The Baby Addict Myth: Debunking Misinformation About Neonatal Exposure

In the 1980s and 1990s it was “crack babies.” Now it’s babies born “addicted to opiates.” We’ve spent 30 years trying to debunk the baby addict myth; that newborns can be born “addicted.” However, the misinformation continues with current headlines like “Life begins with agony of withdrawal for opiate-addicted babies.” Over ten years ago 30 leading medical doctors, scientists and psychological researchers signed a letter sent to the media entitled, “Top Medial Doctors and Scientists Urge Media Outlets to Stop Perpetuating ‘Crack Baby’ Myth.” They said terms like “crack baby” and “meth baby” “lack scientific validity and should not be used.” In 2013 a similar panel of experts took the media to task again for incorrectly reporting on the misuse of prescription opiates by pregnant women.

There is no doubt that the number of infants born opiate (heroin, prescription painkillers, etc.) exposed had risen four-fold in the last decade but what is not so well reported is what happens in utereo after that exposure. Mere exposure does not equate necessarily with harm. The 40 experts who wrote to the media in 2013 said, “…long-term harms to children … have not been shown to be associated with opiate intake – prescribed or unprescribed – during pregnancy.“ Opiate exposure is not associated with birth defects nor is there any scientific evidence that growth and development are compromised by exposure to opiates according to the experts.

Effects of Exposure are Unclear

We know, for instance, that Fetal Alcohol Syndrome (FAS) is the number one preventable cause of mental retardation yet the effects of illicit drugs such as marijuana and stimulants (cocaine and methamphetamine) are not so apparent. Short- and long-term effects of exposure are unclear because of the high rate of poly drug use and how and when the alcohol or other drugs are used. For instance, one twin may be born with FAS while the other is perfectly healthy. There are just too many variables to make conclusions about exposure. That is not to say that pregnant woman should use alcohol, tobacco or other drugs (ATOD) — on the contrary. But what it does say is we cannot jump to conclusions about alcohol and other drug exposed infants.

We know that pregnant women use ATOD at lower rates than non-pregnant women but 1:5 fetuses are exposed to ATOD which goes undetected 75-90% of the time. The cost of this exposure can be enormous. The lifetime cost of a child with FAS is $2 million with a total cost of $4 billion annually in the United States. Each substance-exposed newborn can cost between $750,000 and $1.4 million to treat and provide services throughout childhood when needed. The good news with opiates is we have had medical protocols to address Neonatal Opiate Abstinence Syndrome (NOAS) for years and, when followed, the infants who were exposed to opiates do well.

Policymakers’ Response is Not Effective

Legislators have responded to this “epidemic” in various and usually unhelpful ways. Four states require a drug test when substance abuse is suspected; 14 require the mother be reported to Child Protective Services if there is a positive test; and, 15 deem substance abuse during pregnancy as child abuse and grounds for termination of parental rights. Minnesota, North Dakota and Wisconsin authorize a civil commitment after suspected alcohol or other drug use and mandate in-patient treatment during the remainder of the pregnancy. In a civil rights lawsuit that seeks to void one state’s law (Loertscher vs. Wisconsin) the state’s request to dismiss was denied in October and the suit will go forward.

In addition to civil penalties many states file criminal complaints against the women for child endangerment/abuse; delivery of drugs to a minor; or, fetal murder/manslaughter. Once convicted, these women are sentenced quite harshly with state prison terms of 10-20 years not unheard of. Such a sentence was recently overturned by the Arkansas Supreme Court saying the statute under which the mother was prosecuted was not appropriate. (Arms vs. Arkansas (Oct. 8, 2015).)

Family Drug Treatment Court

One response to parents at risk of losing their children because of alcohol or other drug misuse is Family Drug Treatment Courts (FDTC) based on the model for adult criminal courts. Bringing resources to the family and providing appropriate and effective evidence-based treatment has proven to be highly effective. Treatment completion rates and family reunification rates were approximately 20 to 40 percentage points higher for the FDTC programs than for the comparison groups in a recent research update. The Substance Abuse Mental Health Services Administration (SAMHSA) recommends a comprehensive model for treating substance using women and their newborns which FDTCs fulfill perfectly.

What is Addiction?

Addiction is a technical term that refers to compulsive behavior that continues despite adverse consequences. Babies cannot be addicted because they engage in no drug seeking behaviors. Not all fetuses that are ATOD exposed will be born with adverse effects and rather than criminal prosecution, it makes more strategic sense to get the interventions needed to treat addiction and enable parents to be good ones.

Resources:

• “Prenatal Substance Exposure” Fact Sheet, National Abandoned Infants Assistance Resource Center, University of California, Berkeley (March 2012)
• National Advocates for Pregnant Women
• Research Update on Family Drug Courts (May 2012)