The other day I caught the headline about a class-action against 20 pharmaceutical companies. Nothing earth shaking there. These lawsuits are well-publicized. What caught my eye was the first nine words of the story. Words that when I see them used in the media, make me cringe not only for the child, but because it’s is not an accurate description of what is taking place. It’s flat-out false.
“The family of a baby born addicted to opioids….”
In the next paragraph:
“……spent the first days of his life in ‘excruciating pain’ as he was weaned from his opioid addiction, inherited from his mother.”
A tragic story and babies going through such anguish is awful, but it is not the anguish of addiction. Babies, by the very definition of the word, cannot be born addicted to drugs. They can be born dependent. The two concepts are NOT the same. Understanding the difference (particularly by the media) matters for many reasons.
Rather than making an attempt with a law degree to explain why it matters that we not use “addicted” to describe babies going through awful and tragic withdrawal of opiate dependence, I went to someone with a medical degree. A world renowned addiction medicine doctor: Dr. Omar Manejwala M.D Below is a lightly edited version of our conversation.
BC: Can a baby be born addicted to opiates or any other drug?
OM: Babies cannot be “born addicted.” In fact, babies can’t even develop addiction. Addiction is a disorder characterized by pathologically pursuing reward or relief through the use of substances. The American Society of Addiction Medicine describes it as “characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.”
None of these things are possible in a baby. When we call babies “addicted,” we shame the mothers, stigmatize the children, impact the family, and there are public health implications too.
We saw this when we began referring to African-American children born to mothers who had developed crack-cocaine addiction “crack babies.” There is no syndrome or condition called “crack baby syndrome” — it was made up and resulted in terrible stigmatization and added fuel to a misguided movement to incarcerate our way out of addiction.
Babies can, however, be born in opioid withdrawal. Physical dependence on some drugs, including opioids, is possible, and when the doses are reduced or tolerance develops, the user can begin to suffer a withdrawal syndrome. We see this phenomenon both in people who have addiction as well as those who just used opioids for a long time (perhaps even appropriately).
Because opioids have a low molecular weight, are water soluble, and attracted to lipids, they easily cross the placenta. Babies born to mothers who are physiologically dependent on opioids may then present with “Neonatal Abstinence Syndrome” or NAS. I emphasize that this can happen whether or not the mother had a substance use disorder — the only thing required is long-term exposure to opioids. This is a syndrome that is usually self-limited, but may require low dose opioids in the baby temporarily to address. Milder cases can be managed without medications, but moderate and severe cases often require opioids — usually morphine — temporarily.
So in summary, babies cannot be addicted, and to say that they are is wrong, harmful, and reflects a misunderstanding of the difference between addiction and physiological dependence.
BC: What is the difference between addiction and dependence?
OM: Addiction is defined as a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Its characterized by pursuing reward and relief through the use of substances and behaviors in dysfunctional ways. Physical or physiological dependence is merely the body adapting to opioids which results in tolerance (needing to use more to get the same effect, or having a diminished effect over time with the same dose), and withdrawal which is a characteristic syndrome caused by the reduction in dose.
BC: Why do you think the general public, and sometimes even the medical profession, fails to understand the distinction between addiction and dependence?
OM: Unfortunately, we in the medical profession, are a primary source of that confusion. For a long time, we called addiction “substance dependence” and physical dependence “physiological dependence.” The books we used to name conditions adopted that language. It made it very confusing for the lay population to understand.
We have a broader problem as well — most people don’t understand that addiction is more than just using drugs — that it’s a disorder that is not present in everyone who uses drugs, even those who use a lot of drugs!
Finally, we used the term addicted loosely in general conversation, “he’s addicted to Netflix” or “the U.S. is addicted to oil.” When a medical term is used loosely, it can be very confusing — even to physicians — as to what we are talking about. I write about this problem in the first chapter of my book.
Bottom line — language matters — it affects how we understand things and how we treat them. If we expect to make a difference in the crisis of people dying from drug overdoses — and the 2-3 times as many dying from alcohol use disorders — we need to be clear in our language as a critical step in eliminating the stigma that is killing people.
They say if you want to kill something, call it a weed, and if you want to nurture it, you call it a flower. There are several studies that demonstrate the negative impact of using demeaning, pejorative, or stigmatizing language — such language doesn’t just hurt feeling — the research shows that when such language is used people are less likely to get the medical care they so desperately need.
Brian Cuban (@bcuban) is The Addicted Lawyer. Brian is the author of the Amazon best-selling book, The Addicted Lawyer: Tales Of The Bar, Booze, Blow & Redemption (affiliate link). A graduate of the University of Pittsburgh School of Law, he somehow made it through as an alcoholic then added cocaine to his résumé as a practicing attorney. He went into recovery April 8, 2007. He left the practice of law and now writes and speaks on recovery topics, not only for the legal profession, but on recovery in general. He can be reached at firstname.lastname@example.org.