This is the third part of a month-long look at opioids in Georgia, specifically the SunLight Project area of Valdosta, Thomasville, Moultrie, Millegdeville, Dalton, Tifton.

VALDOSTA – The number of Georgia children in foster care has nearly doubled in just a few years, as more parents struggle with what is becoming an all-too familiar scenario. 

The state’s growing foster care rolls – made worse in recent years by increased dependence on powerful prescription painkillers – has put substantial strain on a system left struggling to keep up. 

“I have been through three different crises in my career around drugs,” Bobby Cagle, the outgoing director of the state Division of Family and Children Services, told reporters last week. 

First, there was the crack epidemic. Then came methamphetamine, which is still the prevailing drug problem in parts of Georgia. Now, the state is in the grips of another crisis that is killing people nationwide in alarming numbers. 

“The opioid epidemic has been as bad or worse than either of the previous two,” Cagle said. “And it’s a unique one because it oftentimes starts with a person using prescribed drugs.”

Once hooked, people can eventually run into trouble finding more of the prescription drug, turning then instead to the street in search of it or the cheaper alternative, heroin. 

“The opiate phenomenon has been one of those where I think the need to find the drug and be able to maintain that high becomes all-consuming and, therefore, you have kids that are in danger,” Cagle said. 

There were nearly 13,500 children in foster care as of May, up from about 7,800 in 2013, according to information from the state Division of Family and Children Services. 

In 2014, about one quarter of children statewide were removed from their home because of drugs. This year, about 40 percent of them were. In some communities, that percentage is even higher. 

DFCS doesn’t track the specific type of substance being abused, but communications director Susan Boatwright said division officials hear anecdotally from local court officials and others that opioid abuse is driving many of these removals from the home. 

The strain on the state’s foster-care system could all be much worse, if not for the state’s first line of defense: family members. 

“Without grandparents, there is no doubt that the foster-care system would be exploding,” said Joyce Parton, coordinator of the grandparents raising grandchildren program with Family Support Council, a nonprofit in Dalton. 

The courtroom, through family treatment courts, has become a go-to mechanism for handling this rise in opioid addiction. 

In Lowndes County, which had one of the highest percentages of children removed because of drug abuse last year, Southern District Attorney Brad Shealy said he’s seen an increase in opioid-related arrests. 

The district attorney said he sees cases where someone was originally given a legal prescription for painkillers from a doctor, only to become addicted and later resort to trying to find the drug by other, illegal means. 

His office, he said, does its best not to take parents away from their kids, turning when possible to accountability court programs that allow parents to seek treatment before losing custody. This is not an option for parents who are caught selling the drugs. 

“In one case you have someone trying to deal with a problem. The other case is something more serious,” Shealy said. “You have to deal with the addiction problem first.”

But treatment services for parents – particularly ones where they can bring their kids along – are often limited or nonexistent in parts of the state, said Virginia “Ginger” Pryor, the interim director who begins leading the state agency Monday.

“If I’m in the southern part of the state, a parent may have to travel 40-plus miles to get to the closest support center than can help them, or there’s a significant waiting list,” Pryor said. 

Pryor said the division is also exploring other strategies, such as creating internal positions that specialize in substance abuse issues. 

In the meantime, the division has requested an additional $10 million from lawmakers to help cover its growing out-of-home care costs that have been brought on — at least in part — by increased opioid abuse in Georgia. 

The children are spending more time in the system, and – adding to the disruption in their childhood – significant numbers of them in north Georgia wind up outside of their region due to the lack of available nearby foster homes. 

“They stay in care longer because recovery takes longer and relapse is a real part of that scenario, so the parents may do very well for four months and then relapse, and so you start all over again,” Boatwright said. 

“So they stay in care longer and then the years are sort of stacking up on each other,” she added. 

That’s especially true in hard-hit areas, such as northwest Georgia. 

Danny Nuckolls, who is director of the Whitfield County DFCS, said he’s seen an increase in children in foster care since he took over in 2014. There were about 130 at the time; now, there are more than 250. 

Ninety children came into the system in just the first half of last year, he said. 

“They came in for one of three reasons, if not two of three reasons, if not all three, and they were substance abuse, mental health and domestic violence,” Nuckolls said. 

Surprisingly, though, opioids haven’t been the main problem Nuckolls said he sees day to day. Meth, he said, still plagues this community. 

“At the end of the day, it doesn’t really matter with us what the substance is,” Nuckolls said. “It is, ‘Are the kids safe?’”

Hundreds of babies born with addiction 

By Jill Nolin

CNHI State Reporter

The babies often have tremors. Their first sounds are usually a high pitch cry that doesn’t stop, at least not for long. They also struggle to sleep. 

For a growing number of newborns in Georgia, this is how they spend the first months of their lives as they come off of whatever substance the mother was using while pregnant. 

“A lot of these babies, we’ll lay them down, we’ll get them comfortable, we’ll swaddle them, have them sound asleep and 15 minutes later, they’re in there crying again,” said Nikki Pasley, clinical nurse manager with the neonatal intensive care unit at Hamilton Medical Center in Dalton. 

Like other Georgia hospitals, Hamilton is seeing more babies born with signs of withdrawal. The hospital’s NICU has treated 52 babies this year for what is called neonatal abstinence syndrome. That’s 13 times more than just four years ago. 

Statewide, there were 302 confirmed cases in the first half of this year, according to the state Department of Public Health, which started tracking the condition last year. Opioids were the cause for nearly one quarter of these newborns. 

It may even be worse than it appears, since it can take several days before the newborns begin to show symptoms. 

“What that means is that we may be missing some of these babies. They may be getting discharged and going home and withdrawing,” Pasley said. “That’s kind of scary to think that it could be an even higher number than what we know.”  

The babies treated at Hamilton are withdrawing from a range of drugs, and it’s not uncommon for them to be addicted to multiple substances. 

Pasley said a lot of the babies are withdrawing from opioids, such as hydrocodone, oxycodone and drugs such as buprenorphine and methadone that are commonly used to treat addiction. 

There’s also been a notable increase in heroin addiction lately, she said. 

These newborns can experience immediate problems such as premature birth, low birth rate and seizures. There is also a potential for long-term damage, such as lifelong learning and developmental disabilities.

The babies are kept in the hospital for treatment and monitoring much longer than the usual two days, putting a strain on the state’s hospitals. Two to three weeks often pass before the babies are discharged. 

Some hospitals have turned to volunteer cuddlers to help staff tend to these needy babies, a popular duty that has prompted a waitlist at Hamilton in Dalton. 

“When you look at national statistics, a normal term delivery and care is going to be about $3,500,” said Dr. Mitch Rodriguez, the medical director of Navicent Health’s NICU in Macon. “But the cost of care for babies with NAS goes up to about $67,000.” 

Rodriguez said his NICU, which attends babies from more than two dozen counties, including Baldwin County, has seen a 60 percent increase in babies born with neonatal abstinence syndrome in the last three years. 

“Granted, we are nowhere near some of our neighbors such as Tennessee and Kentucky, but about 1.8 percent of all admissions into the (NICU) have the diagnosis of NAS,” he said. “In the state of Georgia, we’re looking at about 1.6 per thousand babies that are born with a diagnosis of NAS.” 

Archbold Memorial Hospital in Thomasville has also seen an increase, said Whitney Sampson, nurse manager of the mother/baby unit at Archbold. 

Last year, Archbold recorded just one baby diagnosed with neonatal abstinence syndrome. This year, the hospital has had four.

And like others, Sampson said some newborns likely slip by. 

“These particular drugs can sometimes not cause withdrawal symptoms in infants until three to five days after the baby is born. At that point, the infant has already returned home from the hospital,” she added.

The cost for treating these babies through Medicaid, which pays for about half of the births in Georgia, has also grown, according to information from the state Department of Community Health, which manages the state’s insurance program for the poor and disabled. 

Last year, 483 babies were treated, up from 163 in 2012. The state paid nearly $870,000 last year for their treatment, more than doubling what was spent four years ago. The state’s vendors also spent nearly $3 million last year for their care through Medicaid, up from $1.1 million.   

Other costs may still not even be apparent. 

“We know that if these babies are born addicted that we have to take care of them for 18 years, probably,” said state Sen. Renee Unterman, R-Buford, who chairs the Senate Health and Human Services Committee. “And what is the cost of taking care of that child?” 

Unterman has floated the idea of pursuing a federal waiver that would allow the state to expand Medicaid coverage for specific populations, such as these babies for behavioral health services, while securing more federal money for their care. 

“We have all kinds of waivers existing,” Unterman said. “It’s just whether the General Assembly has the appetite to have more waivers or to ask for flexibility. Flexibility is the main word. It’s not necessarily expansion but flexibility.” 

Georgia did not expand Medicaid under the Affordable Care Act, which requires states that did expand to provide coverage for those who met the income eligibility requirement. 

A much narrower version of expansion could prove more palatable under the Gold Dome, but it would also have a more limited impact, said Laura Harker, health policy analyst with the left-leaning Georgia Budget and Policy Institute. 

“If you are just targeting people who already are sick and have a condition, you’re missing out on an opportunity to use that money to get them treatment early on and prevent their condition from getting worse,” Harker said. 

For more on Georgia and opioid addiction look for the SunLight Project next Sunday.

The SunLight Project team of journalists who contributed to this report includes Will Woolever, Patti Dozier and Tom Lynn. To contact the team, email sunlightproject@gaflnews.com.