Michele Rout is an assistant law director in the city of Chillicothe, one of the places in Ohio hardest hit by the opioid epidemic.
But her experience with the human toll of the crisis goes beyond the courtroom.
Rout and her husband are raising two grandchildren who were exposed to opioids before birth and experienced symptoms of withdrawal afterward — a condition known as neonatal abstinence syndrome (NAS).
Rout’s grandson, Gabe, is now 8 years old but still has difficulties, she said. He has trouble sleeping, and he’s very sensitive to loud noises — like cheering at a soccer game.
“If the crowd cheered, he screamed like somebody was beating him and we were like, ‘Oh, my gosh, what’s going on?’” Rout said. “So we talked to the doctors, and they said that those were just some of the reactions, probably, from the exposure.”
Rout and other guardians like her occupy an unusual place in the sprawling opioid litigation still unfolding in a federal courtroom in Cleveland. They’re not cities or counties, but they say they also have a case to make against the companies that manufactured, distributed and dispensed opioid painkillers.
Their attorneys blame drug companies for the addiction crisis that led many mothers to use drugs while pregnant. The plaintiffs want the drug industry to pay for treatment and continued study of how opioid exposure affects children as they grow up.
Attorneys for the Routs and hundreds of other guardians are asking U.S. District Judge Dan Polster in Cleveland to recognize them as a group for a class-action lawsuit.
Chillicothe, Ohio, the county seat of Ross County, has been hard hit by the opioid crisis. [Nick Castele / ideastream]
Representatives of pharmaceutical companies did not respond to requests for comment. But in court filings in the local government litigation, they have said the industry shouldn’t be held responsible for a crisis of illegal drug use.
Kelso Reno, an attorney at Villarreal Law in Chillicothe, rejects that argument, saying prescription pills paved the way for hard drugs. Villarreal Law represents the Routs.
“They made the profit, and then they want to step away and go, ‘It’s not our fault that these people are using heroin,’” Reno said. “And in reality, when you trace it back, they’re the ones that opened the market.”
The number of children discharged from Ohio hospitals with neonatal abstinence syndrome more than doubled between 2010 and 2016, according to data from the Ohio Hospital Association. Since then, the number of new NAS cases has fallen slightly, but remains high.
Babies with NAS can be jittery and difficult to console, needing dark, quiet environments, according to Dr. Moira Crowley, a neonatologist at University Hospitals’ Rainbow Babies and Children’s Hospital in Cleveland. Health providers often treat such babies with morphine, tapering off the medication over two weeks, she said.
“They were exposed to opiates. That’s what they’re withdrawing from,” she said. “And so we have to replace what they were seeing, and slowly, more slowly take it away.”
That’s the short-term care. But the research isn’t definitive on how NAS affects children in the years after, as they grow up and go to school, Crowley said.
“We don’t have good long-term neurologic outcome data, but it does seem that sometimes they have more delays in school, as they get to school age, in needing a little more help,” she said. “But we don’t have all of that information yet.”
Tabitha and Tim Smalley hold their son, Liam, in their attorney's office in Chillicothe. [Nick Castele / ideastream]
Tim and Tabitha Smalley, who are also plaintiffs, have a story of extreme medical issues to tell.
Their adopted son, Liam, spent 205 days in the hospital after he was born. Doctors found several drugs in his system, including cocaine and opioids, according to the Smalleys.
Liam is now 7 years old and his life has been full of doctors’ visits and operations. He needed surgery to separate his fingers, and for some of his short life he has already had to use a colostomy bag, his parents said.
“He’s had more done to him than most adults have,” Tim Smalley said. “And for him to go through all that, he’s still a loving and affectionate little boy.”
The Smalleys took in Liam as foster parents and later adopted him. They’ve taken many trips from the Portsmouth area, where they live, up to Nationwide Children’s Hospital in Columbus for Liam’s medical care. Late last year, he had seizures while in the hospital, the Smalleys said.
“Liam’s life can be cut short, and it scares us,” Tabitha Smalley said, “but we keep praying, and we’ve got a higher power, and we believe in God.”
Liam is in school with an individualized education plan. His parents hope to take him to Disney World in May.
“This child was not supposed to walk,” she said. “He wasn’t supposed to do the things he’s doing.”