Heroin is a drug that does not discriminate, impacting men and women of all ages, backgrounds and income levels.
The Centers for Disease Control and Prevention says over the past ten years deaths from heroin overdoses have nearly quadrupled. In 2013, 8,200 people died.
And what some call an epidemic is not only impacting drug users, but also their unborn babies.
Babies don't get to choose their parents. They cannot change the choices their mom makes while being pregnant.
But experts at both Mayo Clinic Health System and Gundersen Health System will tell you they will continue to work to ensure these babies can lead as normal of a life as possible.
"There are days in our NICU where as much as 20 percent of the babies are withdrawing from drugs. There are days, of course, I have no babies withdrawing from drugs," Dr. Dennis Costakos, Neonatologist at Mayo said.
If a mom is on heroin while pregnant and tries to withdraw herself, complications arise for both mom and baby.
"We don't encourage our patients to withdraw during the pregnancy because withdrawl can have effects on the fetus. What we know is that early pregnancy you can have a miscarriage or a stillbirth later on in the pregnancy," Jean Colburn, R.N., O.B. Care Coordinator at Gundersen explained.
Instead doctors suggest prescribed treatment programs, replacing the heroin with another drug. Methadone, Subutex or Suboxone can be used medically so the mother does not get high but the cravings go away.
"When we know what they are taking and we have them in a program where they are getting actual therapy, counseling for their addiction issue then we can hopefully have a better outcome for our mom and our baby," Colburn said.
But even if it's a prescribed treatment, the baby will likely see negative effects.
"The same drugs cross into the baby as a fetus and once they are in the fetus the baby becomes attached to the drugs," Costakos said.
Inconsolable high pitched cries, diarrhea, hyperexcitability are all withdrawl symptoms a baby can experience and if untreated the baby could seize.
"It's basically the same withdrawl that adults go through but it's just in a littler person and they don't handle it as well," Colburn said.
Both Mayo and Gundersen have newborn withdrawl programs, approaches to get the baby off of heroin with minimal side effects. Treatment starts first as non-drug therapy, lowering lights and swaddle the baby. But if the baby is in pain doctors work to slow the withdrawl by giving them morphine. And a baby's stay in the hospital can last for weeks.
"Even if we do a good job treating the baby, for the rest of society the health care costs are much higher. A two day stay in the hospital for a baby that has no drug withdrawl is much different than a baby who stays 22 days. Somehow, somewhere, business and government have had to come up with some way to cover the 20 day stay," Costakos said.
What is not yet fully understood is how heroin exposure impacts a baby later in life.
"It's still an evolving scientific picture for what these all mean for the brain, in terms of what it does physically and biochemically to the brain," Costakos explained. He said from what he's seen, a baby's brain has a remarkable way of bouncing back. He said the babies he treats seem to recover fairly quickly.
And treatment doesn't stop with the baby, health care providers work with the mom too.
"Nobody wakes up and says, 'Hey I think I'm trying heroin today because that really sounds like a wonderful life and I really want my baby to be exposed to heroin.' Because they...they beat themselves up everyday for this and they don't need everybody else doing it too," Colburn said.
But health care workers are mandated reporters and are required notify the County Health Department in these situations. Both Mayo and Gundersen agree that when a mom is actively working to get better, the county will try to keep her and her baby together, provided they are living in a safe environment.
"We have a very very high rate of getting the baby to the parent. Our goal is not to split them," Costakos said.
Gundersen has a team of physicians, nurses, care coordinators and a social worker that follows the mom through her recovery process. The approach is to put judgment aside, to get moms the resources they need to be healthy for their baby. That can include housing and sober living communities.
Colburn said there is hope of recovery for these moms.
"I have a mom that I've worked with through two of her pregnancies that is doing a beautiful job and going to school now and is raising two beautiful babies, in a stable relationship in a stable household, like I said, going to college and has done remarkably well," Colburn said.
"She just needed to have somebody listen to her and to understand and not to beat herself up."
Colburn said health care has come a long way it when comes to working with mothers dealing with addiction.
"We're so much more aware of the problem. We know the questions to ask and what to look for."
Now, she said, what they need most are more resources to help get moms and their babies back on track.