March 11, 2013
To whom it may concern:
A substantial increase has been noted in the number of pregnant women and newborns who test positive for illegal as well as legal opiates, including those utilized as prescribed as well as those misused and/or diverted. A great deal of experience has been gained over the course of almost 50 years regarding the effects of prenatal opiate exposure on expectant mothers and their babies, and guidelines have been established for optimal care of both. And yet, reporting in the popular media continues to be overwhelmingly inaccurate, alarmist and decidedly harmful to the health and well-being of pregnant women, their children, and their communities.
As medical and psychological researchers and as treatment providers with many years of experience studying and treating prenatal exposure to psychoactive substances, as well as treatment providers and researchers with many years of experience studying addictions and addiction treatment, we are writing to urge that policies addressing prenatal exposure to opiates, and media coverage of this issue, be evidence-based rather than perpetuate and generate misinformation and prejudice.
No newborn is born “addicted”
Popular media repeatedly and inaccurately describe children exposed to various drugs in utero as “addicted,” a term that is incorrect and highly stigmatizing. Addiction is a technical term that refers to compulsive behavior that continues in spite of adverse consequences. In fact, babies cannot be born “addicted” to anything regardless of drug test results or indicia of physical dependence. Evidence of physiologic dependence on (not addiction to) opiates has been given the name neonatal abstinence syndrome (NAS), a condition that is diagnosable and treatable. And yet, as the following examples demonstrate, news reports typically and inaccurately describe newborns as addicted (emphasis added).
o “In Broward County, there has been an alarming jump in the number of babies born to pill-using mothers; babies who are themselves born addicted.” (KTHV Television, More Pill-Using-Mothers Delivering Addicted Babies, July 29, 2011)
o “There's a growing epidemic of babies being born addicted to prescription drugs ingested by young mothers…” (Bradentown Herald, Prescription-Abuse Babies a Growing ‘Crisis’ in Manatee, Say Advocates, Nov. 9, 2011)
o “The number of babies born addicted to the class of drugs that includes prescription painkillers has nearly tripled in the past decade…” (USA Today, Addicted Infants Triple in a Decade, May 1, 2012)
o “In the past decade, the number of babies born addicted to opiates has tripled.” (The Huffington Post, More Babies Born Addicted to Painkillers, Multiple Reports Show Growing Epidemic, July 13, 2012)
o “Once, every hour in the U.S. a baby is born addicted to the painkillers that swallowed up its mother.” (WKYC Television, Tiniest Victims of Ohio’s Painkiller Epidemic, Aug. 1, 2012)
o “10 percent of the babies born are addicted to opiates.” (WSAZ News Channel, Scioto County and Portsmouth Make Strides in the War on Drugs, Oct. 31, 2012)
o “A new study showing a major increase in Tennessee babies born addicted to drugs has prompted the state Health Department to require hospitals to report that information.” (WFPL News, Tennessee Requiring Hospitals to Report Babies Born Addicted to Drugs, Dec. 5, 2012)
In addition to labeling newborns addicted when they are not, major news outlets have also drawn parallels between children born to women who have used opiates during their pregnancy and those who, a decade ago, were branded “crack babies.” For example, Brian Williams began an NBC news report by saying, “For those of us who were reporters back in the 1980s, it was an awful new trend we were covering at the time, and it was the first time our viewers were hearing about the young, innocent infants. A generation of crack babies, born addicted to drugs because of their mothers’ habit. Sadly, a new generation has meant a new habit – prescription pain meds, Oxycontin, Vicodin; other powerful drugs in that same category. And now we are seeing the infants born to mothers abusing these drugs.” (NBC News, Prescription Drug Addiction Among Pregnant Women Becoming ‘Monstrous Tidal Wave’, July 5, 2012) An ABC news report likewise claimed: “The increasing numbers of women who abuse prescription painkillers while pregnant are delivering the crack babies of the 21st century, specialists say.” (ABC News Medical Unit, Newborns Hooked on Mom’s Painkillers Go Through Agonizing Withdrawal, Nov. 14, 2011) And The Wall Street Journal described newborns exposed prenatally to cocaine and methadone treatment as “reminiscent of the ‘crack babies’ of the 1980s and 1990s.” (Wall Street Journal, Pain Pills’ Littlest Victims, Dec. 28, 2012)
In more than 20 years of research, none of the leading experts in the field have identified a recognizable condition, syndrome, or disorder that should be termed “crack baby” (See Open Letter To the Media, February 25, 2004). Rather than learning from its alarmist and false reporting about pregnant women and cocaine use (e.g., New York Times, The Epidemic That Wasn't, Jan. 26, 2009), media outlets have now irresponsibly revived the term “crack baby” and created new, equally unfounded and pejorative labels such as “oxy babies” or “oxy tots.” (FoxNews, 'Oxytots' Victims of Prescription Drug Abuse, October 28, 2011; The Examiner, "Oxytots": A National Disgrace, Oct. 30, 2011)
Equally unjustified is the suggestion that some women who become pregnant and carry their pregnancies to term give birth not to babies but rather to “victims.” As noted above, a story in The Wall Street Journal was headlined Pain Pills’ Littlest Victims. (Wall Street Journal, Dec. 28, 2012) Another recent article in USA Today referred to newborns prenatally exposed to prescription opiates as “the tiniest victims.” (USA Today, Kentucky Sees Surge in Addicted Infants, Aug. 27, 2012) Of course, where there are victims, there also are perpetrators – in this case, pregnant women and mothers. None of these women – whether receiving methadone or
other opiates for the management of pain, obtaining federally-recommended treatment of dependence, or misusing opiates and experiencing a dependency problem – may fairly be characterized as perpetrators or victimizers.
The most respected and objective authorities in the U.S. and throughout the world, including the World Health Organization, have determined that drug addiction is not a “bad habit” or willful indulgence in hedonism, but a chronic medical condition that is treatable but – as yet – not curable. Demonizing pregnant women creates an environment where punishment rather than support is the predominant response, and will inevitably serve to discourage women from seeking care.
Long-term implications for offspring misrepresented
News media also typically report or suggest that “those born dependent on prescription opiates … are entering a world in which little is known about the long-term effects on their development.” (New York Times, Newly Born, and Withdrawing from Painkillers, April 9, 2011) And yet, when controlling for factors such as economic status, access to healthcare, and concomitant medical problems, including use of nicotine products and alcohol, decades of studies reported in the professional literature have failed to demonstrate any long-term adverse sequelae associated with prenatal exposure to opiates, legal or illegal. On the other hand, it is not an exaggeration to state that labels such as “victim” or “tiny addict” or “born addicted” carry with them severe negative consequences, both medical and social. Children so labeled are at substantial risk of stigma and discrimination in educational contexts starting at the pre-school level. They may be subject to medical misdiagnosis and unnecessary, detrimental separation from loving and supportive families as a result of ill-informed and inappropriate child welfare interventions.
It should be clear from the above that we are not preoccupied with semantic niceties, but deeply concerned about reporting that, very literally, threatens the lives, health, and safety of children.
Neonatal abstinence syndrome, when it occurs, is treatable and has not been associated with long-term adverse consequences
Both the occurrence and severity of NAS have been shown to be affected by a variety of factors that are unrelated to possible pharmacological effects of prenatal exposure to opiates. For example, a 2006 study demonstrated that babies who stayed in their mothers’ room while in hospital (i.e., “rooming in”) rather than being placed in neonatal intensive care units (NICU) had less need for treatment of NAS, shorter length of hospital stay, and significantly greater likelihood of being discharged home in the custody of their mothers. Similarly, a 2010 study found that only 11% of babies who boarded with their mothers required treatment of NAS compared to more than four times as many who were placed in an NICU.
Moreover, it has long been known that NAS, when it occurs, can be treated effectively. NAS can be evaluated and managed with scoring systems and treatment protocols that have been available for decades in standard textbooks and in numerous articles in the professional literature. Appropriate care, which may include breastfeeding and "comfort care" (e.g.,
swaddling and skin-to-skin contact between mother and baby), is often sufficient to prevent or minimize signs of distress in the baby. There simply is no reason why babies should as stories report “go through agonizing withdrawal” or demonstrate “…merciless screams, jitters and unusually stiff limbs.” News reports describing newborns suffering suggest lack of appropriate medical training and the failure to provide optimal medical care rather than inevitable, untreatable, effects of prenatal exposure to opiates. (e.g., The Gadsen Times, Our View: Addicted at Birth, Nov. 15, 2011; PBS Newshour, Painkiller ‘Epidemic’ Deepens in U.S., Nov. 2, 2011; Knoxville News Sentinel, Drug-addicted Babies Difficult to Treat, Nov. 1, 2011)
Media misinformation and stigmatizing characterizations discourage appropriate, federally recommended treatment
Recent reporting also frequently dangerously mischaracterizes methadone maintenance treatment as harmful and unethical. For example, a CNN story irresponsibly portrays a woman’s decision to follow recommended treatment as a form of abuse:
Narrator 1: Guided by her doctor, April did what she thought was best for her baby and stayed on methadone for her entire pregnancy. The end result? Mariah was born dependent on drugs.
Narrator 2: What did that feel like to know that your use of methadone had caused her so much suffering?
April Russell: Oh it’s, I mean, I can’t explain it. I mean, it killed me. I mean, still today I mean it’s, it’s hard (April starts to cry). But, (stops talking due to crying), sorry.
(CNN video broadcast, One Baby Per Hour Born Already in Withdrawal, April 12, 2012) Similarly, NBC News reported that a pregnant woman in treatment “can’t save her baby from going through withdrawal. Because methadone is another form of medication similar to painkillers, there is a good chance her baby will be born addicted to that drug.” (NBC News, July 5, 2012) And The New York Times reported that “those who do treat pregnant addicts face a jarring ethical quandary: they must weigh whether the harm inflicted by exposing a fetus to powerful drugs, albeit under medical supervision, is justifiable.” (New York Times, April 9, 2011)
The evidence for the efficacy of methadone maintenance treatment – most particularly its use in the care of pregnant women – has been overwhelmingly consistent for almost half a century. The highest U.S. government authority on drug abuse treatment, the Substance Abuse and Mental Health Services Administration, summed it up in a pamphlet it produced several years ago and continues to distribute. It is directed to pregnant, opiate-dependent women and states in unusually clear and concise terms: “If you’re pregnant and using drugs such as heroin or abusing opioid prescription pain killers, it’s important that you get help for yourself and your unborn baby. Methadone maintenance treatment can help you stop using those drugs. It is safe for the baby, keeps you free of withdrawal, and gives you a chance to take care of yourself … Methadone maintenance treatment can save your baby’s life.” Recently, buprenorphine treatment has also been used effectively to treat opiate addiction in pregnant women.
There are, however, enormous financial, regulatory, and cultural barriers to this treatment that
are exacerbated by misinformed and inaccurate news reporting. Indeed, we are aware of numerous cases in which judges and child welfare workers have sought to punish as child abusers pregnant women and mothers who are receiving methadone maintenance treatment.
It is deeply distressing that US media continue to vilify mothers who need and those who receive treatment for their opiate dependence, and to describe their babies in unwarranted, highly prejudicial terms that could haunt these babies throughout their lives. Such reporting, judging, and blaming of pregnant women draws attention away from the real problems, including barriers to care, lack of medical school and post-graduate training in addiction medicine, and misguided policies that focus on reporting women to child welfare and law enforcement agencies for a treatable health problem that can and should be addressed through the health care system. It fosters inappropriate, punitive, expensive, and family-disruptive responses by well-meaning but misinformed criminal justice and child protective agencies, creating a reluctance on the part of healthcare professionals to recommend and offer the services that evidence clearly indicates are best for their patients.
More very informative info can be found here; http://pediatrics.aappublications.org/content/131/3/e1009.full.html
Knowledge is power...isn't that why we're here?
These poor babies are born terribly irritable, unconsolable crying for hours on end the first several weeks. Poor feeders, poor suck, digestive problems. It is bad.
It is horriable he was beautiful and suffering .5 wk old.Baby Haden is going to be laid to rest today.My sister was never addicted to herion and the clinics give her methadone.She was addicted to loritabs.*Dah* Dr.s of METHADONE CLINICS~HOW ABOUT LOCK UP IN REHAB? Dr.s said, he had sleep apnea instead of the truch /addiction.Methadone is killing babies and parents .Now let me guess my sister is going to get a higher dose right ? Come on she has kids already and she does'nt care for them they care for her because ,she SLEEPS all the time .
I just wish it could go back to people it was intended for .THE INJERED for war.I no it has become a cheeper way of STAYING HIGH ......SO SO SAD...Our government is killing my loved ones saying it is ok to be addicted to methadone . But, you better not deliver a CRACK/HERION baby or we'll take it from you and charge you .What is the difference ? I want to know. NONE. My sister is Never comming off .......The governmant is profitting RIGHT???? I have lost two family member due to METHADONE in a years time..........Please, fix this problem if you have a hearth at all readers..........
but no they will not have any long term effects on the babies, unless they were born with something wrong, and if that was the case i highly doubt that the methadone cause it. Babies going through methadone withdrawal are treated with morphine, as contradicting as that sounds.
They don't cry all the time thats not true. If that shows up later on its probably colic. My sons doing great, hes gone through the worst which was some crying and wakefulness. don't worry your children will do fine.