Heartbreaking media reports abound regarding how pregnant women who use opioids allegedly “pass down addiction to unborn children.” But news stories that describe any baby as “born addicted” (for example see here and here) not only misunderstand addiction but also foster hysteria that can have unintended negative consequences.
Let's begin with the critical distinction between dependence and addiction. Dependence means that a person’s body has adjusted to a drug that has been repeatedly consumed such that they experience withdrawal symptoms in its absence. Examples include the emotional agitation and sensation of having hot, itchy, skin that many heroin-dependent people experience on days when they do not use the drug, and the headache and grogginess a caffeine-dependent person experiences when deprived of coffee.
Addiction, by contrast, involves repeated, difficult-to-restrain behavior intended to acquire and consume a drug in the face of destructive consequences. A pain patient who has taken an opioid once a day for many years as advised by their doctor and is functioning well is not addicted but is dependent — that patient would have withdrawal symptoms if they stopped the medication. But a pain patient who begins taking a much greater amount of a drug than their doctor has recommended, starts stealing pills from others when the prescription runs out early, becomes too impaired to show up to work or meet once-cherished parental responsibilities, and yet finds it extremely difficult to stop using opioids despite these negative consequences, is both dependent and addicted.
In the womb, babies are exposed to what their mother consumes, including opioids. Heavy opioid use by a pregnant woman will make the baby dependent on the drug but not addicted. The mother will increasingly seek out and take the drug, which is reinforced each time she consumes opioids. The fetus, however, isn’t being reinforced by seeking and taking a drug; it’s being passively exposed to a drug. It therefore doesn’t learn the powerful associations between drug-taking behavior and the drug effects that can produce addiction.
This doesn’t imply that opioid exposure in utero is harmless, but it does mean that it’s inaccurate to describe any newborn as addicted. Rather, such infants are opioid-dependent and therefore begin experiencing withdrawal symptoms soon after the umbilical cord is cut. A combination of emotional soothing and opioid tapering is usually sufficient to care for them.
Another reason we shouldn't panic about babies born with drug dependence is that it could lead to overly negative views of the capacities of children born to opioid-addicted mothers. It could also encourage crushing guilt among and hostility toward the women themselves. “Crack babies” provide a cautionary tale in this regard. In the 1980s, the “littlest victims” were routinely described as irreparably damaged, and this justified in many people’s minds ferocious criminal penalties toward their mothers and crack cocaine users more generally. But as these children grew up, they showed on average only modest impairments.
Clearly, the fact that some pregnant women are addicted to opioids is a legitimate concern, as it has negative effects on them and their babies. But stirring hysteria about “addicted babies” spreads dangerous myths and creates a toxic atmosphere that does more harm than good.