Last week, it was hard to escape headlines that read, “Mom Dead, Dad Revived at Cincinnati Children’s Hospital.” The story of two young parents who traveled from Alabama for their 7-month-old daughter’s reconstructive windpipe surgery was a heart-rending one, one with a tragic ending.

While his child recovers from a successful surgery, Wesley Landers, 32, sits in jail. His wife, 31-year-old Mary Ann Landers, is dead from a reported heroin overdose. As a recovering heroin addict with children of my own, I wondered: How could this have happened? The facts are shocking, even to a seasoned veteran of addiction like myself: The mother found dead; the father extracted from the bathroom, a gun in his pocket, and a needle still in his arm, fatefully revived with naloxone.

The Landers’ family photos on Facebook and GoFundMe reveal little of a battle with heroin.

But parents who abuse opioids lead a shadowy existence where any knowledge of their substance abuse could lead to loss of their children. Exposure of children to illegal drug activity is also addressed in 33 states’ criminal statutes (PDF).

As a former heroin user, I am continually grateful my children were born long after my active addiction. In my search for parents with dependence on opioids, I was shocked when close to 20 individuals contacted me in less than 24 hours. They’re addicts with children, children of addicts, “functional users,” and those who recovered along the way to parenthood. All wished to remain anonymous, and names have been changed throughout.

“I’ve really wanted to talk about this for quite a long time,” one told me. He repeatedly mentioned that he had never spoken about addiction with anyone else.

Another was a father who lost his children due to heroin use. “It’s awful,” he wrote. “They are my whole world. In fact, they are probably the only reason I’m still alive because I want to be in their life.

“I can relate to the [Cincinnati] story,” he said. “When my daughter was born I had to stay well [by using heroin] for the two days we were in the hospital after she was born, and I was on methadone when my son was born.” He said he recently “made the decision to tell my parents everything… [and] hopefully gain full custody for the time being until I can get my life together.”

There was a common thread among the parents I talked to. A man who used the alias John Batt summed it up to me by writing, “We have a problem, that doesn’t mean we love our children any less. We want the best for our children and we want them to be better than we are. We teach them right and wrong. We’re just like you, imperfect.”

Addict parents are not unique in their struggle. The National Institute of Health (NIH) estimates that over 2.5 million Americans currently abuse opioids, and the National Survey on Drug Use and Health (NSDUH) reported 2.2 million children live with a parent who is dependent on or abuses illicit drugs. In cases where help is requested, systems are frequently unprepared to meet the needs of family systems where substance abuse is an issue. Many families, like the Landers, fly under the radar.

Autumn Lee is a single mother raising a toddler and a 7-year-old. “I’ve been familiar with opiates for almost five years now, from occasional use for the first year or so to… now, IV heroin,” she told me. “[I stopped] for about a year, and now I’m back to using anywhere from three to seven days a week.”

After an incident in which Autumn’s child ended up in the hospital for a spiking fever, “Her father had come for us with [drugs] for me. When we got home I went ahead and did some. I felt lousy for doing it. Even though [my daughter] was deemed healthy, it made me feel guilty and pretty selfish that I was willingly detaching myself from the situation. Nothing bad came from my dose, and my stressful night/morning had come to an end. I’m not telling you this because the situation was caused by my using, but that I chose it to cope.”

In asking what she feels makes her different from other parents, Autumn said, “along with the normal parental struggles, I need to make it possible to be well. While I probably should be spending that money on the kids, it’s spent on myself—though my girls never go without, so to speak. They always come first. Just like I would go without food for them to eat, I would never place them behind my own wellness or wellbeing. They’re happy, healthy, smart little ladies, and that will always be my primary concern—just like any other parent.”

Autumn told me that she “gets up at 6:30 a.m. to get my oldest ready for school. Some of the time she will get a ride, but for the most part I walk her to (and from) school. After that we do homework, dinner, movies/entertainment, bath, bed. I know that all sounds redundant, but that’s my day.”

John Batt wrote, “My wife had been in pain management for some serious issues with her back. When she started it was legitimate and abusing the prescriptions really wasn’t a thought to us, but that soon changed.” Things escalated for the couple over time.

“As with most pain management I assume, the prescriptions were low,” he said. “However, over time the quantities and dosage increased. For about the last year she was prescribed 360 30mg Oxycodones along with Fentanyl patches and some other medications. We thought we hit the lottery and that there was no way we would ever run out again. But as is the story, what would last us a month became three weeks, then two, and by the end we somehow managed to go through that in a week. During this time, we would supplement with heroin. Eventually, the prescriptions stopped altogether and we were solely using heroin. We’ve been using heroin via IV for about two years now… We didn’t even realize we were addicted until it was too late”.

John’s story echoed Autumn’s: “We are like any other parents. We help our children with their homework, we play and color. We hug and dance. We teach and discipline. As addicts, we have as much love in hearts for our children as a clean parent.”

The difference comes with the lack of the drug. “Once we’re well again, everything goes back to normal,” John wrote.

Child welfare experts would disagree. According to a report (PDF) on child welfare and substance abuse, being raised by a drug-dependent parent leads to poor cognitive, delayed social and emotional development, depression, anxiety, and other mental health symptoms, physical health issues, and substance-use problems for the child.

Users argue that the stigma surrounding their use creates many of these problems. Unable to reach out for support for fear of losing their children, parents with opioid dependence are frequently pushed into isolation where they cannot access resources that are widely available for parents. “I think the stigma associated with abuse is abhorrent in general,” Autumn told me. “Yes, there are some very sad cases, but a drug doesn’t necessarily dictate your parenting. Just because someone has vices doesn’t make them a bad person or parent—just like being clean won’t guarantee a good one.”

There has been much speculation as to why the young parents overdosed in the bathroom at the hospital in Cincinnati. The consensus seems to be that as users from out of state, they would have been unfamiliar with potency of the drugs available in Cincinnati. In addition, the area surrounding Cincinnati has been plagued by heroin tainted with fentanyl (PDF). Whatever the case, using in unfamiliar surroundings could have exacerbated their problems, leading to the fatal overdose. Wesley Lander remains in jail on numerous charges, and only time will tell if he will be given the opportunity to rehabilitate himself.

Cincinnati, like many of the towns the couple would have passed as they drove along Route 75, has been transformed by heroin. There are now so many children in foster care, Ohio had to expand to 20 family courts peppered throughout the state. It has used the expansion of Medicaid to increase treatment services to address burgeoning demand.

For those lucky enough to get services, BL (his alias) provides some hope. “I’ve been, in the past, 100 percent physically dependent on IV opioids, homeless, living literally on the streets. [Now I’m] a registered nurse working in psychiatry, with a substance abuse certificate, working with mostly homeless folks with co-occurring disorders.

“Opioids are still fun to me,” BL told me, “but I don’t seek them out, and I don’t use IV anymore. I probably do [prescription opiates] a couple times a year.”

When asked how BL’s history with drugs impacts his relationship with his son, he said, “I affirm and validate [my son] and his choices and actions. I explain why things are okay and not okay. And he loves me and tells me I am the greatest dad in the universe. What a triumph. This is the greatest success in my life.”