Answer Addiction

Tag: drug dependent babies

  • The Problem with "Addicted Babies"

    The Problem with "Addicted Babies"

    The “addicted baby” issue is not simply linguistic. You’re not just contributing to stigma when you use this term, you’re misrepresenting medical facts.

    “She was born addicted, but without methadone, she may never have been born at all.”

    That was the last sentence of my first published article with a major media outlet, Vox. The story was about giving birth to my elder daughter while on methadone. The “she” was my newborn daughter. I was terrified to “come out” as a methadone patient, something I’d hid from my family and friends even through my daughter’s prolonged hospitalization and the child welfare investigation that was triggered by her neonatal abstinence syndrome (NAS), but I was also excited to be published by Vox — and rightfully so. This story would effectively launch my freelance writing and journalism career. What I didn’t realize at the time was that my first big article was factually inaccurate.

    It’s embarrassing, now that I know better, to realize I contributed to a harmful, widespread misunderstanding of addiction as equivalent to dependency. My editor on that story and I have since agreed to a correction in the terminology — but this story garnered enough attention to end up in my then-treatment counselor’s addiction newsletter and to land me a spot on the NPR podcast All Sides With Ann Fisher. Both appearances were well before that correction was made.

    A story that once brought me immense pride now fills me with shame as I remember the stigmatizing mistake I made when I first wrote it, but I remind myself that it was a personal essay — my first major one — and I was simply echoing the language I’d heard over and over again everywhere, from the neonatal intensive care unit where my daughter was treated for NAS to NBC, and even former incarnations of the New York Times. What some of these outlets are finally realizing is that reporting infants as “born addicted to drugs” is, effectively, fake news.

    Doctor Jana Burson, an opioid addiction treatment specialist and outspoken advocate for methadone and buprenorphine, summarizes the issue like this: “According to our definition of addiction…you have to have the psychological component of craving or obsession. By definition infants are not able to experience addiction.”

    Have you ever seen a baby beg for more morphine from her crib, or crawl across the NICU to snatch a dose from another infant? Do you see evidence that they are ruminating over opioids, or that they even understand their discomfort is tied to opioids? Do any infants ever require methadone or buprenorphine maintenance once their physical dependency symptoms have declined, in order to manage psychological addiction and prevent harmful, compulsive drug use?

    Of course, the answer to all of these questions is “No.” Infants born to mothers taking prescribed or non-prescribed opioids are sometimes born with a physical dependency on opioids. This means they will experience physical withdrawal, and may require extra comfort and possibly even titrated doses of opioids to wean them down. Their bodies will tense up, they’ll be extra cranky and have loose stools, and other symptoms of physical distress. It’s a painful experience, and my heart broke watching my own daughter go through it, but the fact remains: neither my daughter nor any other infant is born with an addiction.

    An infant capable of experiencing addiction would be remarkable for reasons far beyond the addiction; she would have capabilities of thought, expression, and action so far advanced beyond any infant born thus far that the government would probably snatch her up for extraterrestrial gene testing! In all seriousness, a baby who could ruminate about drugs, understand consequences, and then intentionally self-administer drugs despite those consequences would be a genius with super-strength. This baby is impossible outside of the X-Men Universe.

    So why do so many media outlets, legal professionals, and even some treatment providers continue to use this incorrect language? In part, it’s probably due to the very thing that makes the language problematic: it’s highly stigmatizing. And stigmatizing, unfortunately, equals drama. Which headline grabs your attention more? “The Number of Babies Born Addicted to Drugs Skyrockets” or “Babies Born with Opioid Dependencies on the Rise.” One is true, one is not, but the one that is not will probably get many more clicks. The consequences of this mischaracterization go beyond delivering incorrect information. “Any time you misstate facts or exaggerate, as many news outlets have, it increases the stigma and makes the problem worse because mothers feel more shame and they’re less likely to seek care…they’ll get less prenatal care because of it,” says Burson.

    Sensationalizing a medical disorder to sell papers or clicks has other real world consequences. Many medications have the potential to cause dependency and for that dependency to transfer from a pregnant woman to her baby. But we don’t say that babies born to moms taking anti-depressants are drug addicted, even though some of them will also experience a mild form of NAS. So why do we say it about babies born to moms who take methadone or buprenorphine, which are the gold standard of care for opioid use disorder for pregnant and non-pregnant patients?

    When you make a mother feel like she is going to turn her child into a “drug addict” by taking these medicines, you scare her from seeking treatment. The problem with that, of course, is that she remains at high risk for illicit drug use, which may cause a dependency in her child but also has other complications, like a heightened risk of miscarriage or stillbirth.

    Pregnant women aren’t the only ones who are harmed by the false equation of addiction with dependence. A lot of people think that people who take methadone or buprenorphine are just trading one addiction for another. In fact, methadone and buprenorphine will continue an opioid dependency, but are evidence-based treatments for opioid addiction approved by the World Health Organization and the FDA.

    This misconception leaks into correctional facilities and drug courts. Most jails and prisons forcibly detox methadone and buprenorphine patients, and many drug court judges disallow their use, even going so far as to order patients to taper off their medication. The false equivalency also harms other opioid patients. Across the country, people who require opioids to manage pain are being taken off their medications as doctors scamper to avoid being labeled “pill mills” or enablers of addiction. In some cases, the pain and withdrawal are so unbearable, these patients commit suicide.

    Because of this stigma, the debate about whether the press should use the term “addicted baby” has been lumped in with other language-centered debates, like whether or not the word “addict” is offensive. Personally, I think that news outlets should absolutely use person-first and medically-based language when talking about people who experience addiction. “Person with a substance use disorder” is a little clunkier than “addict,” but it’s worth it to relieve the sting and prejudice that’s associated with “addict.” But the “addicted baby” issue is not simply linguistic. You’re not just contributing to stigma when you use this term, you’re misrepresenting medical facts.

    It is the job of the press to disseminate the truth. Sometimes mistakes get made, like in my personal essay for Vox when I referred to my daughter as having been born addicted. That’s why we have a process for submitting corrections. When news outlets use terms like “drug addicted babies” or “baby addicts,” they’re misrepresenting the truth, which means they’re not doing their job

    If ever a “baby addict” comes into existence, there will be a far bigger story than the one about her addiction. Until we enter the age of superhumans, however, it is imperative that media outlets perform the most basic function of their job by delivering the actual facts. Babies born to mothers on methadone, buprenorphine, or other opioids may be born with a dependency on opioids. They are not born addicted.

    View the original article at thefix.com

  • Promising New Treatments for Opioid-Dependent Babies

    Promising New Treatments for Opioid-Dependent Babies

    Compassionate care for the mothers was crucial to positive outcomes for opioid-dependent babies.

    I gave birth to my daughter in late January of 2014. It was the kind of birth you see in the movies—the contractions started hard and grew closer together within moments. By the time I realized I was in labor, I was already in too much pain to walk. I began needing to push while my husband was on the phone calling for an ambulance. The 911 operator had to walk him through the beginning of my daughter’s delivery. Luckily, paramedics showed up to take over while she was still crowning. The lieutenant who delivered her said it was her first completed childbirth. I will never forget holding my newborn daughter in the elevator while we rode down to the ambulance, or how the entire labor and delivery staff burst into applause when we wheeled into the hospital. But the joy and pride of my wild, badass childbirth was quickly replaced by a deep sense of guilt.

    Within hours, my daughter began showing symptoms of opioid withdrawal—symptoms like rigid limbs, sneezing, and a sharp, screeching cry that burrowed into my belly and filled me with self-loathing. The withdrawal was from methadone, which I was prescribed and taking under a doctor’s supervision. Methadone has been the gold standard of care for pregnant people with opioid dependencies since the 1960s. I did the right thing. Still, watching my newborn daughter go through withdrawal was excruciating. Unfortunately, the treatment she and I received at the hospital—after that initial congratulatory applause—did not make the experience easier.

    My daughter’s level of discomfort was rated using the same system used by the majority of U.S. hospitals. It’s called the Finnegan Neonatal Abstinence Scoring Tool (though its inventor, Dr. Loretta Finnegan, notes with a laugh that her name was tacked onto it later without her knowledge). It consists of a comprehensive list of observable newborn withdrawal symptoms. Hospital staff, usually treating nurses, observe the babies every four hours and tally up the number of listed symptoms they observe. Each symptom is a point, and the overall score for that observation period is used to determine how to move forward with treatment. Usually a score above eight means the infant should begin an opiate wean, or have his dose raised if he has already been started on medication.

    The scoring system is the product of meticulous observations recorded by Finnegan in the early 1970s, when babies were dying from opioid withdrawal simply because nobody knew how to define and treat it. But in 2014, when my daughter was subject to it, and when her scores caused her to be sent to the Neonatal Intensive Care Unit (NICU) to be medicated with titrated doses of morphine for over a month by staff who were less than welcoming to me, I resented the Finnegan Score. Other methadone and buprenorphine-dependent mothers whom I have spoken with have related similar discontent with the system. Usually, the complaints center around variability between the way that different nurses score the babies, or at having their babies sent to the NICU. It turns out, the way some of these hospitals use the scoring system is not in keeping with best practice, according to its creator.

    Loretta Finnegan, who is now the Executive Officer of the College on Problems of Drug Dependence, says that inter-rater reliability is key to correct usage of the tool, and recommends that hospitals which use it conduct re-orientations “a minimum of every six months.” She also doesn’t believe that the modern NICU set-up is appropriate for babies who are experiencing NAS without other complications. In fact, she says that “the NICU is the worst place for these babies,” because of the overstimulation caused by the noise and bright lights. Finnegan puts out a training manual, and gives recommendations for the care of infants include swaddling, non-nutritive sucking, decreased stimulation, and plenty of access to mom. When she was doing her clinical work in Philadelphia, she says they “had [their] moms come in every day,” and that “compassionate care for the mothers” was crucial to positive outcomes for the babies. If I had received treatment more in line with Finnegan’s protocols, I probably would have resented the scoring system—and my daughter’s extended hospital stay—a lot less, and I suspect that other mothers would agree.

    But besides providing better training to staff who are using the current standard NAS protocol, there are a couple of promising new tools for NAS that could help decrease hospital stays for infants, and promote better trust between parents and hospital staff. One of these tools, developed by Matthew Grossman, M.D., an assistant professor of pediatrics at Yale School of Medicine, is called “Eat, Sleep, Console.”

    Renee Rushka gave birth to her daughter in July 2018, while taking methadone prescribed for opioid addiction. Her daughter was treated for NAS at Danbury Hospital in Connecticut. She says that they used the Finnegan NAS Scoring System to assess her baby, but they also performed another form of assessment. Although she says she never heard the term “Eat, Sleep, Console,” and she can’t remember the exact measures, she describes a protocol that sounds very much like the system first developed and researched by Grossman in 2014.

    Grossman’s system essentially measures exactly what the name implies—whether the baby is eating at least one ounce of milk, whether the baby can sleep for an hour straight, and whether she can be consoled within 10 minutes of becoming fussy. The protocol suggests maternal contact and non-pharmacological approaches whenever possible. Pharmacological intervention is indicated based on the infant’s level of functioning and comfort, rather than with the goal of reducing all withdrawal symptoms. According to Grossman’s trial conducted at Yale New Haven Children’s Hospital, only 12% of infants required morphine therapy, as opposed to 61% using the Finnegan system (though the study does not tell us whether they used it the way Finnegan herself recommends), and it significantly reduced the length of stay for many of the babies.

    Rushka reports that her experience with the combined Finnegan and ESC-like approach was extremely positive. She brought her baby home, healthy, after five days, having required zero medication intervention. She also notes that she did not feel judged by the staff, and even recalls receiving compliments and affirmations about her recovery—pointing toward the compassionate, inclusive approach that both Finnegan and Grossman deem crucial to the care of opioid-dependent infants. Finnegan expresses concerns that inter-rater reliability might also be an issue should ESC become more wide-spread, in part because of the design simplicity. But she’s definitely in favor of various treatments being designed for NAS. “In most diseases there are many ways to treat them,” she notes, adding, “I just need to see more proof [that ESC works.]”

    Another promising new tool for treating NAS takes a surprising form. It’s a crib called SNOO, whose designer was not initially thinking about NAS at all—his goal was to reduce Sudden Infant Death Syndrome (SIDS). Pediatrician Harvey Karp says that the crib can not only sense when a baby is in distress, but also what level of distress he’s experiencing—and will rock and emit soothing sounds to help calm the baby, similar to a human caregiver, but all while the real caregiver gets some much-needed rest. Karp says that “NAS babies are more skewed to the irritable side,” then, “the more sciencey way of saying it is that they have poor state control…basically you take a child with terrible state control and give them the rhythmic stimulation they need to get down to a calmer state…it’s so important to our neurology that even adults calm down this way; it’s not an accident we fall asleep in planes, trains, and cars. It’s an echo to this ancient, ancient response to the normal womb sensation.”

    Currently, Mark Waltzman, Chief of Pediatrics at South Shore Hospital in Boston, is conducting a study to test the efficacy of the SNOO in reducing distress in babies with NAS. He’s also using Grossman’s Eat, Sleep, Console tool to assess the babies’ level of discomfort. Waltzman’s study is still enrolling, so there’s no data available yet, but he is hopeful that SNOO will offer a relatively simple, non-pharmacological approach to treating the discomfort associated with NAS.

    It has been almost five years since my elder daughter was treated for NAS. Mothers across the country still report complaints similar to the ones I had then—but there are also moms like Rushka who are finding community and support in the hospitals where their babies are being treated. Regardless of the outcome of Waltzman’s SNOO trial, or further testing for Grossman’s Eat, Sleep, Console tool, the fact that this kind of diverse attention is being paid toward NAS—and alongside it a resurgence of the compassion toward the mothers that Finnegan first championed in the 70s—gives me a sense of much-needed hope. Maybe attitudes about addiction are making a positive shift within the medical community. Maybe, in the future, experiences like mine will be obsolete, and all opioid-dependent mothers and infants will have the compassionate care and affirmative respect enjoyed by Rushka and her daughter.

    View the original article at thefix.com