In the late 1980s and early ’90s, it was almost impossible to avoid hearing about the plight of “crack babies” — infants born to mothers who had used crack cocaine during pregnancy. These offspring were predicted to become a generation of either superpredator criminals or mentally disabled government aid recipients, unable to care for themselves.
Now, the New York Times reports on the children of mothers who misuse prescription painkillers like Oxycontin:
As prescription drug abuse ravages communities across the country, doctors are confronting an emerging challenge: newborns dependent on painkillers…
Infants like [this] may cry excessively and have stiff limbs, tremors, diarrhea and other problems that make their first days of life excruciating. Many have to stay in the hospital for weeks while they are weaned off the drugs, taxing neonatal units and driving the cost of their medical care into the tens of thousands of dollars.
Like the cocaine-exposed babies of the 1980s, those born dependent on prescription opiates — narcotics that contain opium or its derivatives — are entering a world in which little is known about the long-term effects on their development. Few doctors are even willing to treat pregnant opiate addicts, and there is no universally accepted standard of care for their babies, partly because of the difficulty of conducting research on pregnant women and newborns.
Sound familiar? The symptoms described in opiate-exposed babies are virtually identical to those of babies exposed to crack — even though, pharmacologically, cocaine is a stimulant and opiates are depressants. That’s because most drug-exposed infants have other factors in common: they’re typically born preterm, a condition that can cause similar symptoms even without drugs. Further, most drug-exposed babies have been exposed to more than just one drug. Most addicted mothers use multiple substances, and many “crack babies” were also exposed to opiates. (More on Time.com: Top Ten Legal Drugs Linked to Violence)
So whatever happened to the generation of crack babies who prompted so much media hand-wringing? Although the Times story doesn’t mention it, research ultimately found that crack exposure itself didn’t cause significant problems for these children. The life outcomes of fetuses exposed to crack were more closely related to their parents’ resources and behavior after they were born than to what happened to them in utero. Domestic violence during childhood was far more likely to be damaging, for instance, than drug exposure during the mother’s pregnancy. Brought up in safe, loving homes, these children mainly did fine. Overall, in fact, the crack generation did fewer drugs and committed less crime than their parents had.
Ultimately, the data showed that a mother’s crack use during pregnancy was as bad for her fetus as cigarette smoking. That may sound like no big deal, especially to a generation in which 30% to 50% of women smoked while pregnant. But smoking can cause prematurity, low birth weight, even stillbirth — all of the same problems attributed to crack cocaine. And 90% of mothers who have drug-exposed infants also smoke cigarettes.
Indeed, the Times story does note:
Experts say that since many drug users also smoke and abuse alcohol, not to mention that they face extenuating circumstances like poverty, it is difficult to tease out the effects of each substance on their offspring.
“Most of the literature suggests consistently that the drug exposure itself is not the primary concern,” said Karol Kaltenbach, a professor at Jefferson Medical College in Philadelphia who studies addiction in pregnant women. “It’s the cumulative effect of the drug-using lifestyle — poverty, chaos in the home, domestic violence. All those things affect development.”
But the story doesn’t address the damage of being labeled a “crack baby” (or an “Oxycontin baby”) to begin with — which turns out to be even more damaging than the drug. Research has shown that caregivers who were told that a child was a crack baby tended to interpret the baby’s normal behavior as disobedient and pathological, and thus became more punitive. Cases of severe child abuse were even ignored because the children’s behavior and medical problems were seen as the result of crack exposure, not parental abuse or neglect. (More on Time.com: Will the Government’s Drug ‘Take-Back’ Do Anything to Reduce Misuse?)
Focusing on the new generation of “Oxycontin babies” could create the same problem. And the media coverage makes me wonder: why don’t we pay more attention to the harm done by the most common and most dangerous recreational drug used during pregnancy, alcohol?
Unlike opiates or crack, heavy drinking is known to produce a characteristic and incredibly damaging suite of defects in infants. Fetal alcohol syndrome (FAS) is marked by specific facial defects, heart and lung defects, intellectual disability (formerly called mental retardation) and impulse-control problems. In babies with FAS-related brain damage, the corpus callosum — the broad bundle of nerve fibers that connects the left and right sides of the brain and allows them to communicate — may be abnormally small or missing entirely. Alcohol exposure can also cause a range of other permanent birth defects — brain damage without the facial defects, for instance — known collectively as fetal alcohol spectrum disorder.
Fetal alcohol syndrome is the most common known cause of intellectual disability — more common than Down syndrome — and affects 40,000 children each year. But in part because it’s not associated with the latest craze in drug use by teenagers, it’s virtually absent from the media. Perhaps rather than worrying about potential subtle damage associated with opiates, we might focus on reducing the known severe harm linked with heavy drinking.