NEW DRUG WAVE DELIVERS 'CRANK BABIES'

Earlier Alarm Over Cocaine's Effects Could Limit Aid For Meth Abuse

It was as if "crack babies" burst into the world with an alarm bell ringing
in their cry. Researchers peered at them over clipboards with concern. The
public stared at them on the evening news with shock. And the din of
predictions about these babies, exposed to crack cocaine before they were
born, doomed them to a fate that would never fully materialize.

Now, the backlash against those exaggerations has left a resounding silence
about a new generation of drug-exposed infants: "crank babies."

As many as one in 10 babies born at UC Davis Medical Center between 1990
and 2002 had been exposed to methamphetamine - known as crank - according
to a recent UC Davis study of babies in the neonatal intensive care unit.
Sacramento County numbers underscore the problem: Half of the babies that
tested positive for drug exposure here last year had traces of
methamphetamine and other amphetamines in their systems. Funding for
studies on how those crank babies are faring is skimpy, researchers say,
noting that they have been loath to generate a buzz that vilifies another
generation of mothers. They've also shied away from stigmatizing the
children and dredging up public cynicism over the crack baby uproar.

But without such a buzz - and the resulting funding - county health and
social workers worry about how to adequately cope with the crank babies at
a particularly crucial moment - just as the former crack babies reach
childbearing age. Research has shown drug-exposed babies are more
susceptible to drug use as they grow up and to continuing the cycle with
their own offspring.

"We watched one group march through all of our systems," said Penelope
Clarke, administrator of Sacramento's Countywide Services Agency. "Now
we're seeing them reaching an age when they can have children of their own
. The bottom line is we are seeing (drug-exposed) babies having babies and
coming through the Child Protective Services system."

The shift from infants exposed to crack to those exposed to crank can be
documented in the handful of programs around the Sacramento region
dedicated to helping mothers with drug problems. The Volunteers of
America's Options for Recovery center in Del Paso Heights, for instance,
was established in 1990 to support mothers coming clean from crack. Today
about seven in 10 clients sign up to kick meth instead.

Kari R. McGinnis Rals is one of the 24 women currently living there. Rals
smoked meth while pregnant with her newborn son, Eddie Valencia - her third
child - even after her fiance locked her in a room so she couldn't get
high. She sought help only when he issued an ultimatum: put down the pipe
or I'll take the children and leave.

Now Rals tells her life story with a beginning (little girl in ruffled
dress at church), a middle (when she last got high) and an end: Five months
since her last high, she craves a very different kind of rush.

"Today I can look forward to finger paints and parks, laying on the couch
with all of the kids watching 'Scooby-Doo,' " she said. "I'm looking
forward to having such a hard day and having my fiance put his arms around
me when I sleep."

Although Rals sought help, she came forward only after having smoked meth
during the early months of her pregnancy. Sacramento County officials are
about to launch an effort to identify drug-using women even earlier in
their pregnancy, hopefully before any damage is done.

But Paula Schmidt, the director of the Options for Recovery program - the
only one in the county that houses mothers like Rals with their children -
questions whether she can handle the influx of women discovered by a better
early-screening program. Schmidt already has a perpetual waiting list for
housing.

"Where are we going to put the women?" she asked, throwing up her arms.
"Where are the beds?"

State funding targeted for drug-using women who are pregnant or have young
children has fallen 27 percent in Sacramento County over the past 10 years,
from $2.6 million in 1995 to $1.9 million in 2005, in inflation-adjusted
dollars, based on figures from the California Department of Alcohol and
Drug Programs.

Grants from the National Institute on Drug Abuse to learn more about
drug-exposed babies rose gradually during most of the last decade, to about
$14.1 million in 2004 for crack and crank research combined. But, even
though the focus of the funding has shifted in recent years, far more still
goes for crack baby studies - at a rate of $6 for every $1 spent for crank
baby research last year.

The overblown early claims of cocaine exposure also have overshadowed
results of long-term research showing that problems do indeed endure for
the former crack babies, the oldest of whom are now 21.

A Brown University-based study that has looked at crack effects since 1993
in four cities recently concluded that cocaine exposure shortchanges a
child of nearly five IQ points by age 7. Former crack babies also were
found to be more impulsive and distractible than their peers, prone to
short-term memory loss and aggression.

Initial research on infant exposure to methamphetamine reveals that its
damage could cause 4 1/2 times more birth defects than those found in a
crack-exposed infant, Dr. Michael Sherman, a retired UC Davis
neonatologist, discovered from a sample of Northern California babies.

"We're just getting the tip of the iceberg of the severity of the problem,"
Sherman said.

The alarm that started the crack baby uproar first was set off in 1985,
when Dr. Ira Chasnoff, a Chicago researcher, published a startling report
in the New England Journal of Medicine. A crack-exposed baby, Chasnoff
reported, has a smaller head and lower birth weight, and is more irritable
than other infants.

Television stations broadcast images of stiff and shaky babies. Washington
Post columnist Charles Krauthammer, whose work is carried in newspapers
across the nation, declared the babies a "biological underclass."

"When the earliest reports came out ... it was really sensational, slung
all the way in one direction, and things were horrible," Chasnoff recalled.

Chasnoff's initial study looked at 23 infants and did not control for
addicts' alcohol use or their typically chaotic environments. In 1992, when
his more extensive study reported that crack had little effect on a
toddler's intelligence, the issue was dismissed.

"It's like the flavor of the moment," Chasnoff said. "As the public concern
drifted in other directions, this large population of children was left
behind."

Just as Chasnoff published his initial findings, outside of the media glare
Penelope Scott began a 20-year dance with crack that would dash her hopes
of nurturing her oldest children.

Now off drugs for four years and raising her four children in Del Paso
Heights, Scott tells her story in a mix of pop psychology and street slang,
while driving an SUV and keeping a lieutenant's eye on her youngest daughter.

She grew up on the streets of the Tenderloin District in San Francisco. She
first smoked marijuana at 9, sold her body for sex at 14, ran with an
abusive pimp and snorted cocaine.

After giving birth to a daughter at 15, she was sure motherhood would
change her. "After I had her, I finally had someone to love," she said.

Three years later, Scott took her first hit off a crack pipe; she was
hooked. She sold the drug to get more while pregnant in 1988. Baby Kaisha
lived just two months.

Within a decade, mothers like Scott would begin to see criminal penalties.
Scott had three more children and engaged in a 15-year tug of war to retain
custody, letting go whenever she was strung out or in prison on drug charges.

By the time such punitive policies began to discourage mothers from seeking
prenatal care, the media and public had already disavowed the detrimental
effect crack had on a baby.

Yet Scott believes she can see its mark in the distractibility of her
daughter, now 14, who was born with crack in her bloodstream. She was quick
to fight as a child, Scott said, though she is starting to mellow as a teen.

Crack-exposed children act out in ways apparent in classrooms, said Dr.
Chandice Covington of UCLA. She studies Detroit-area children, quizzing
teachers about students' behavior. Researchers know which of the students
have been exposed to crack before birth; teachers do not.

And yet the teachers "were right on," Covington said. "The children they
thought (had been exposed to cocaine) needed a lot of assistance getting
through the day; they had hyperactivity and were extremely disorganized on
tasks."

While researchers are seeking to avoid the rush to judgment of crack
babies, many predict the same attention deficits and distractibility for
crank babies.

Infants already are showing signs of trauma locally, said Sherman of UC
Davis. He is completing a study of 6,555 babies born in Northern California
since 1990 and admitted to neonatal intensive care units. About 560 were
exposed to methamphetamine and 325 to cocaine, he said.

The meth-and amphetamine-exposed babies were 4.5 times as likely as all
California babies to have birth defects; crack babies were just 1.3 times
as likely. Although babies admitted to intensive care are more prone to
complications, Sherman believes his findings are still remarkable. The
crank babies were more likely to have certain types of strokes and feeding
problems, and to be born with their intestines outside of their bodies.

"How could we let this get so out of hand?" Sherman asked. "We should start
with junior high and high school education - take (students) through the
(intensive care unit) nursery, show them broken babies, let them have a
visual image of how serious the problem is."

Schmidt sees its seriousness every day. She welcomed one woman into
Volunteers of America who had taken methamphetamine at age 6. Her mother
put it in a sippy cup so the child could stay up all night with her.

"Our clients are very broken individuals," Schmidt said. "And, I must add,
very brave individuals to say 'I'm willing to change my life.' "

Rals, with fuzzy blond hair and darting hazel eyes, smoked meth during the
first four months of her pregnancy, but says she sees none of its effect on
the 7-pound, 11-ounce boy she delivered on March 25.

She does see what counselors and researchers see: the cycle. She first
tried meth in a rage at her mother's denial that there was drug use in the
family.

"I hated drugs, I hated drugs," she said. "I watched them tear my family
apart."

Rals' second binge lasted three weeks and left her looking like a gray
ghost haunting Florin Road by the time her mother found her. From 18 to 21,
she either smoked meth or craved it.

But her son was born without a trace of meth in his system, she said,
between kisses to the baby's forehead. Now, Rals plans to move into a
Volunteers of America transitional housing complex where she will care for
her infant with staff support.

The ideal situation for mothers like Rals, researchers say, would be
professional monitoring to pinpoint and address their toddlers' possible
learning delays or behavior problems. But outside the halls of research
hospitals, such long-term care is rare.

"The bottom line is: Something can be done," said Chasnoff, who now works
with drug-exposed children in a Chicago hospital. "We get good outcomes
with our kids - they need early intervention, which is pretty rare. They
are a population that very easily can be missed."

DRUGS AND BIRTH DEFECTS Researchers have documented birth defects and other
prob-lems among children born at the UC Davis neonatal intensive care unit
from 1990 to 2002 who were exposed to drugs. 6,555: Number of babies
studied from 1992 to 2002

563: Infants born exposed to methamphetamine

54: Number with a birth defect, or nearly 96 defects per 1,000 births, 4.5
times the average 325: Infants born exposed to cocaine

9: Number with a birth defect, or nearly 28 defects per 1,000 births, 1.3
times the average

Note: The birth defect rate among all infants born in California is 21
major defects per 1,000 births.

Source: Michael P. Sherman, Pediatrics, University of California, Davis;
and Jan Sherman, School of Nursing, Family Health Care, University of
California, San Francisco