CINCINNATI -- In just a few weeks, Crystal Cook will achieve her most important goal: She will reclaim her children.
Her six kids have been living with her mother for almost three years as Cook has struggled to beat her addiction to heroin. But Cook has been clean and sober for nearly two years now, she said, and she's eager to get them back.
"I know I have a purpose on this earth, and my purpose is to take care of my kids," said Cook, who credits First Step Home in Walnut Hills for helping her through her recovery. "A kid's supposed to be with their mom."
As heroin use continues to rage across Greater Cincinnati, it isn't only desperate addicts and overdosing adults who are suffering. Cook's sons and daughters are among the scores of children who have become hidden sufferers of the region's opiate crisis.
"These children are the silent victims of the heroin epidemic," said Moira Weir, director of Hamilton County Job and Family Services. "We need to think about the consequences and the outcomes for these children."
Weir's agency has seen a significant spike in the number of children who have entered Hamilton County's foster care system in the last two years -- an increase that she attributes to more widespread drug abuse. And Greater Cincinnati hospitals have seen a 14-fold increase in the number of babies born exposed to heroin or other opioids since 2009.
Last year alone, 814 babies born in the region were exposed to opioids in the womb, said Dr. Scott Wexelblatt, regional director of newborn services at the Perinatal Institute at Cincinnati Children's Hospital Medical Center. Of those, 315 had such serious withdrawal symptoms that they had to stay in the hospital for pharmacological treatment, he said.
"It's a new issue that we never had to deal with until the prescription opioid epidemic happened," said Wexelblatt, whose institute began studying the issue in 2012. "It started filling up our special care nurseries and our Neonatal Intensive Care Units."
'It's hard to be a baby going through withdrawal'
The numbers are staggering.
At one local hospital, 18 percent of all babies born there in 2016 had some kind of drug exposure, according to the Cincinnati Children's study. That figure includes exposure to prescription drugs as well as illegal drugs including marijuana, heroin and cocaine.
When it comes to exposure to opioids, babies are not born "addicted." Rather, they can be born experiencing withdrawal, although not all babies exposed to opioids go through that.
Local hospitals test the urine of every woman who gives birth to check for drugs in her system. That's because it can take 48 hours for a baby exposed to opioids to show symptoms of withdrawal, Wexelblatt said. If those symptoms aren't treated, the baby can experience seizures. So hospitals want to make sure they know if a baby is exposed before the baby is sent home from the hospital.
Although doctors don't yet know the long-term effects for children who were exposed to heroin during their mothers' pregnancies, the newborns do have some behaviors in common.
"They're extremely irritable," Wexelblatt said. "They cry much, much more, and they're harder to console. They need to be constantly held, and they constantly want to suck."
The babies also have what he called an "uncoordinated suck," meaning that they have trouble feeding and can lose weight as a result, he said.
Babies exposed to opioids in the womb are kept in the hospital for extra time so doctors and nurses can check for signs of withdrawal. Those with severe symptoms get treated with medication for 11 and a half days and then stay in the hospital for another couple days to make sure they're OK, he said.
"It's hard to be a baby going through withdrawal," he said. "It's hard to be an adult going through withdrawal."
'A troubling trend'
Cook knows that all too well.
She became addicted to Percocet and then heroin before she got pregnant with her fifth child. She was desperate to leave the drug behind for the sake of the baby.
"I tried to quit every three days," she said. "I couldn't take the sickness, but I didn't want to ask for help because I was afraid."
Afraid, she said, that someone would take away her kids.
She had that baby -- a girl -- and managed to keep custody for a couple more years. But before long she decided to give her mom custody of her five small kids and a newborn son who was born months prematurely rather than see them go into the foster care system.
That's something that is happening more and more across Ohio.
The Public Children Services Association of Ohio estimated in a 2014 report that 70 percent of all infants in Ohio's foster care system were there because of their parents' opiate addiction.
"This is a troubling trend," said Scott Britton, the association's assistant director. "We believe children are very much the invisible victims of this epidemic."
Hamilton County Job and Family Services has seen a spike in child welfare cases over the past two years.
Those increases have put a strain on the agency, Weir said.
The agency had a record-breaking 700 calls to its 241-KIDS hotline in October. And while JFS doesn't specifically track cases related to heroin, Weir said 72 percent of the agency's cases have substance abuse, mental health problems and violence -- all occurring at the same time.
"These children have been exposed to so much trauma," she said. "There's a lot of stress with that."
And because people addicted to heroin have such a difficult time overcoming the addiction, child welfare workers are seeing more children stay in care longer.
"We're seeing people make tragic decisions because of their addictions to actually walk away from their families, and we haven't seen that in recent years," Weir said. "The challenge and the fear we all have in the child welfare system is does this mean kids will languish longer in care? Which is not a good solution."
'I used to judge people'
First Step Home, the organization that helped Cook, gets to know kids who are hurting as it works to help their moms. The Walnut Hills nonprofit provides addiction treatment and support services for women who are 18 and older. It also has places for moms to stay with their children.
Starting in 2013, a growing number of First Step Home's clients have been women addicted to heroin and other opiates, said Jeane Cole, the nonprofit's maternal services coordinator.
Women who enter treatment when they are pregnant get counseling and parenting classes along with their addiction treatment, Cole said. After clients give birth, they can return to First Step Home with their babies and continue treatment surrounded by the support the program offers, she said.
"We've really learned that pregnancy is a perfect time to intervene with services," Cole said. "The mothers are more motivated at that point. We really like it when the women can bring their babies back here."
While some mothers battling addiction aren’t ready to take care of their newborns and children, Cole has seen others create the strong bonds their babies need even as they're recovering from their addictions.
"I believe when the babies are with their moms, and the moms are doing well from birth, the babies do so much better," she said. "If a mother is working hard on her recovery, I'd like to see a chance for her to be with her baby from the start."
Cook said knowing that she soon will regain custody of her children is what keeps her going, even when things get rough.
"Before I used drugs, I used to judge people, especially mothers who I felt they were putting drugs before their kids. Then I started my little journey," she said.
It's hard for anyone who hasn't been addicted to heroin to understand how hard it is to quit, Cook said. But now that she is clean, she has a message to the other moms out there that are addicted and struggling and scared about losing their kids:
"Going through treatment is definitely worth it," she said. "No matter how long you have to go without your kids, there's always a chance to get them back. And you do what you have to do, no matter how hard it is."
9 On Your Side reporter Ally Kraemer contributed to this story.
Lucy May writes about the people, places and issues that define our region – to celebrate what makes the Tri-State great and shine a spotlight on issues we need to address.