‘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.

The Hamilton Spectator - - FRONT PAGE - MOLLY HAYES

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

end­ings.

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

PHO­TO­GRAPH BY GARY YOKOYAMA, THE HAMIL­TON SPEC­TA­TOR

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.

GARY YOKOYAMA, THE HAMIL­TON SPEC­TA­TOR

Dr. Jill Wiwcharuk, one of the doc­tors in PROSPR (Pro­gram for Sub­stance Use in Preg­nancy) at the down­town Ma­ter­nity Cen­tre.

BARRY GRAY, THE HAMIL­TON SPEC­TA­TOR

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.

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