A Letter from the Children of the Opioid Crisis

I was born opiate dependent with Neonatal Abstinence Syndrome. I am not just necessary collateral damage as a result of the opiate crisis or an afterthought. I am a tiny human who deserves your respect just like my mom, who struggles with Substance Use Disorder. My mom may have gotten hooked on illicit drugs, prescribed opiates following an accident, or may have actively chosen to engage in Medication Assisted Treatment to keep herself well and to give me the best shot at improved outcomes. I went through active withdrawal at birth, the same withdrawal that adults experience without the understanding of what was happening to me. I may have had muscle tightness, vomiting, GI upset, fevers, tremors, irritability, sensitivity to sensory stimuli, and that high-pitched cry. My parents will never forget that high pitched cry. They sat with me through it. They rocked and swaddled me, they held my hand, they told me they loved me. These symptoms may have lasted up until I was several months of age. I may not have been a happy or comfortable baby but every time I smiled my parents knew that I was going to be ok.

Hopefully I was immediately hooked up with Early Intervention, a free federally funded program that works with me to help me meet my developmental outcomes like my peers. Here in Massachusetts I am given one year of automatic eligibility based on my NAS diagnosis. Due to my muscle tightness I may need physical therapy to loosen me up, so I can roll, crawl, and walk. I may need occupational therapy to make sure that I can manage the sensory environment around me which can be difficult for me because of my exposure. They may teach my family how to swaddle and soothe me, how to keep a predictable routine, low lighting and voices, and minimal visitors. I may need a speech language pathologist to help me coordinate suck, swallow, and breathe so that I can learn to eat. Nurses may help me work through my GI upset and teach my parents about ways to keep me comfortable and what formulas or medicines may help. I can get these services until I am three years old and often need them throughout.

In 2010 there was a significant uptick in heroin abuse. This means I am in your elementary schools. Schools that maybe weren’t prepared for me and the extra needs that I often have. Due to my hypertonia I may have trouble grasping and holding a pencil like my peers. Due to my deficits in executive functioning I may be a little rough because I don’t understand how to apply proper pressure and may not understand my body in space. People may say I have “behavioral problems” but really, I have issues with sensory processing. Like when I was a baby, things may be too loud, lights may be too bright, smells may be too smelly. I crave routine and extra time for transitions. I need time to organize a new activity or experience. Sometimes I need a break from the classroom. All of this extra work my brain and body has to do can make me really tired. I may take some extra time to respond to you or ask you to repeat things a lot because my working memory may be impaired, and my processing speed may be a little slower.

I understand that you may not know all of this by looking at me. My parents may have not told you about my background because they were worried that you would treat me differently or stigmatize me or even them. You may have certain feelings about them and what has happened to me but please know that my parents, they too are victims of the opioid crisis. They may be working towards recovery or in active recovery. They are doing the best that they can and deserve your support and respect. I may be being raised by foster, adoptive, or relative caregivers. They too need your support and resources.

When it’s all said and done I need your help NOW. I don’t have time to wait for your research, your “stats” and your “numbers”. I have long term developmental consequences that my family and my community are seeing. I need you to talk about me, not just my mom. You see, not talking about me is delaying the funding that I need to get the services that will help me. I need the medical community to listen to what my mom and dad are telling you about what they are seeing and to stop minimizing their experience. I need people to stop believing that these issues are not due to opiate exposure, instead of insisting that my troubles are caused by alcohol or tobacco exposure. We know that opioid exposure to an adult brain has lasting implications so why would my developing young brain have no impact? Help me now, help me early, help me beyond early intervention. Early intervention is not a magic wand. I still need help beyond three years of age. Get me adequate behavioral health services, occupational therapy, physical, and speech therapy. Know that with continued services, and a stable and loving placement I can do really, really well. You can help me meet my true, full potential. Help my parents. When you help my parents you ultimately help me. However, don’t forget my needs are sometimes separate from theirs, and cannot, should not be ignored. Doctors: Talking about my needs will not deter my mom from Medication Assisted Treatment. I need you to know that you underestimate my mom. Provide her with education that Medication Assisted Treatment shows best outcomes for her health and safety as well as mine. Empower her to make informed decisions about what is right for her and me. It is your job as a doctor to give her the benefit of all the information available. Talk about me because I am important. I am a person. I am not just collateral damage or an afterthought.

Theresa Harmon, MSW, LICSW, Founder & Executive Director of To the Moon and Back.
A 501(c)(3) non-profit dedicated to supporting children born opiate dependent with Neonatal Abstinence Syndrome and the families that care for them.