How infants are falling victim to the opioid crisis

One overlooked “victim” of the opioid epidemic are children born to opioid-dependent mothers who actively used throughout pregnancy

By Dr. Michael Pittaro, Faculty Member, Criminal Justice at American Military University and Shanna O’Connor, alum of the Philadelphia College of Osteopathic Medicine

According to a U.S. Department of Health and Human Services report, 116 people, on average, die each day as a result of an opioid-related drug overdose. The 2018 report indicated there were 42,249 opioid overdoses resulting in death in 2016, which is more than any previous year on record, and 15,469 of those overdose deaths were specifically from using heroin. The opioid epidemic, as it has become known, is estimated to have cost the United States $504 billion dollars in 2016 alone.

The Centers for Disease Control and Prevention (CDC) noted that the increase in opioid overdose deaths can be attributed to three distinct, yet recent, waves.  

Is a mother’s use of drugs during pregnancy tantamount to “child abuse”?
Is a mother’s use of drugs during pregnancy tantamount to “child abuse”? (Photo/Pixabay)
  1. The first wave began with the increased prescribing of opioids in the 1990s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 1999.
  2. The second wave began in 2010, with rapid increases in overdose deaths involving heroin.
  3. The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids – particularly those involving illicitly manufactured fentanyl (IMF). The IMF market continues to change, and IMF can be found in combination with heroin, counterfeit pills, and even cocaine.

Many criminal justice professionals focus their research on the addict and their engagement in crime, as well as those impacted by those crimes (i.e., the primary and secondary victims). However, one particular “victim” of the opioid epidemic that has been largely overlooked and understudied are the children born to opioid-dependent mothers who actively used throughout pregnancy. This is a topic that warrants immediate attention.

Infants harmed by opioid exposure

The Substance Abuse and Mental Health Services Administration  (SAMHSA) reported in 2017 that the past decade has seen a significant increase in the number of infants exposed to opioids before birth. The report noted that between 2000 and 2009, opioid use among women who gave birth in the United States increased from 1.19 to 5.63 per 1,000 hospital births per year.

As a direct result, the United States has witnessed an incredible increase in the incidence of neonatal abstinence syndrome (NAS) among newborns. NAS primarily caused by maternal opioid use during this same period went from 1.20 to 3.39 per 1,000 hospital births per year. These are the most recent statistics, so one can only assume that these percentages have increased even further given that the opioid epidemic has considerably worsened since 2009.

To compound matters, the aforementioned SAMHSA report also concluded that heroin use is most common among those who are unmarried, unemployed, under-educated, and uninsured. High-risk lifestyles and social, physical, and mental health problems are, as one could imagine, more pronounced in heroin users. These mothers’ ties to the criminal justice system, if any, are unknown to these writers; it would be interesting to determine what percentage of heroin dependent mothers are under some type of custodial supervision (pretrial, incarceration, probation, and parole).

What is neonatal abstinence syndrome?

Stanford Children's Hospital defines neonatal abstinence syndrome (NAS) as a group of problems, mostly medical, that a baby experiences when withdrawing from exposure to narcotics. Nearly every drug used by a mother during pregnancy will pass from her bloodstream through the placenta to the fetus.

In the case of opioids, like heroin, drug dependence in the mother can lead to drug dependence in the newborn. At birth, the baby’s dependence on the substance continues; however, since the drug is no longer being passed from the mother, the baby’s central nervous system becomes overstimulated resulting in symptoms associated with opioid withdrawal. Symptoms of withdrawal may begin as early as 24 to 48 hours after birth, or as late as five to 10 days.

Each baby may experience different symptoms of neonatal abstinence syndrome. However, the most common symptoms of withdrawal in newborns may include:

  • Tremors
  • Irritability (excessive crying)
  • Sleep problems
  • High-pitched crying
  • Tight muscle tone
  • Hyperactive reflexes
  • Seizures
  • Yawning, stuffy nose, and sneezing
  • Poor feeding and sucking reflex
  • Vomiting
  • Diarrhea
  • Dehydration
  • Sweating
  • Fever or unstable temperature

The withdrawal symptoms can last as long as 4-6 months after birth. A number of potentially dangerous complications also include:

  • Poor intrauterine growth
  • Premature birth
  • Seizures
  • Birth defects

Behavioral effects associated with perinatal opioid exposure

According to a 2014 research study entitled Behavioral Effects on Perinatal Exposure, researchers concluded that children who are born from mothers who are heroin-dependent or those who are using methadone are more likely to develop Attention Deficit Hyperactivity Disorder (ADHD) and exhibit aggression. Additionally, the social environment in which the child is raised seems to play a crucial role in development of adverse behavioral effects. This aligns well with several prominent sociological theories of crime and deviance.

From a sociological perspective in criminology, our social environment has a powerful influence on shaping and molding the behaviors we exhibit. For example, social learning theory, when used in a criminological context, states that crime, like all other behaviors, is a learned behavior. Social learning theory has found consistent and robust empirical support within the research literature for more than four decades. For example, in the 2010 research study, The Empirical Status of Social Learning Theory: A Meta Analysis, researchers noted that social learning theory has remained one of the core criminological paradigms over the last four decades.

Should mothers be charged for using drugs during pregnancy?

Is a mother’s use of drugs during pregnancy tantamount to “child abuse,” and if so, would this give child protective services workers and law enforcement officers the legal means to remove the newborn from the mother’s care?

According to Pro Publica, advocates on both sides of the issue continue to debate whether it’s best to leave a drug-exposed child with the mother, or remove the child from the mother’s care soon after birth and place the child with “clean” foster parents. The issue is a difficult one without a clear or easy resolution. 

As of 2015, Pro Publica noted the majority of states within the U.S. do NOT criminalize a mother’s drug use during pregnancy, but mothers have been successfully prosecuted under alternative criminal laws. For example, some states treat substance abuse during pregnancy as child abuse.

However, very few states have a specific law that requires healthcare workers to report the mother’s drug abuse and even fewer states require health workers to conduct a drug test if drug use is suspected during pregnancy.

In my opinion, lawmakers need to start discussing how to address the topic of a mother’s drug use during pregnancy, especially since incidence of neonatal abstinence syndrome cases are clearly on the rise with no indication that the opioid epidemic is close to slowing down.

About the authors

Dr. Michael Pittaro is an Assistant Professor of Criminal Justice with American Military University and an Adjunct Professor at East Stroudsburg University. Dr. Pittaro is a criminal justice veteran, highly experienced in working with criminal offenders in a variety of institutional and non-institutional settings. Before pursuing a career in higher education, Dr. Pittaro worked in corrections administration; has served as the Executive Director of an outpatient drug and alcohol facility and as Executive Director of a drug and alcohol prevention agency. Dr. Pittaro has been teaching at the university level (online and on-campus) for the past 15 years while also serving internationally as an author, editor, presenter, and subject matter expert. Dr. Pittaro holds a BS in Criminal Justice; an MPA in Public Administration; and a PhD in criminal justice. To contact the author, please email IPSauthor@apus.eduFor more articles featuring insight from industry experts, subscribe to In Public Safety’s bi-monthly newsletter.

Shanna O’Connor received her Master of Science in Mental Health Counseling concentrating on Addictions counseling from Philadelphia College of Osteopathic Medicine in 2017. Since graduating, she has worked at a methadone clinic providing individual and group therapy from those suffering with an opiate addiction and dual diagnosis. She is currently working as a Mental Health Specialist in the Lehigh Valley area. Shanna received her B.S in Psychology from East Stroudsburg University with a Criminal Justice concentration in 2015. Shanna wishes to continue her education in a doctoral program, furthering her knowledge in addictions and forensic psychology. 

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