It’s not easy, and when you’re able to admit to another person … that you need some help … then they’re like, ‘OK this is real.’ Because there is no perfect parent,” she says.
“Everybody makes mistakes.”
When her first daughter was born, she was excited to take her home from the hospital. But it was tough, and she eventually relapsed In addition to the immediate risk of ingestion or overdose, there are also risks of violence to children
Linda is raising her son’s newborn twin daughters and four-year-old son because he and his girlfriend (their mother) both struggle with opioid addictions. He is currently in jail.
Dr. Jill Wiwcharuk, one of the doctors in PROSPR (Program for Substance Use in Pregnancy) at the downtown Maternity Centre.
The Neonatal Intensive Care Unit at St. Joseph’s Hospital cares for babies that suffer from NAS. Here, student nurse Sarah Van Allen works in the unit.