INDIANAPOLIS (AP) - The case arrives with all the routine of a traffic citation: A baby boy, just 4 days old and exposed to heroin in his mother's womb, is shuddering through withdrawal in intensive care, his fate now here in a shabby courthouse that hosts a parade of human misery.
The parents nod off as Judge Marilyn Moores explains the legal process, and tests arrive back showing both continue to use heroin. The judge briefly chastises, a grandmother sobs, and by the time the hearing is over, yet another child is left in the arms of strangers because of his parents' addiction.
There is little surprise in any of this, for it's become a persistent presence at Indianapolis' juvenile court. A Monday with a heroin-dependent newborn spills into a Tuesday in which a trembling mother admits breaking her 70-day clean streak with a four-day bender. A Wednesday with two children found in a car beside a mother passed out on pills fades into a Thursday with a teen who found both his mother and grandmother overdosed on heroin.
Shawnee Wilson holds her son, Kingston, in her apartment, Tuesday, Aug. 8, 2017, in Indianapolis. Kingston was born in 2016, and it took a month for doctors to wean him off the heroin Wilson exposed him to. He is in foster care now in Indianapolis, and Wilson is fighting to get him back. (AP Photo/Darron Cummings)
Across the U.S., soaring use of opioids has forced tens of thousands of children from their homes, creating a generation of kids abandoned by addicted parents, orphaned because of fatal overdoses or torn from fractured families by authorities fearful of leaving them in drug-addled chaos.
"This isn't a trickle. This isn't a wave. It's a tsunami," Moores said of a child welfare system grappling with an unprecedented crush of parental drug cases.
From her first full year on the bench in 2006 through last year, the number of filings for children in need of services more than tripled to 4,649 in Marion County, driven largely by cases involving opioids - a glimpse of a problem that has swept across communities of all sizes.
Behind each of those cases is a child subjected to the realities of life amid addiction - of barren fridges, unwelcome visitors and parents who couldn't be roused awake. Moores is still haunted by the story of a 2-year-old found alone at home with his father's corpse, a needle still poking from his arm. A neighbor was drawn in by the boy's relentless wails.
By Friday, the largest pile of cases on Moores' desk has reached a towering two feet, and she has plodded on in bureaucratic fights to get more judges, more court reporters and more mediators to deal with work in which the despair dwarfs the fleeting moments of hope.
"It seems like there's a whole generation of people disappearing," Moores said.
In Miami, a 10-year-old boy died after the painkiller fentanyl somehow found its way into his system. In Philadelphia, a library once known for its after-school programs is now such a magnet for heroin users that the staff practices overdose drills. From New York to Kentucky, schools stock the overdose antidote naloxone in the nurse's office.
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have a look at the webpage. As opioids have thrived, children have suffered. And families are being torn apart, again and again.
New foster care cases involving parents who are using drugs have hit the highest point in more than three decades of record-keeping, accounting for 92,000 children entering the system in 2016, according to just-released data by the U.S. Department of Health and Human Services.
The crisis is so severe - with a 32 percent spike in drug-related cases from 2012 to 2016 - it reversed a trend that had the foster care system shrinking in size over the preceding decade. All told, about 274,000 children entered foster care in the U.S. last year. A total of 437,000 children were in the system as of Sept. 30, 2016.
Though substance abuse has long been an issue for child welfare officials, this is the most prolific wave of children affected by addiction since crack cocaine use surged in the 1980s, and experts said opioid-use is driving the increase.
Among the states with the biggest one-year increases in their foster care population were Georgia, West Virginia and Indiana.
"It's been an overburdening of our system," said Cindy Booth, executive director of Child Advocates of Marion County, which represents kids at the center of drug cases.
The Associated Press delved further into the troubling numbers, examining county-level foster care statistics obtained from the National Data Archive on Child Abuse and Neglect through the end of 2015. The analysis showed counties with higher levels of opioid prescribing and opioid deaths also had higher shares of foster cases linked to drugs. Last year's county-level statistics are not yet available.
The data show that foster children of drug users are on average about three years younger than others in the system. Indeed, a wave of babies born to opioid-using mothers has led hospitals to add detox programs for pregnant women and save umbilical cords in case they need to pinpoint what drug an infant was exposed to. Volunteers are enlisted to cuddle heroin-dependent babies - often born premature and underweight with a distinctive high-pitched cry and tremors in their arms and legs.
In Indiana, drug-related foster cases shot up more than sixfold between 2000 and 2015. Vanderburgh County, with a population of 179,000, had more children of drug users enter foster care than major cities including Seattle, Miami and Las Vegas. And here in Marion County, cases involving drugs went from about 20 percent of foster children in 2010 to 50 percent five years later.
Stephanie Shene, who started in 2003 as a case manager at the state Department of Child Services, recalled how use of heroin and other opioids went from a virtual non-issue to a constant part of her day. She and her colleagues became increasingly vigilant looking for shaking, fidgety parents or needle marks on their arms, behind ears and between fingers.
Her agency has added more than 1,200 workers in four years and its budget has increased from $793 million to more than $1 billion. Keeping up with the caseload remains a challenge, though, and turnover among case managers is high. Especially maddening is the huge number of parents who can't stay clean long enough to get their kids back or keep them.
Shene remembers one of her first cases, a mother whose four children were taken because of her morphine and heroin addiction. Just 10 months after getting clean and regaining custody, the woman not only had returned to drugs but had given birth to a heroin-dependent baby.
"Stuff like that is hard to look at," she said.
By the time Rachael Stark arrives at her office at 8:45 a.m., she has already been working for hours. At 2:30 a.m., it was a call seeking an emergency placement for a child. Around 4 a.m., a series of texts alerted her that an alarm went off at a foster home and police showed up. Since 8 a.m., she's been furiously tapping away at her phone, juggling 15 foster cases. Now she's splashed with coffee and running late for a 9 o'clock appointment when a state DCS worker calls looking for a foster family for three siblings.
"I've got no one," she reports somberly.
For the past 13 years, Stark has managed cases for The Villages, the largest private foster care and adoption agency in Indiana, which contracts with the state to find children homes. All but a few of her cases involve drugs and of those that do, about half are opioid-related.