HUNTSVILLE, Ala. - An average of 130 Americans die from opioid use every day and every 15 minutes, a child is born in opioid withdrawal, according to the National Drug Institute.
These are alarming statistics. Many of the children born dependent are diagnosed with Neonatal Abstinence Syndrome.
And they're growing up and entering school.
Research poses the question, "How does being born dependent on drugs affect them as they enter the school system?"
At this point, there isn't a clear answer.
One Huntsville couple adopted their grandchildren and both the five-year-old and three-year-old were both diagnosed with NAS.
Edie Lawhorne says she remembers the day her now-adopted grandchildren came home from the hospital.
"It is a high pitched blood-curdling scream," Edie said.
Her grandchildren were exposed to opioids while in the womb and when they were born, their little bodies continued to suffer the physical effects of withdrawal. The withdrawal symptoms are not something that ends when they go home from the NICU.
"The withdrawal takes months, and months, and months. With the oldest, it was almost a year," Edie said.
While withdrawal finally ended, the rest of the effects of neonatal abstinence syndrome had yet to begin.
"And most of them don't even manifest until they are preschool or kindergarten age. So, you may have a normal...Our three-year-old shows no signs of anything right now. Next year, when she is ready to go into preschool a lot of these things may start manifesting themselves," she said.
Her oldest started school this year.
"They have behavioral problems, and the learning disabilities, and the developmental delays. Our five-year-old will be six in December and he is on a two-and-a-half-year-old mentality level, maturity level. He's catching up, but it's so slow...And every little victory you just cry, and you smile, and I clap for him a lot. We're his biggest cheerleaders," she explained.
Her grandson has been in occupational and physical therapy since he was three. He`s in a general education classroom but does receive special education services - like an aide who visits him in the classroom.
Edie says he`s also been diagnosed with severe ADHD.
"Oftentimes kids that are born drug-exposed show signs of hyperactivity, attention deficit hyperactivity disorder," said UAH assistant professor, Kimberly Hile.
Kimberly Hile is an assistant professor at UAH with a doctorate in special education. She teaches future teachers. Hile says students who are drug-exposed can also experience cognitive delays. Some behavioral issues can be triggered by lights, noise, and people.
"They may fall apart, they may start tantruming, they may start striking out against their peers, throwing things..And it's really just a way of them saying this is too much for me,,, I can't handle it," she stated.
There have only been a handful of studies on the longterm effects of NAS.
An Australian study published in 2017 concluded that quote "A neonatal diagnostic code of NAS is strongly associated with poor and deteriorating school performance."
In some states, a NAS diagnosis immediately qualifies a student for free early childhood intervention services. But not in Alabama.
The Alabama Department of Public Health does not track the number of babies diagnosed with NAS.
The number of cases of NAS covered by Medicaid in Alabama more than doubled from 2010 to 2013. In 2010, there were 170 NAS cases covered by Medicaid. Those increased to 354 in 2013. This is just the number of cases covered by Medicaid, not all cases in the state.
And once those children are school age, the effects of NAS follow them into the classroom.
WHNT News 19 reached out to Huntsville City, Madison City, and Madison County Schools to talk about what they`re seeing. Only Madison County Schools would do an interview.
"Any time a society goes through an increase in different types of substance abuse, such as the opioid addiction problem that we've had, an epidemic over the last, probably increasing over the last 10 years, I think we definitely are going to see an impact on the school systems, said Keith Trawick.
Trawick is the student services director for the district.
"I wouldn't necessarily say that we have seen an increase in, you know, issues that are directly related to opioids, but I certainly think we are seeing an increase in mental health-related concerns at a younger age for children, which in turn could potentially be related to an opioid addiction," he stated.
He says right now, NAS is not on Alabama's radar, but that doesn't mean children diagnosed with NAS won't receive special education services.
"Regardless of what the root cause is of any type of developmental delay or any type of cognitive delay in general, our job is to treat the unique individual, meet the unique individual need of that child regardless of what the root cause it," Trawick said.
So far, it appears no one is ready to say how children will be affected as they grow up.
"I don't think there's any study that could show you right now the effects that it's going to be when they're in middle school, high school, college," Edie Lawhorne said.
But, the Lawhorne family is ready for whatever comes.
"He could do just fine, and it could be that he doesn't graduate when he is supposed to. I don't want to look at it that way. I want to be hopeful," said Edie.
The state of Tennessee has been proactive in addressing the opioid epidemic. Last year the state's health department, supported by the CDC and March of Dimes, conducted a study about the long-term effects of NAS.
"We saw a ten-fold increase in the number of babies born with NAS in Tennessee between 2000 and 2010 and so we wanted to learn more about the potential needs of this growing and important population," said Dr. Mary-Margaret Fill, a doctor cited in the study.
And what they observed?
"About 15% of the children with a history of NAS were eligible for special education services compared to about 11% of the children without a history of NAS. However it is important to note that our study wasn't done in a way that allows us to translate those numbers to the general population," Dr. Fill said.
Dr. Fill doesn't want people to get too caught up in those numbers. Instead, she wants people to focus on what this says about the children's needs.
"The importance of early and ongoing evaluations for developmental delays or educational disabilities is probably one of the most important takeaways from this study. The great news is that we know that enrolling children in things like early intervention and special education services work really well. These services are hugely beneficial and have been shown to developmental outcome and educational outcomes in the children that use them, she explained.
In Tennessee, NAS is a qualifier for state early childhood intervention. In Alabama - it is not.
In 2015, Alabama had the highest opioid prescription rates in the county. Even so, the Department of Public health does not track the number of babies born dependent on opioids and has not studied their outcomes.
Australian doctors also conducted a study on the long-term effects of NAS. They concluded that children with an NAS diagnosis associated with poor and deteriorating school performance.
Madison County Schools
Madison County Schools is working to address students' wellbeing. The district is developing a partnership with Wellstone and the Novus Center.