Perspective on Heroin Babies

According to a recent story on WBUR, the NPR radio affiliate in Boston,

Massachusetts hospitals are seeing evidence that the opioid epidemic is affecting the next generation, with an increasing number of babies being born exposed to drugs.

Is this cause for concern? Perhaps, but the “crack baby” scare of the 1980s suggests caution in jumping to conclusions.

In the mid-1980s, as crack use spread and garnered attention from law enforcement officials, the public health community, and the media, it seemed that crack use by pregnant mothers was generating horrific harms. For example, the New York Times reported in 1985 that

Cocaine use may be dangerous for pregnant women and their babies, causing spontaneous abortions, developmental disorders and life-threatening complications during birth, doctors reported today.

Similarly, a 1985 article in the New England Journal of Medicine concluded that

these preliminary observations suggest that cocaine influences the outcome of pregnancy as well as the neurologic behavior of the newborn.

And many media assessments  were extremely pessimistic; Charles Krauthammer, for example, wrote that 

the inner-city crack epidemic is now giving birth to the newest horror: a bio-underclass, a generation of physically damaged cocaine babies whose biological inferiority is stamped at birth.

Three decades later, however, with the benefit of calm reflection and better data, the assessment of crack’s impact is strikingly different.   In 2009, the New York Times wrote:

So far, these scientists say, the long-term effects of [crack] exposure on children’s brain development and behavior appear relatively small.

And the Washington Post, in 2010, noted that

[crack babies] were written off even before they could talk. But in the two decades that have passed since crack dominated drug markets in the District and across the nation, these babies have grown into young adults who can tell their stories – and for the most part, they are tales of success.

More broadly, CBS News noted in 2013 that

a new review published May 27 in Pediatrics finds little proof of any major long-term ill effects in children whose mothers used cocaine during pregnancy… Studies at the time blamed prenatal drug use, suggested affected children had irreversible brain damage and predicted dire futures for them. 

While some studies researchers looked at for the new review linked pregnant women’s cocaine use with children’s behavior difficulties, attention problems, anxiety and worse school performance, the effects were mostly small and may have resulted from other factors including family problems or violence, parents’ continued drug use and poverty, the researchers said.

Thus increased opioid use, and its potential impact on newborns, undoubtedly deserve attention from the medical community. Fortunately, the early evidence suggests that, with appropriate medical treatment, these newborns suffer little long-term damage from their in utero exposure to opioids (see here and here).  

In contrast, punitive approaches like jailing pregnant women who use drugs, or removing newborns from such mothers (which many advocated during the crack hysteria; see here, here, or here), can easily harm newborns by discouraging drug-using, pregnant women from seeking treatment and medical advice.