Nikki Baker-Limore never thought she would see anything worse than methamphetamine hit her community.
But the executive director of the Indian Child Welfare Act office for the Cherokee Nation in Oklahoma says she has: opioids.
Now she’s leading the effort to help protect the tribe’s children from the drug’s devastating effects.
A baby born addicted to opioids faces a longer and more dangerous withdrawal process. They often have to be transferred to a hospital with a higher level of care.
For infants born here, that means being transferred to a hospital one hour away, a distance that can be hard for resource-strapped families and mothers to travel.
Staffers also say they can run into problems when trying to place the infant in foster homes. Children who are born addicted to opioids are given morphine treatments to ensure they are comfortable and don’t encounter the dangerous side effects of withdrawing too quickly. Over a number of weeks, the newborn is weaned off the morphine.
In the process, they can be fussy, hard to console and take care of, she said.
Because of that, some families who would otherwise be willing may pass up the opportunity to be a foster home, making placement for the opioid-addicted babies more difficult, she said.
Symptoms of a baby addicted to opioids may not appear for up to 72 hours after birth, she says. Babies born with the drugs in their system tend to be fussier and jittery. They may have diarrhea and appear agitated. They often have a very shrill cry, Baker-Limore says.
It’s hard to console the babies through traditional means of rocking or swaddling. There’s no escaping the withdrawal symptoms they are feeling inside them, she says.
Cases of infants born addicted to opioids has become about 40 percent of the office’s caseload, which Baker-Limore characterizes as an “epidemic” in the Cherokee Nation.
The tribe sued drug manufacturers and pharmacy retailers in April 2017, saying a flood of pills had swept into its 14-county jurisdiction in northeast Oklahoma.
In Oklahoma, prescription opioid abuse has been particularly harmful and even more so for members of the nation, who endured the forced removal of its people in the mid-1800s during what is known as the Trail of Tears.
“We are facing another challenge, a plague that has been set upon the Cherokee people by these corporations,” Todd Hembree, attorney general for the Cherokees, told The Washington Post last year. “Their main goal is profit, and this scourge has cost lives and the Cherokee Nation millions.”
“Tribal nations have survived disease, removal from our homelands, termination and other adversities, and still we prospered,” Bill John Baker, principal chief of the Cherokees, told The Post. “However, I fear the opioid epidemic is emerging as the next great challenge of our modern era.”
Baker-Limore says a drug test will be administered when a doctor suspects that a mom may be using or a mother admits to drug use.
If it comes back positive, the medical staff calls the ICWA office and an investigation commences. Trained staff consider medical records and interviews.
If it’s believed that the baby’s safety is in jeopardy, the tribe’s Attorney’s General Office is called and custody is asked for.
If a judge agrees, staff takes custody of the child and works on foster placement, with a preference toward placing the infant with a family member.
Baker-Limore wrote in an affidavit that the increasing prevalence of such cases threatens the future of the Cherokee Nation. The majority of Cherokee children who are placed in foster care — about 1,000 each year — go to non-Cherokee homes.
“The placement of the next generation of Cherokee children in non-Cherokee homes is one of the single greatest threats to the Cherokee nation,” Baker-Limore wrote. “These children are raised without learning how to speak the Cherokee language, and without learning the traditions, history, and customs of the Cherokee people.”
On any given day, the tribe will have custody of around 80 Cherokee babies, she says.
Baker-Limore’s office also investigates other instances of child abuse.
“We see the worst of the worst,” she says. “We see children abused in every way shape or form.”
Despite the challenges, for her and her staff of 120 scattered across five locations, the job is a calling.