The ones who can't say no.

Byline: Anne Williams The Register-Guard

EDITOR'S NOTE: From infants born with meth in their veins to teens buying their next hit from a parent, meth's grip on many Lane County children is horrific. The Register-Guard today launches a five-day series examining how methamphetamine affects local children and teens.

ELMIRA - Joshua Donovan, 3 months old, did not have a fair or healthy start to life.

The bright-eyed, Gerber Baby-beautiful boy was born July 3 at Sacred Heart Medical Center, soon after his birth mother showed up at the emergency room in hard labor. She gave her name and said she was visiting from out of state. Doctors requested a drug screen. She tested positive for methamphetamine.

A few hours later, the new mom said she needed a cigarette. She walked outside, climbed into a friend's waiting car and vanished. Hospital employees and child protection workers tried unsuccessfully to track her down; they figure she gave a fake name.

The 5-pound baby she left behind was in rough shape. Born with a club foot, he also had high levels of methamphetamine in his bloodstream.

Teresa Donovan, who would become his foster mom, received a call from the local office of the state Department of Human Services' Child Welfare Program and agreed to take the baby the next morning.

She remembers how he shook with tremors and cried with an odd, high-pitched squeal, both symptoms associated with drug-addicted babies.

`We called him `Squeaker,' because he sounded like a mouse,' she said.

To Donovan and her husband, Wayne, Joshua's condition was all too familiar. Trained and state certified to look after medically fragile infants, the couple have taken in at least 20 drug-affected babies in the five years they've been foster parents, all but two of them exposed to methamphetamine, Donovan said.

"It's awful for them - it's miserable and they hurt," said Donovan, who angers quickly when talking about moms who use meth. She is convinced methamphetamine damages the fragile, developing newborn brain, robbing children of potential later in life. She equates it with a criminal act: "If your child tests positive, it's abuse."

Given the witch's brew of chemicals used to manufacture meth, along with the documented effects the drug has on adult brains and behavior, it might seem a developing fetus exposed to the stuff would stand little chance.

But there's disagreement and uncertainty in the medical community about the nature and extent of the drug's impact in utero, both in the immediate and the long term. Because the national surge in meth use is a relatively recent phenomenon, little research has been done.

While some experts warn of devastating possibilities, most say the jury's still out. Children such as Joshua might do just fine - or they might not.

No consensus on effects

Dr. Barry Lester, professor of psychiatry and pediatrics, and director of the Brown University Center for the Study of Children at Risk, is among those who caution against jumping to dire conclusions before the research is clear. He's leading what may be the largest study to date on the effects of methamphetamine use in pregnancy; it's being carried out in four states and New Zealand, and initially involved 13,000 infants. About 400 of those will be included in the follow-up phase.

The fledgling study, done at the behest of the National Institutes of Health, follows in the footsteps of a similar investigation led by Lester on the impact of cocaine on children whose mothers used during pregnancy.

Now in its 10th year, findings from that earlier study suggest that fears about a lost generation of "crack babies" were unfounded, Lester said. He was one of 92 signatories to a letter sent by leading researchers to media in July warning against the use of stigmatizing terms such as "meth babies."

"Let's not make the same mistake with meth," he said in a recent interview. `You say `cocaine baby' or `meth baby,' there's an implication that there's a syndrome associated with the drug, which there is not.'

The effects of meth and cocaine, he noted, are not like those of fetal alcohol syndrome, which has distinct diagnostic criteria and has been proven to cause permanent, often severe, damage. The cocaine study did find effects from the drug, most notably a decrease in IQ - 3 or 4 points, on average - in exposed children.

"That's significant and meaningful, but it's a far cry from the devastating, brain-damaged, institutionalized child we feared in the 1980s," Lester said.

Early results from the methamphetamine study also show relatively few dramatic effects, he said, although he warned that the subjects are still toddlers.

"The major kind of medical, pediatric issue that we're seeing is a higher proportion of infants small for gestational age," he said. "They're not pre-term babies; they go to term. But they are small and underweight for their gestational age."

In addition, the drug's effects on the brain may make babies "a little bit more reactive and a little more excitable," he said. "They cry quicker and get more excited, more aroused. And it tends to be harder for them to quiet once they're upset."

Lester said his research has found no evidence of some of the other effects commonly linked to meth and often cited by pediatricians, such as premature delivery, heart defects, gastroschisis (a condition in which the baby is born with a hole in the abdomen) or skeletal abnormalities, such as Joshua Donovan's club foot.

But other experts question that conclusion. Dr. Michael Sherman, a neonatologist retired from the University of California-Davis, studied infants treated in the hospital's neonatal intensive care unit and found a significantly higher rate of birth defects in those exposed to methamphetamine, compared with children exposed to cocaine and those not exposed to any drugs. Among them, he said, were heart defects, gastroschisis and club foot.

"Certainly, there needs to be more research in the area, and I agree with the claim that we shouldn't make broad statements until we have a lot more information," said Sherman, now a professor of pediatrics at the Southern Illinois University School of Medicine. "But we can take some information from what is known, and I think we have an obligation to at least provide the pregnant mother with caution about using drugs."

Lester said he realizes his study's early conclusions are controversial. The alarmist response to the crack epidemic of the 1980s had many undesirable consequences, he said, including the vilification of drug-addicted mothers, dismissal of their children's potential and a shift of dollars away from treatment and into the criminal justice system.

"Obviously, any pediatrician, any clinician, is going to tell people that they should not do drugs while they're pregnant because there's a risk of harming the baby - that's certainly true," Lester said. "But I would much rather see us change our attitude and work toward prevention and treatment."

Another national expert, Dr. Rizwan Shah, has treated hundreds of methamphetamine-affected children in her clinic at Blank Children's Hospital in Des Moines, Iowa. She believes that the effects depend in part on the purity of the drug and the duration of use during pregnancy. She said she has seen a greater incidence of premature delivery in mothers using methamphetamine - about 20 percent, compared with about 8 percent overall. Methamphetamine also places babies at greater risk of hypertension, high blood pressure and even strokes, she added, and many have difficulty sucking, swallowing and regulating their sleep cycles.

But she's seen few lingering problems in her clinical population, she said.

"By the time a child gets to 6 or 8 months, I can't tell meth children from the kids whose mothers didn't use drugs," she said.

A whole host of problems

Complicating the question of methamphetamine's effects during pregnancy are the myriad other risk factors associated with the drug. Pregnant women who use methamphetamine often use other drugs in tandem, as well as alcohol and cigarettes. They may avoid prenatal care, and are not likely to follow any semblance of a healthy diet. Domestic abuse is another frequent corollary of meth use, as is extreme stress.

When attempting to track longer-term effects on children exposed to meth in utero, environmental factors come into play. Babies may continue to be exposed through breastfeeding, the subject of several recent trials in the state. Young children living in a household where meth is present may suffer harm through proximity to the chemicals, especially if meth is being manufactured in the home. Almost surely, they will be victims of poor parenting at best and horrendous abuse and neglect at worst.

"The problem with meth is it's so hard to separate out all these other things," said Dr. Mary Holo, a Eugene pediatrician who treats Joshua and most of the other Donovan foster children - all of them drug-affected - between the ages of 3 months and 6 years. The couple, who will soon adopt two of their foster children, also have three of their own, plus an adopted 2-year-old who came to them as a drug-affected foster daughter.

Whatever the source may be, all the Donovan foster children bear some evidence of harm. One boy, now 5, quit breathing several times when the Donovans took him in as a newborn; he has since been diagnosed with autism, and has vision and hearing defects. A 6-year-old girl is learning disabled and has difficulty with self-control - she'll eat mounds of food, for example, not realizing she's full, Donovan said. A second infant, a girl just days younger than Joshua who also was exposed to methamphetamine, couldn't stop vomiting early on and remains hooked up to a monitor around the clock because of spells of sleep apnea, a condition in which regular breathing stops intermittently.

Teresa Donovan would love to invite anyone who is skeptical of the severity of the meth problem - whether they be medical researchers, legislators or tax-paying citizens - to spend a day with them in their Elmira home.

"We're living with it," she said one recent evening, dishing up 10 portions of fried chicken, corn, green beans and mashed potatoes while her 15-year-old son, Brandon, placated a fussy Joshua. "They should come out here and see for themselves."

"The guilt is just tremendous"

Mary Holo, who estimates she's treated about 20 methamphetamine-affected babies in the past year, said the lack of solid research on the drug's effects is a huge source of frustration. But she believes that methamphetamine is extremely dangerous for both mother and child.

"Some of the women say they can feel the baby kick when they inject the needle," she said. "The guilt is just tremendous, but they can't stop. They just want to get high again to forget about it."

That guilt often reaches its apex in the maternity ward, especially when nurses and social workers step in with probing questions about the women's history of drug use, requests for drug screens and, in many cases where meth is involved, orders to take the baby into state custody.

Karen Ziros-Smith, a social worker at Sacred Heart Medical Center, said she believes that most women about to give birth will be up-front about their drug use, though they may try to minimize it. Mindful of its potential consequences for their babies, most are willing to undergo a screen, even though they have the legal right to refuse.

"To their credit, moms tend to be honest when it comes to the health of their baby," said Ziros-Smith, who estimated that Sacred Heart sees an average of two babies per week born to women confirmed to have used meth during pregnancy.

When a baby is taken away by child welfare caseworkers, it is invariably a scene of anguish for all involved - the mother and whatever family members are present, as well as the hospital employees, whose role is to treat mothers and babies with dignity and to preserve the sacredness of the birth experience.

"There is a wail - a keening wail - that comes out of the mouth of a woman who is losing her baby, whether the baby has died or whether DHS comes and takes the baby away," said Mary Duke, nurse manager for Sacred Heart's Mother-Baby Unit. "It is heartbreaking."

Cases such as Joshua Donovan's are extremely rare, she said; the vast majority of new mothers want the best for their babies, and have no intention of abandoning them.

"No woman who is otherwise not totally psychotic sets out to harm her baby," Duke said. "It speaks to the power of the addiction."

METH BY THE NUMBERS

72

Admissions per 100,000 people being treated for meth addiction in Oregon in 1992, worst in the country

324

Admissions per 100,000 people being treated for meth addiction in Oregon in 2005, worst in the country

217

Admissions per 100,000 people being treated for meth addiction in Hawaii in 2005, the second worst state

71

Estimated percentage of children placed in foster care statewide due to parents' meth use

30

Percent increase of babies placed in foster care in Lane County in the past year

CAPTION(S):

Karen Ziros-Smith, a social worker at Sacred Heart Medical Center, says mothers tend to be honest about their drug use for their babies' sake.