Charleston, W. Va. — His body dependent on opioids, he writhes, trembles and cries. He is exhausted but cannot sleep. He vomits, barely eats and has lost weight.
He is also a baby. Just 1 month old, he wails in the nursery of the CAMC Women and Children’s Hospital here. A volunteer “cuddler” holds him while walking around, murmuring sweetly, hour after hour, but he is inconsolable. What his body craves is heroin.
Every 15 minutes in America, a child is born after a prenatal exposure to opioids. Here in West Virginia, 14% of babies are born exposed to drugs, and perhaps 5% more to alcohol, totaling nearly 1 out of 5 newborns. Some get by without symptoms, but for many, their very first experience after birth is the torment of withdrawal.
These babies reflect the catastrophic implosion of drug policy in America, from the war on drugs that filled prisons to the continuing failure even in 2019 to provide enough treatment for drug users. By government figures, only 3.7 million Americans received treatment for substance use disorders last year, out of 21.2 million who needed it — just 17%.
How is it acceptable that we treat only 17% of those with a life-threatening disorder?
Pharmaceutical executives are battling lawsuits by blaming drug users. I wish those executives had to cuddle these infants who, partly because of their reckless greed, suffer so much.
Executives in three-piece suits were drug lords as guilty as any from Medellín. The Washington Post reported that pharma companies shipped 76 billion opioid pain pills from 2006 through 2012. A single pharmacy in Kermit sold more than 13 million over those seven years — and Kermit has a population of just over 400 people.
So today, hospitals in West Virginia and across America struggle to calm babies who sometimes begin to go through withdrawal as soon as the umbilical cord is cut.
“He’s frantic,” Dr. Stefan Maxwell, a neonatologist at CAMC Women and Children’s Hospital, said of the infant going through withdrawal. “Baby isn’t sleeping, isn’t eating, isn’t growing. It’s a disaster.”
“Nurses are in tears at the end of a shift,” said Maxwell, an expert on prenatal drug exposures.
When babies are going through severe withdrawal, hospitals give them medication to ease the symptoms — here it’s methadone, elsewhere it’s sometimes morphine — and then try to wean them off it over two or three weeks.
There’s plenty of blame to go around, encompassing opioid-abusing moms and opioid-prescribing doctors. But it’s appropriate to feel special loathing for executives at pharma companies whose corporate strategy was to profit by getting people hooked. Some of the companies funded a movement claiming that pain was the “fifth vital sign” and urged doctors to prescribe more painkillers, and then paid them kickbacks to do so.
Almost 80% of heroin users began with prescription pain pills, though not necessarily prescribed to them.
In contrast to the executives, some moms acknowledge their failings. They are already suffering terribly from their own addictions, and many will lose custody of their babies.
“Lots of these moms are very well meaning,” said Dr. Cody Smith, a neonatologist at the J.W. Ruby Memorial Hospital in Morgantown, 150 miles northeast of Charleston. “The vast majority of these moms love their babies, and they feel a tremendous amount of guilt.”
Smith notes that many of the mothers have mental health problems and their own traumas that they are wrestling with, and he estimates that 85% of the pregnancies involving drug exposure are unplanned. Yet the Trump administration is curbing access to Title X family planning funding in ways that may lead to the closing of the only Planned Parenthood clinic in West Virginia.
Better prenatal care for these moms can reduce the suffering of their babies. Overcoming addiction is so difficult — and so unlikely to be successful — that these hospitals do not ask pregnant women to try. Rather, they steer them from street drugs like heroin and fentanyl to alternatives like methadone to stabilize them.
Newborn babies struggling through withdrawal are only one dimension of America’s opioid crisis. Every seven minutes another American dies of an overdose; 2.1 million children live with a parent with a drug dependency.
McKinsey and Co., the global consulting company, issued a sober report last fall warning that “the opioid crisis will worsen over the next three to five years.” What McKinsey didn’t say was that it had previously advised Johnson & Johnson to be more aggressive in peddling opioids for back pain and to encourage doctors to prescribe stronger, more addictive pills.
These drug-addicted newborns are suffering partly because of Johnson & Johnson, McKinsey, Purdue Pharma, McKesson and many other companies; these babies are a reminder of why corporate regulation is essential.
We need accountability, as well as deterrence. That means sending executives to prison along with other big drug dealers, and ensuring that shareholders in these companies suffer as well.
Anyone doubting the need for tougher accountability, and for a far more robust public health approach to address drug use, should visit one of these nurseries and see babies suffering withdrawal.
Nicholas D. Kristof | The New York Times (CREDIT: Damon Winter/The New York Times)
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