Pubdate: Tue, 12 Aug 2003
Source: Courier-Journal, The (KY)
Copyright: 2003 The Courier-Journal
Author: Steven d. Passik
Note: Steven d. Passik is Director Symptom Management and Palliative Care
Markey Cancer Center Associate Professor of Medicine and Behavioral Science
University of Kentucky
Bookmark: (Women)
Bookmark: (Pregnancy)
Bookmark: (Methadone)


The July 27 Associated Press article about an increase in babies being
born "addicted" to pain medications did a disservice both to good
medicine and to good journalism.

It is indeed a tragedy that babies are born to drug-abusing mothers.
It is also a shame that the article focused on the sensational aspects
of the story, with less regard to an accurate medical portrayal,
especially in its imprecision in terms. Nevertheless, one would hope
that this article can and should be a call for more services directed
to women with drug problems during pregnancy (such as methadone
maintenance) and other forms of addiction treatment that have been
shown to be helpful to the mother in dealing with her addiction and
safe for the developing child.

However, the article misrepresents medical facts about drug dependency
and addiction. Despite what the nurse in the article was quoted as
saying, babies cannot be "born addicted" to drugs. When a woman abuses
drugs while pregnant, it is possible for her child to become
physiologically dependent on that substance. But dependency is
treatable with proper care - and is not the same as addiction. At
birth, babies do not have the mental capacity to develop the
psychological syndrome of use despite harm and uncontrolled,
compulsive use of substances that separate addiction from
physiological dependence.

The alarming portrayal of newborns as "addicts" not only perpetuates
myths and fears that already exist surrounding the use of illicit
drugs but also can bleed out and affect the perceptions of the use of
licit drugs such as pain medications. Such sensationalized reports can
lead to patients becoming afraid to take the medicine they need (if
they, too, confuse dependence for addiction), or doctors hesitating to
prescribe a necessary treatment for fear of prosecution.

And if one were to consider the problem of moderate to severe pain
during pregnancy, most physicians certainly agree less is more; but
many also concur that opioids for moderate to severe pain in that
context are about the safest class of medications one can use. Opioids
do not cause birth defects (witness the birth of children to women on
methadone maintenance), and the newborn can be safely tapered off of
them without withdrawal. The effect of the stress of chronic pain on
the mother has been poorly studied, but one can imagine that pain
could play a role in making the intrauterine environment as
inhospitable as opioids might ever have.

As a medical professional, there are other questions I must raise with
the article. Shouldn't the article have explored why the infants were
allowed to needlessly suffer withdrawal? Those symptoms can and should
be medically managed. Why did the article characterize babies as
"addicted" when the source of the information provided the number of
babies "exposed" to opiates? Shouldn't the article have stressed that,
under a doctor's care, chronic pain during pregnancy can be safely
treated? Why wasn't the abuse of alcohol versus other drugs described
and stressed?

We cannot allow such media reports to skew the proper treatment of

Steven d. Passik

Lexington, Ky.
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