Dear my friends in the news media, repeat after me:
An infant cannot be born #$%#$% addicted to drugs.
I do not know what’s been going on lately, but I have seldom heard so much flat-out stupid, uninformed, backward reporting on the opioid epidemic as I have been hearing in the last couple of weeks. It’s been so widely distributed among different outlets that I’m not sure it’s even fair to single out any one particular corporation.
The first such noises I heard were about “fetal assault” laws. It boils down to threatening imprisonment for women who are pregnant while using illegal drugs if they don’t get treatment. The getting-into-treatment part I dig; however, interestingly enough, one often finds such States have a lot more room in jails than they do in treatment programs. Funny, that. Wouldn’t it be nice if the States had enough treatment slots to provide treatment on request and massively ramp up the drug court system, instead of all this retroactive stuff? I think so.
The media pointing out the ethical problems of this is fine with me. However, we got into a whole other realm when pregnancy outcomes started getting discussed. One was the neonatal abstinence syndrome – basically, opioid withdrawal in an infant. In some of these reports, reporters were constantly and unself-consciously referring to “infants born addicted to drugs,” including when talking about kids born to mothers who take methadone or buprenorphine.
There are several huge problems with this and I’m only going into a couple because I’ve already had too much coffee and I’m trying to maintain normotension. The first is this: Why are you not talking about cigarettes and alcohol?
To be fair, this is a problem with the media and with the legislatures. Illicit drugs are tremendously stigmatized and they do godawful amounts of damage, but let’s face it – the legal drugs probably cause the most public health harms. If your goal was seriously to impose consequences to prevent pre-natal injury to infants, you would hang a breathalyzer around every pregnant woman’s neck and lock up anyone who tested positive for nicotine while pregnant. In terms of long-term outcomes, “neonatal abstinence syndrome” is probably nothing much compared to fetal alcohol syndrome and all the stuff that smoking can do.
So that’s one. Here’s the second: the constant lumping of therapeutic drugs in with active addiction.
It happens several ways; one of them with the use of the word “clean.” As in:
She couldn’t tolerate the withdrawal, and her doctor told her that quitting cold turkey could be dangerous. So she went to a methadone program, hoping that it could serve as a bridge to getting clean.
Because, you know, nobody on methadone is really “clean.” Even if, for the last 5 years, she happens to be showing up to work at 8:00 every morning, leaving at 6:00, looking after her kids, abiding by the law, paying taxes, and generally being a productive human being. She is still “dirty.” Unlike that guy who just walked out of detox two days ago and refused to get into the treatment that would keep him from relapsing in the next two weeks. He’s “clean.” Right? Right.
I wonder how many reporters writing these stories spent the morning talking about who’s “clean” and who’s “dirty,” and then hoisted a couple at happy hour after work.
I get my knickers particularly twisted about this because this stigma kept coming up for the people in a program I worked in. They had to be careful in the Fellowships because even though some newbie might be nodding out in the back row with pupils the size of the period at the end of this sentence; if they talked about being on methadone, they were instantly “unclean.” It’s even more ridiculous out in the community, where being on either methadone or buprenorphine cuts you off from all kinds of resources. You can have treatment for your cravings and withdrawal, or you can have a roof over your head, but not both. Crazy.
The common thread to this craziness is a fundamental confusion.
Addiction is a behavioral disorder.
You cannot know how people are behaving based on what chemicals are in their blood. Go to a cancer ward and check out how much morphine and fentanyl are floating about. Now ask which of them should be locked up, or which are “dirty.”
This also is why you can’t be born addicted. No three-day-old is going to raid Daddy’s medicine cabinet or slip out to the corner to meet his boy to cop some pills.
It’s about how you act. There are situations in which taking opioid medications, like methadone and buprenorphine, helps people act better. It helps them stop using, stop getting infected with really nasty viruses, helps them turn into functional parents and citizens. As long as there is some implicit assumption that success only counts if you do it without medicines, and the highest goal for addiction treatment is to be medication free; we will be encouraging people to stop doing stuff that works. That is not the way we’re going to dig our way out of this hole.
I don’t know why these various media outlets feel they can file such reports with an obvious lack of expert guidance. Any good they do questioning the ethics and effectiveness of criminal justice based responses gets washed away when their next sentence stigmatizes some of the most effective treatments we’ve got, and further teaches potential patients that such treatments render them “unclean.” They are operating with exactly the same stigmatizing assumptions that lead these legislators to pass these laws.
Dear my friends in the media:
Find some actual addiction docs, talk to them. Take this seriously.
The truth is out there, but on your own, you’re not going to find it …