Worries grow that the opioid epidemic is creating a 'lost generation' of children

America's opioid crisis is harming an entire generation of children in ways that will last a lifetime.

In Western North Carolina, hundreds are entering a foster care system already burdened by a surge in opioid-related cases. Hospitals in Appalachian states sometimes spend weeks helping newborns withdraw from opioid dependency after their mothers used during pregnancy. Teens are finding easy access to prescribed and illegal opioids, such as heroin.

The Citizen Times interviewed more than 35 parents, 25 children, 50 medical professionals, 45 social workers and dozens of people from other agencies to understand the scope of the opioid crisis's effect on children in the region.

The project started in September and included interviews in North Carolina, Tennessee and Kentucky.

 MORGANTON – Emanie’s head of thick, raven hair was kept closely shaven before he entered foster care. His parents knew they could lose their child — then barely old enough for elementary school — should a test on a strand of hair show drugs in his system. 

To escape the nightly wrath of his drug-addicted parents, Scottie would sleep underneath a trampoline in his backyard. He was not yet in middle school. 

Mariah was placed in foster care, adopted and then returned to the system before she turned 18. Now she struggles with post-traumatic stress disorder and has flashbacks to the times when she was left uncared for by parents overcome by their addictions. 

All three reflect the trauma endured by hundreds of children, from newborns to teenagers, who have overwhelmed the foster care system in some Western North Carolina counties in the wake of America’s opioid epidemic.

Overdoses involving opioids killed 33,100 Americans in 2015, up 69 percent from 2008, according to the National Institute on Drug Abuse, a part of the National Institutes of Health.

Social services departments in 16 Western North Carolina counties reported a steady increase in foster care numbers during that period.

In Buncombe County, 387 children lived in foster care at the end of last year, up 22 percent from 2016. In seven years, the number of foster care cases in Buncombe has almost doubled.

“In my opinion, we are creating a lost generation of children who are going to be without their biological parents because of this epidemic,” said Tammy Shook, Buncombe's recently retired social services director. 

Children now flooding the foster care system come from households where drug abuse started with an addiction to painkillers and moved on to other substances. 

Ninety percent of foster children in McDowell County have tested positive for two or more drugs after being taken from their homes, said Lisa Sprouse, the county's social services director. In McDowell, 130 children lived in foster care before Christmas. That is 40 more than at the same time in 2016 and an 86 percent increase in cases since 2010. 

“It’s becoming common at this point to see kids testing positive for at least three or four drugs,” she said.

One infant, Sprouse said, entered care after testing positive for eight different drugs. 

Emanie, Scottie and Mariah all camefrom homes torn apart by opioid addiction, and they all found refuge in the same foster home started by a former basketball coach in McDowell who became alarmed by the realities of the life experiences of some of his young athletes.

More:SPECIAL REPORT: Opioids are endangering a generation in WNC

Key facts about America's opioid epidemic 

Emanie and Mariah still live with foster parents Shantel and Zack Wyatt. Scottie did for six years, but left to see his birth mother and acknowledged taking opioids with her when he returned, the Wyatts said. They have since lost touch with him.

The Citizen Times in November spent hours in the Wyatts’ home over multiple evenings and in separate interviews in compiling this story. The children’s last names are being withheld to protect their privacy. 

A refuge

At 8 p.m. on a Thursday, the street outside the Wyatts’ home is undisturbed. Bicycles lay on front lawns along a row of white houses that drapes a hill in Burke County.

The scene inside the home is anything but quiet.  

Country music — Emanie's favorite — blasts from living room speakers. The 8-year-old darts from room to room, poking fun at his older foster sisters who playfully tease him back.  

Suddenly, he stops, falls to the ground and pounds the floor with both fists. His body goes rigid as he screams.  

Shantel rushes to him, wraps her arms around him and hugs him tightly, long enough for his breath to even and a small smile to emerge. 

“This is just another night with Emanie,” she said before he sprints off once again. 

It’s been nearly a year since the Wyatts moved into their new home in Morganton. The decorations they’ve managed to unpack are framed pictures of the 20 or so foster children who have stayed with them over the years. 

The photos hang on walls and rest on mantels, with Bible verses and warm welcomes painted on wood plaques in between. "Family and Friends Gather Here," reads one.

Their home is still coming together, with their remaining possessions still locked in storage.  

Being a foster parent is a commitment that puts lives and personal projects on hold, but the Wyatts have no complaints.

Zack works as a maintenance technician for a private company and Shantel works as a supervisor at Lowe's home improvement store. Foster parents are paid between $475 and $634 per month per child, but the money is hardly the incentive.

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“When these kids actually make that first 'A' on that report card, or when they have that first epiphany that makes them realize ‘I am capable and I am worth it,’ then it makes this every bit worth it for us,” Shantel said.

Before they were licensed foster parents, the Wyatts offered their former home as a refuge for teammates and classmates of their two biological children. 

Zack coached his son’s weekend recreational basketball team and the Wyatts would host weekly dinners at their home, where the boys would linger long after dinner.

“You would be surprised at the number of children that stayed at our home from that basketball team over the years,” Shantel said. “I don’t even think the parents knew where they were or for how long."

The Wyatts refer to their foster children as son or daughter.

But it was Scottie, the boy who slept under the trampoline in his backyard at night, that redefined their purpose. 

Scottie was so frequently a guest that the Wyatts said they grew concerned if he was not around. 

Zack helped him with his homework, and as he gained trust, he learned Scottie was sleeping outside, either at school or at home. At age 12.

“I contacted a school counselor who said there was already a report made. They were just waiting for investigators to complete the assessment,” Shantel said. 

The Wyatts took Scottie into their care under the guidance of the McDowell Department of Social Services while they created a permanent placement plan for him. It was the first time the Wyatts were asked to consider becoming state-certified foster care parents.

The judge granted Scottie Wyatt an adoption after his mother terminated her parental rights, a process that took six months. 

Foster children may stay with a family for as few as 24 hours, Shantel said. But some kids, like Mariah in the Wyatts' home, will stay years with one family. Those decisions are usually left up to the courts.

Emanie, the Wyatts' newest foster child, was placed with them in June after his older sister tested positive for a mixture of prescription pills and methamphetamine. Because his hair was kept short, social workers could not test Emanie.

Both Emanie and his sister were born needing treatment for substance withdrawal.

When Emanie moved in with the Wyatts, he came with a set of conditions — tantrums, night terrors, anxiety, hyperactivity, sleeping disorders and learning disabilities, among other things.

There is debate within the medical community over whether babies born needing treatment for withdrawal will suffer long-term damage. Social workers and foster parents are less hesitant to make a connection.

“We know opioid exposure changes the brain makeup,” said Shook, Buncombe's former social services director. “Thinking about young children who are exposed, I would hypothesize that something is going to come of it in the future.”

Doctors who don’t believe there are lasting effects should spend a night with their family, Shantel said.

“Take one home with you and live with them,” she said. “You can say studies don’t prove anything with opioids or other drugs affecting kids after birth, but I have lived with the studies. I watch the study.”

Like any other family

Over the last decade, the Wyatts say they have noticed disturbing sleep patterns in kids where drugs were present. They twitch, kick and punch involuntarily. 

“Every few minutes an arm goes flying out, then a leg goes flying out, and you can watch it happening,” Shantel said. 

Scottie, their adopted son, is now 18. He became a straight-A student in high school and was accepted into college. But before leaving for school, he decided to reconnect with his biological mother. 

Hours later, Scottie’s girlfriend called the Wyatts and told them Scottie was high on prescription pills. The Wyatts have not seen him since.

“He is not my son right now, but he is in there somewhere,” Shantel said. “I have to believe that Scottie can come back from this and do something with his life. I truly believe his story will serve his community.”

As for Emanie, the Wyatts have pinned hopes on therapy and unconditional love.
With Mariah, they know they've found success.

Mariah’s bedroom does not reflect a typical 18-year-old high school student. It is simple and organized. 

Colorful lights hang from a balcony window and a small disco ball decorates one corner. A giant "U.S. Navy" blanket spreads across her bed. She often wears a Navy T-shirt to match.

Her foster sister, the Wyatts' daughter, braids her hair as she flips through photos from when she first moved into the Wyatts’ home five years ago. 

She has changed dramatically. Her hair is shorter with blonde highlights. Her tan arms are toned, and she has lost weight.

“I cannot believe that is what I used to look like,” Mariah said with an exaggerated eye roll while her sister yanked her shoulder-length hair into clusters of braids. Emanie danced in circles around them.

She pulled out photos of her boyfriend. They are both in ROTC, which she considers her second family.

“My ROTC captain is a mentor to us, and we are all one community who is there for each other every day,” she said with a smile that reached her eyes, making them squint.

Mariah didn’t always have two families. For much of her formative years, she was in foster care.

“Her case worker told us in Mariah’s history sheet there was mention of her being left alone in a crib with a gate on top to make sure she didn’t crawl out,” Shantel said.

Mariah has had one failed adoption between moving to and from multiple foster homes. 

Shantel and Zack would adopt Mariah in an instant if they could. But because of her experiences, she has trust issues, and the social worker assigned to her case feels like an official adoption could reopen old wounds.

Mariah refers to Shantel and Zack as her "mom and dad."

“She is supposed to be with me,” Shantel said.

Zack feels that way, too.

“She is a major success story of one of our kids who has not only survived but thrived in foster care despite what happened to her,” he said.

Zack beams as he shows photos of her in the high school homecoming court. He swipes through hundreds of photos of Mariah on his phone, boasting of her successes, while she blushes and giggles.

Despite her progress, she still goes through rough patches.

“Most nights I don’t sleep well because of the nightmares,” Mariah said. “I get woken up by flashbacks of my time as a kid and then I have horrible anxiety until morning.”

But she chooses to keep looking forward.

“I am enlisting in the military when I graduate next year,” she said with confidence, displaying a trait that did not exist a few years ago. She hopes she gets placed at a base close to home.

As the night winds down, Shantel stands behind Mariah and wraps her arms around her shoulders. Mariah leans onto her mother’s chest and closes her eyes. The moment is fleeting. 

Shantel goes back to wrangling Emanie into bed, and Mariah puts her photos away.
Zack busies himself by cleaning the living room where Emanie left destruction in his wake.

Just like any other family on Meadow Drive, they turn off the lights, say their "I love yous" and go to sleep.

It is heartwarming — and it is far from the world that sometimes leaves Beth Browning in tears during her drive home from work.

Straining the system 

As the director of Lily’s Place, a child advocacy center in Marion, Browning is on the front lines in dealing with child abuse, especially cases involving neglect due to opioid addiction. 

Over the past two years, she has seen an alarming number of kids come into care in McDowell County.

 Like Buncombe, McDowell County sometimes has children spend the night in the social services building waiting for a foster home opening.

Fluffy pink, blue and purple pillows are scattered across the floor in Lily’s Place to keep children comfortable while McDowell County social services workers bustle about in an adjacent room during the day. 

A social worker and therapy dog will stay the night if needed.

“Our numbers have increased tremendously, and I attribute that to the drug-exposed children,” said Browning, who is also a certified nurse practitioner. 

On average, eight of 10 children entering foster care in McDowell are testing positive for a mixture of drugs — mainly opioids and methamphetamine.

Browning struggles to feel sympathy for parents when she sees kids who are malnourished and dirty and have low grades in school.

“We are seeing these families come in that are not even providing clothing for their children and yet they are strung out on meth,” Browning said. “Are they using the money that they should be using to provide for kids to get their drugs?” 

Without a support system, Browning fears parents will not stay sober, which is traumatic for their children who witness their parents relapse multiple times. 

In Clay County, on the opposite side of Western North Carolina, opioid abuse is at the heart of 22 out of 26 cases. Of the 22, 10 involve children younger than 3 who tested positive at birth for substances.

Social workers there are intimately engaged with families to keep them intact, which they view as their main priority.

To do that, most children removed from their parents’ custody are placed into kinship, meaning a grandparent, aunt, uncle or another family member will assume responsibility for their well-being while the parents work to meet court mandates.  

“We work hard with families to overcome the addiction,” said Debbie Mauney, Clay County social services director. “We do safety plans and they get intense services while the kids are separated.” 

The biggest hurdle for parents, Mauney said, is finding steady employment. 

“They have trouble holding down jobs, are jumping from house to house, and have a hard time paying attention to their kids’ needs,” Mauney said. 

Small counties similar to Clay, such as Jackson, Mitchell and Macon, struggle with access to resources, including a lack of treatment options. 

“Opportunities for us out here are few and far between,” said Patrick Betancourt, Macon County's social services director.

Addicts living in Macon and McDowell routinely must drive over an hour to access services like suboxone and methadone clinics in another county.  

“The further you move away from Buncombe, the further away you get from the core of the services,” Shook said.

Unknown future

After foster care numbers began spiking in Buncombe five years ago, social services, hospitals and law enforcement collaborated on programs and applied for grant money to fund them.

That has not been the case for other counties, which are smaller and whose agencies are understaffed.

“We are stretched thin way out west and have seen so much turnover in all areas of child welfare,” Betancourt said.

Sprouse knows what her families need in McDowell, but she does not have the resources to offer them. 

“The days of just going to the office to have group talks once a week are gone because that is not the intense engagement that the families we work with need,” Sprouse said. “We really need boots on the ground to go to families' homes to work one on one. But we can’t.” 

In McDowell, foster care services cost more than $690,000 in 2016 — state and federal dollars covered 69 percent of the cost; the rest was paid by the county. Last year foster care services cost more than $1.1 million.

In cases where newborns are testing positive at birth for multiple substances, Sprouse said the cost is greater to treat and house the babies in foster care, adding more financial strains.

As Browning looks ahead, her biggest concern is the unknown future of this current generation of foster children. 

“Speech delays, trouble in school, difficulties focusing, ADHD … these are just multiple concerns at this point,” Browning said.  

“These kids do not ask to be in a home where drugs are being used. They never asked for that, and they don’t deserve that,” she said.

Coming Monday: Hospitals in Western North Carolina and surrounding areas are seeing surges in the numbers of babies born to mothers who used opioids during pregnancy.

Alexandria Bordas is a reporter at the Asheville Citizen Times. You can reach her at abordas@citizentimes.com.