The opiods reached as far as Europe. I had a major operation in 2008, was given what I now realize was a major opiod as a painkiller. I used it for about a year, and thank my lucky stars I did not become addicted. No warnings were issued.
1
I'm sorry, profit isn't evil.
If the pharmaceutical manufactures falsified studies about the addictive effects of opioids, knowingly diverted opioid supply outside legal prescription channels, or sprinkled fentanyl in school lunches to get kids hooked, then I would get on the "lock them all up" bandwagon.
The reality is every drug has side effects, and the FDA has a very complex regulatory framework to establish risk/benefit with any legal pharmaceutical. If the drug companies test and report per the rules, sell per the rules, and market per the rules, then we should be outraged at the rules if we are disgusted by the results.
Addition is a known side effect of many / most pain management drugs. It it printed on the label. The doctors know this, the pharmacists know this, and patients should know this, but life in pain isn't living. If anything, we should be outraged at the FDA.
14
This is absolutely heart breaking. So much pain at all levels: these babies born into addiction, parents of the addicted babies, extended family members, treating healthcare officials and the list goes on.
America is the greatest country on earth and I love her dearly. But the high level of overall greed in this country is staggering. These doctors and pharma companies are not surprised about the devastation they helped to create. They were aware of what would happen from the beginning. However, all they cared about was making money for themselves.
For a whole host of reasons, this country really needs to check its values and take a clear stand for doing the right even when it means not making a profit.
13
McKinsey, staffed by the best and brightest, people with every advantage. McKinsey is dirt in my book and I will make sure none of our 401k holds any J&J. Every aspiring MBA/ consultant needs to watch these tormented babies in ethics class.
11
So wait... closing Planned Parenthood - resulting in more unwanted pregnancies and babies suffering like this baby, is “pro-life”? I’m so livid I can barely write this.
30
The language here is way too passive. The true version of “Every 15 minutes in America, a child is born after a prenatal exposure to opioids“ is, “Every 15 minute in America a mother who took drugs while pregnant gives birth to a drug addicted baby.”
19
Hmm.... 13 million pills sold over 7 years in a town of 400...
That's just over 12 pills per day per person.....
8
I encourage other readers to go back in the NYT archive and read about the crack epidemic. The authors were a little less sympathetic when the victims weren’t lily white and there weren’t million dollar settlements flying about.
20
How terribly frustrating it must be to be a member of the Times editorial board right now. You write a brilliant 8 part series ("A Woman's Rights) debunking myths about pregnant women and substance use; you castigate the media - including the Times - for spreading hype and hysteria about "crack babies" you urge us all to do better this time -- and now it turns out one of your own columnists apparently never bothered to read it. I hope Times readers don't make the same mistake.
Richard Wexler
National Coalition for Child Protection Reform
7
It was so painful to read of babies who are writhing, trembling, crying, vomiting , who exhausted but sleepless, ,inconsolable,
and craving heroin ,and even harder to view the video.
I thank Mr. Kristof for this critical Opinion Piece, and all those who are caring for these babies, and doing everything possible to help and comfort these poor babies, including the volunteer "cuddlers."
I live on the south shore of Long Isand, New York, and would like volunteer to become a "cuddler " .
If anyone knows how I can go about becoming a "cuddler " please let me know.
Thank you,
DJS
5
I love reading your columns, Nick. Thank you.
1
Women who are addicted to drugs like opiods should NOT have children as long as they are addicted. They are unable to care for themselves, much less a child. What is happening to these children is akin to torture. Why not offer them free or very low cost abortions? Thanks, pro-lifers for being in the way here.
16
Terrible withdrawal like in this video and described in the first paragraph is not observed in a NICU if withdrawal is treated properly. My guess is that this infant was discharged home without knowing there was an addiction problem. Infants of known opioid users are scored for withdrawal symptoms and treated before reaching this stage. This video is heart wrenching to watch but also vilifies the mother for her disease and increases stigma against her. Pregnant addicts are routinely treated poorly in health care settings as though they are selfish, stupid and uncaring. The mother did not see her health care team as committed to her, caring and respectful so she hid her addiction. I work to be sure that women know if they come to me, no matter how bad it is, I will help them. We will work out a plan to control the disease and leave her dignity intact. I have not had an infant I delivered come back in withdrawal like this because trusting patients with compassinate care givers reveal their fears and we help them.
20
Where is Kristof getting the bit of information:
“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.”
Is this just an assumption by Kristof since there is no reference.
3
The Rich get richer, and suffer not. The poor get jailed, get no treatment, no healthcare or contraception, just scorn and punishment. And the Babies get a horrendous start at life, destined to falling behind, without much hope. Rinse and repeat.
RISE UP, Folks. VOTE for Democrats only, in 2020.
12
Big Pharma has demonstrated just how evil it is. Profits over people. But it’s safe to trust them regarding all vaccines. Right?
I DO NOT have Hep B and did not vaccinate my infant with it or the vitamin K shot when she was born. I was treated like a kook. Am I allowed to even ask a question? Am I allowed to pass on getting the flu vaccine that’s manufactured in China? Or will I be labeled, shamed and ostracized? Some vaccines are necessary BUT big Pharma is gonna make sure that the sheeple keep on getting as many injections as they can for the MONEY. They are motivated by dollars and we must be allowed to have informed consent because they have proven themselves UNTRUSTWORTHY.
Cue the nasty comments.
1
It's easier and much less disturbing to CEO consciences to blame the users rather than admit that the aggressive selling tactics they approved of caused a tragedy that will reverberate for at least a generation.
I think that each time an industry's lobbyists try to get Congress or the state governments to relax regulations the opposite should occur. Why? Because the results of deregulation have hurt most of us whether it's with Big Pharma, finance, trucking, workplace safety, soil and water and air pollution, auto manufacturing, and food.
In truth most industries and professions cannot regulate and discipline themselves. They do a marvelous job protecting themselves, holding back vital information, blaming others, etc., but fail to remediate serious and minor problems without forceful intervention. We can't jail corporations but we can regulate them and we should and we should not believe them when they say deregulation is the best way to go.
9/7/2019 10:37pm second submit
4
I am in no way a fan of Big Pharma; however, when I see the wailing newborns - clearly in pain - I blame the parents, as well. No baby should have to suffer like this. And if an addict cares more about the drug than her baby, maybe she should consider sterilization.
7
It is not just new born babies. I am crying for drugs too. But no one ever seems to give me any. Legalize all drugs right now!
2
Finally the media takes notice of the epidemic. Our foster grand baby was born with the big four, heroin, fentanyl, meth, and cocaine. Twenty six days in the NIC unit at Mass General, med flighted after birth. All on the taxpayer dollar.
The foster care system is under strain, the numbers are going through the roof, and the politicians don’t care. They blame big pharm for the opioids when the real problem is the cheaper alternative, heroin.
Build the wall.
3
Citizens United perfected our dollar democracy and wrapped it with a bow.
Given that corporations are people, I say punish the entire corporation: board members, officers and shareholders, when they harm or kill people.
6
Those who promote the decriminalization of drugs should keep in mind that one side effect would be more addicted babies from parents using legal drugs.
2
@Jason People Upside of decriminalization outweighs downside 100 fold.
2
I totally agree that the executives/owners who made these marketing decisions should end up in prison. Despicable greed. Unconscionable. How can they go home to their own families and sleep with a clear conscious at night? And to blame the victims? Shame on them! Plus, doctors must share part of the blame. They're supposed to be the experts regarding the prescribing of addictive substances. Too many are either too busy, too lazy or too greedy to be the guardian at the gates.
3
https://www.ncbi.nlm.nih.gov/pubmed/24176200
These infants will often suffer developmental difficulties and by evidence of the above linked article we are creating an inherently addicted class of Americans.
6
Does anyone remember the "crack baby" howling in the '80s???
I wonder what happened to all those kids. Probably someone knows.
3
I wonder if our beloved leader would be interested in doing a photo op with this infant? Nothing like a good old “thumbs up” to remind us of how he is making America great again.
6
So what if these babies twitch, tremble and cry? Who cares?
Most of them come from mothers who are poor or black or live in hardscrabble conditions or have had no access to effective birth control. Often all four. I am not poor, not black, live in a nice area. Why should I care?
"And the King shall answer and say unto them, Verily I say unto you, Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me." [Matthew 25:40]
Whether professing Christianity, Judaism, Islam or being a non-believer, no one who presumes to have a moral core can countenance the suffering of infants in hospitals or children in cages.
In all senses of the word, it's HIGH time to put pharmaceutical drug pushers in prison and not just leave them to separation with the goats in a future divine retribution.
6
I am beginning to find this opioid "crisis" tiresome. Tens of thousands of people are killed by our tobacco pushers every day and we hear hardly a peep from the media. Most people who die while using opioids in Amercica are also intoxicated on alcohol, but the media and politicians don't call their deaths alcohol overdoses. More to the point of this article, most babies born to mothers using opioids won't suffer withdrawal and research suggests that there are no long term negative consequences for the rare babies who do go suffer through withdrawal. Let's face it, stories like Mr. Kristoff's, what I refer to as opioid "porn", sell papers and lays out a crisis that helps politicians score easy points without raising the ire of the American industrialists pushing tobacco and alcohol. Finally, and sadly, despite Mr. Kristoff's call for more accessible and affordable substance abuse treatment, which is indeed sorely needed, all we are likely to get from this article is more incarceration of mothers.
3
It's easier and much less disturbing to CEO consciences to blame the users rather than admit that the aggressive selling tactics they approved of caused a tragedy that will reverberate for at least a generation.
I think that each time an industry's lobbyists try to get Congress or the state governments to relax regulations the opposite should occur. Why? Because the results of deregulation have hurt most of us whether it's with Big Pharma, finance, trucking, workplace safety, soil and water and air pollution, auto manufacturing, and food.
In truth most industries and professions cannot regulate and discipline themselves. They do a marvelous job protecting themselves, holding back vital information, blaming others, etc., but fail to remediate serious and minor problems without forceful intervention. We can't jail corporations but we can regulate them and we should and we should not believe them when they say deregulation is the best way to go.
9/7/2019 8:56pm first submit
9/8/2019 12:01am third submit
1
what kind of parents do this to their children?
God help our country if this is the level to
we have fallen. as for the pharmaceutical
companies,they are responsible to the
extent that they probably knew early on
about the addictive quality of these
drugs but did nothing about it. however,
this does not excuse the users of these
drugs who must bear personal responsibility
for the tragic results of their ignorance
and willfulness.in my neighborhood, I see
the results of this tragedy every day.
I wonder if we will ever get a handle on
this national catastrophe. I doubt it.
3
People have a right to take opiates if they want to take opiates. The war on drugs is tyranny, full stop.
1
It's easier and much less disturbing to CEO consciences to blame the users rather than admit that the aggressive selling tactics they approved of caused a tragedy that will reverberate for at least a generation.
I think that each time an industry's lobbyists try to get Congress or the state governments to relax regulations the opposite should occur. Why? Because the results of deregulation have hurt most of us whether it's with Big Pharma, finance, trucking, workplace safety, soil and water and air pollution, auto manufacturing, and food.
In truth most industries and professions cannot regulate and discipline themselves. They do a marvelous job protecting themselves, holding back vital information, blaming others, etc., but fail to remediate serious and minor problems without forceful intervention. We can't jail corporations but we can regulate them and we should and we should not believe them when they say deregulation is the best way to go.
9/7/2019 8:56pm first submit
1
Burgle a business late at night with no weapons, and if you're the wrong color you'll get 3-5 in a prison. Purposely addict a million people, for billions in profits, an they take a billion or two from you and let you have a great life on what's left.
This situation of treating white collar crime with kid gloves will, eventually, take a heavy toll in civil disobedience and undermine the foundation of our government.
White collar criminals must be treated as exactly what they are--criminals.
4
Absolute cruelty children. These states which have addictive issues produces "gifts" to the GOP. So how are they going to change?
I think the government should stop waiting for the Big Pharma cases to pay off and start providing the money and care it is charged with providing. How about today? We can sort out the civvil and criminal liability, if any, at a later date.
1
Everytime I read an article about opioid drugs, I read drug stores like Kermit WV selling 13 million pills to city with 400 people ,Delay Beach Florida selling enough opioid drugs to have every person living in this city to have 40 opioid pills each, why do we not charge the drug stores who sell these drugs?
Why does every single terrible thing on earth have McKinsey’s fingerprints on it?
I am sorry but the premise of this article is ridiculous. It’s implausible that the majority of these West Virginia moms, women of child-bearing age, were addicted due to legally prescribed opioids. And even if they were, using opioids as prescribed is by no means a direct route to addiction - as long as you use them as prescribed and wean yourself off as the pain lessens. So how is people misusing a product that has many legit uses the pharma companies’ fault? How is drug addicts not using birth control the pharma companies’ fault? Where is personal responsibility in all of this? Yes these people have many issues but just blaming manufacturers makes no sense
10
Heartbreaking.
Who knew?
While I don't doubt the possibility of what Mr. Kristoff presents here, it has a few too many echoes of the breathless "crack baby" stories of 30 years ago (which mostly turned out to be a myth), for me to take at face value.
https://www.nytimes.com/video/players/offsite/index.html?videoId=100000002226828"
4
This article needs some fine-tuning by an informed editor. There is a opiate problem affecting babies but many would argue Nicholas Kristof doesn't have an accurate handle on the problem. Dependence is not addiction but thanks to the careless use of the terminology there is a lot of confusion. Kristof is not alone. To understand the problem facing those in the media, read "Dispelling Common Myths about Opioid Use Disorder in Pregnancy" by By Sarah Bernstein, MD and Jessica Gray, MD and available on the Harvard Medical School Continuing Medical Education online site. I understand the babies affected by opioid abuse are suffering but Kristof has the story wrong and his error is part of the problem and not part of the solution. As the Harvard article points out, "...words matter. There is a growing body of literature that demonstrates how impactful the language we chose is on perpetuating stigma and shame for women with opioid use disorder." Kristof, a professional word smith, should do better. Here is a link to the Harvard article: https://leanforward.hms.harvard.edu/2019/03/21/dispelling-common-myths-about-opioid-use-disorder-in-pregnancy/
5
It would be very tough being a Neonatal Intensive Care nurse these days......
4
“Every 15 minutes in America, a child is born after a prenatal exposure to opioids. Here in West Virginia, 14 percent of babies are born exposed to drugs, and perhaps 5 percent more to alcohol, totaling nearly one out of five newborns. Some get by without symptoms, but for many, their very first experience after birth is the torment of withdrawal.”
When punishments are handed out towards the Sackler family and all of the corporations that created, prescribed and dispensed the opioids that so many are chained to, I hope the words above find a voice.
1
I really wish that journalists would stop with this three quarter blind approach to covering the abuse of opioids.
I was there when the crack epidemic decimated Black and LatinX communities and Washington decided to lock the users and dealers up in prison, creating tens of millions of disenfranchised young men of color and creating a whole generation of children living in abject poverty and fatherless. There were no treatment options. I also knew the grandmothers who took these babies in.
There is a reason people use - and just like the 90’s, it has everything to do with divisive, racist policies going back to the founding of this country the majority of its victims still being African Americans.
Now that it is a “white problem,” we blame the drug company - really? This is about poverty and disenfranchisement. Poverty is traumatic. It forces people to have to invent new off the book routes to survival because their families will starve if they do not. It motivates people to align themselves with the Hate Monger In Chief because some are desperate for any sense of empowerment in a country that has decimated our dreams of a middle class.
This administration represents everything the aspirations of the Constitution and Bill of Rights do not; including the brutal doubling down on policies that intensify levels of trauma and fear. We have a housing, race and income inequality problem that leads to disenfranchisement and addiction and jail. Let’s start there.
4
Not to minimize the tragedy for newborn babies who are addicted because of their mothers but we now have another tragedy occurring: deaths because of vaping. When will we ever learn that some addictions are not worth the trouble and pain and deaths they cause?
2
"A single pharmacy in Kermit, W.V., sold more than 13 million [opioid pain pills] over those seven years — and Kermit has a population of just over 400 people."
Not to let corporate America off the hook (I wouldn't do that), but where was the government oversight? Has it improved?
1
First of all, the nurses and nurses aides and volunteers who care for these babies are saints and some, especially the nurses aides make peanuts in comparison to hospital administrators, doctors, insurance CEO's and big pharma. They have to have tremendous patience and it must take an enormous emotional toll on them caring for inconsolable, screaming babies. They, more than anyone else deserves whatever money these big pharma companies are paying as penalties. Secondly, as Kristof states, most of these opiods were not abused by patients for whom they were prescribed but by people who illegally obtained them. I am not saying that big pharma doesn't have some responsibility, but perhaps more government control of medical practices are in order here and should become a reality if universal healthcare is ever implemented in this country. Lastly, women who are addicted to alcohol and any other drug which harms a baby sometimes with lasting lifetime consequences should be sterilized as they have caused great harm to a human life and also to society. It's still easy today to get birth control, but many of these women become pregnant by choice, by carelessness because of their addiction and their babies are their only source of personal achievement. Often, they are the last women who would ever get an abortion because to them a baby is all they'll ever achieve in life.
4
Sadder still is mother's that are not ready or prepared to become mom's navigating a trail without much assistance with a newborn. What of these babies they will follow in the same unstable footsteps of their mothers. This is a gift to society from the Republican Party, too much religious dogma without support for healthcare, food, shelter, education or jobs, that simply decimates families.
1
This is but one aspect that is overlooked, dismissed, or not considered at all by those that oppose birth control and/or abortion. Who will care for children born prematurely, with birth defects of varying severity, with inherited genetic diseases, unwanted by parents who cannot or will not care for them, the result of rape or incest born to girls who are children themselves, those left orphaned by a mother dying in childbirth...Childhood is a long process. Rearing a child successfully is difficult under the best of circumstances. Doing so with a child with mental, emotional, ot physical handicaps is impossible without the help of the federal government.
We already know how much our society values children—cuts to children’s services of all kinds are the first on the block by Congress. After all, children don’t vote. No lunch money? Go hungry, be humiliated, or even prosecuted for debt. Meanwhile, we lavish money on weapons, week-ends and jaunts by those in gov’t, walls we do not need, etc. etc., ad nauseum. Have we no shame?
There is a story that a certain tourist was admonished by his host not to go to the aid of a person lying on the street, obviously in need of help. “If you save his life, you will be obliged to care for him for the restof his life.” Something to think about when we self-righteously insist on the “right to life.” Life doesn’t end at birth.
1
What percentage of these addicted mothers were corporally punished when they were kids? What percentage of the addiction is directly attributable to the trauma of corporal punishment? This is where it starts.
1
Of course, we depend on corporate America to provide jobs. The government needs to balance its aid and protection of corporations and the public. Too often in recent years the government is protecting and aiding corporate America while people suffer pain and even death. It’s called follow the money! We allow with almost no restrictions gun manufacturers to sell their weapons – many AR’s are $1500-$2000 purchases – helping the companies make money. Children and parents are separated at our border while those companies holding the children and adults make significant dollars. Opioids have clearly been sold to anyone and any amount providing corporations much wealth. In the military, they refer to collateral damage as those civilians injured in military operations. In America, the collateral damage grows for those impacted by drugs or guns or imprisoned for crossing our borders. So many suffer the loss of life, grief, long term injuries, emotional trauma, and the government talks about mental health needs but doesn't budget more funds. We have become collateral damage to a limited elite group of wealthy individuals who apparently think corporations have free reign.
First it's the doctors who are the professional that did not do their jobs.... They are suppose to heal not sicken or even kill their patients. Sure the pharmas share the blame for offering and promoting opinoid but the central blame is the medical profession.
Big rewards for the legit companies to turn people into addicts. But what's happening now is illegal producers are taking over. So we'll sooner or latter be back to square one. The war on drugs. Except now the experts want to save money want to legalize it. Drug companies, drug cartels and the government can be our pusher.
It isn't just the suits in the drug companies. It's the ones in Hollywood, the music industry and the media celebrating drugs and alcohol that keeps us addicted . Maybe a wonky politician can explain the cost benefit of having millions die before the reach Social Security and Medicare age.
How do you stop people from turning to hard drugs? Why aren't kids turning to drugs and crime like they did in NYC? You're not going to find the answers from with social psychology degrees.
It used to be a Hollywood rule not to show children in jeopardy. You broke it. There's a time and place for everything, this wasn't it.
We need to reassess our priorities. Do we, as a society, feel that people actively addicted to illegal narcotics have an inherent, moral, ethical or positivist right to bear children?
Considering such children will be subject to torturous withdrawal and require intensive support from the commununity at large, wouldn't it be better to encourage or even force addicts to receive long term injectable, albeit reversible, birth control which prevents the union of spermatozoon and ovum in the first instance?
1
It has been truly hard and sad reading this article, seeing the heart wrenching video of the uncontrollably suffering newborn .
What a greedy and immoral plutocracy is in charge of this Country, once the example of wisdom , altruism and morality.
We have to strengthen and rectify the pillars of our society, removing from power all the politicians against the advancement of our citizens , making good living wages , healthcare , education and housing accessible to all Americans .
These newborns are the innocent victims of greed , we , as a society, have ruined their future , their health , by being unable to create a government for everyone, even the weakest ones, we have been turning our heads away from this humongous problem to get more profits from Wall Street , that is poisoning our society in many ways .
I wish these newborns will get the medical help and love they so much deserve and will be able to fit comfortably in our society, once their terrible avoidable ordeal will be over .
Please , from a very old citizen , I ask all of you readers to vote with your conscience in 2020 .
1
Ever since Sherlock Holmes was getting high on opium, Americans have known that opioid drugs were addictive. How on earth did pharmaceutical companies get away with marketing opoids like oxycontin and pretending they weren't highly addictive. This just defies common sense. How could the medical community be complicit in this horror? And how can we imagine a rationale for dragging the next generation into this mess?
It's the doctors not the business guys. Doctors are educated to understand illness and drugs and they are the ones who knowingly and willfully over prescribe for profit. They are supposed to be knowledgeable enough to see through drug salemans' hype. This is sort of like booze, the salesmen sell "lifestyle", "pleasure", "self image" but everyone knows booze is dangerous and wine, whisky, & beer salesman are not put in jail.
"Dr. Smith...estimates that 85 percent 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."
Stunning, and yet there are those anti-choice zealots who see any form of birth control - beyond putting an aspirin on behind one's knee and crossing one's legs - as being inappropriate. Such persons are akin to an American Taliban in their views of women. Are we that far off from, say, El Salvador where even miscarriages are viewed as a crime and women consigned to prison? Will we start seeing a resurgence of Jane, the underground abortion network that had been operative before Roe? Yes, this opioid crisis needs to be addressed more comprehensively - and fat chance of that happening given the woefully inadequate and morally corrupt administration that is in place along with their do-nothing enablers (and this means the likes of Moscow Mitch) - but having access to good and reliable sex education, prenatal care and yes, abortion is part and parcel of what needs to be addressed with this heart rending situation. Of course, nothing will be done given that this profoundly sad situation is likely to be minimized - or even dismissed - as "fake news" so that the corporations can continue to harvest a profit.
1
It is a tragedy that babies are born addicted to drugs but ultimately it is the mother who is responsible. No one held a gun to the mothers' heads and forced them to use drugs and get pregnant. Narcotics Anonymous is prolific across the US and costs nothing, and many addicts have stopped using drugs. It's so easy to blame others but until everyone takes responsibility for their own personal actions, we're lost. Of course government and industry influences everything, that's obvious. Why not blame the FDA and DEA for not doing their jobs? If they had, maybe we would not have had a prescription opioid abuse epidemic. However, as another NYT article points out, the US has a despair problem, and people will continue to use drugs to escape the pain. It's currently illicit fentanyl coming from China. Who are you going to blame for people abusing and dying from fentanyl?
4
What a heart breaking column. Every single one of these corporate drug lords belongs in prison. Their dirty drug money should go back to the hospitals and facilities that help to treat the babies and families they’ve destroyed. How easy is it to get opioids? I had a minor car accident and my doctor was ready to prescribe with numerous refills. I said no thanks. I’m sure I can manage routine pain in other ways. Which I did. Very few pain sufferers need opioids. Doctores are complicit.
Women aren't supposed to taking opioids during pregnancy or while they're breastfeeding their infants. Read the label on that bottle of pills. Maybe the real disconnect is between doctors and patients. Lack of communication is just as dangerous as the pills.
Any mother who would subject her child to such horrific pain and danger should have the child immediately removed never being able to regain custody and arrested for child endangerment. If the child was one week old and you gave it drugs you would be so why not for giving the child before both. I have no sympathy for these people and let’s face it what are the chances that these poor children will have a great life with this type of mother
2
ONE's heart goes out to the children, victims of the drug crisis, in west VA., but I find fault with the author's tendency to skip from one crisis, quandary to another, w/o remaining anywhere for very long, long enough to make a difference. When Kristof wrote about the emergency in the south Sudan, whose people were at the mercy of the Janjaweed militias on the one hand, and starvation and lack of medical resources on the other.why did Kristof not stick around longer to pitch in to help?He could have been of ENORMOUS assistance to the sole doctor there, "denomme Caetano, but no sooner did author alert us to that crisis than he was elsewhere the following week singing the praises of a teenager who had invented a new sanitary pad! How r we to take him seriously? Is NK after a story or is he willing to be of material assistance, especially in the Sudan? Could have applied for visas for at least 1 family from that region of despair.Were I there that is what I would have done.Mr. Kristof needs to be more "engage!"
How can we hold big pharma, pharmacies and doctors accountable for the terrible conditions our society faces? I'd like to do something but don't even know where to start. I am furious that the wrong people end up in jail. Isn't there something illegal about what they have done that should result in jail time for...oh, let's say, premeditated murder?
I have been a pediatric nurse and nurse practitioner for over 35 years. I have cared for NAS (neonatal abstinence syndrome) babies. My students are often assigned NAS babies to rock and soothe for an entire 8 hour shift.
And I have seen many addicted adolescent and young adult patients whose first exposure was a mason jar of Percocet after wisdom tooth removal ( a gold mine) and simple outpatient orthopedic procedures.
I haven’t prescribed narcotics for at least 20 years, and have had plenty of unhappy patients and parents. I don’t get paid for helping or teaching kids non pharmaceutical approaches to pain management.
Americans are suckers. They think TV and advertising are real and true.
Look at the reality TV conman in the WH.
1
This is a quote from an article on the Pain News Network: It should be made "clear that babies cannot be born addicted. The fact that the media commonly uses the phrase "addicted babies" in place of "babies with neonatal abstinence syndrome" only reinforces the misunderstanding of what clinical withdrawal means." The very successful moves made by Portugal in combating the drug abuse problem were foreshadowed by the book Licit and Illicit Drugs released decades ago by Consumers Union. Here it is 2019 and newspapers still cannot get the story quite right. If others are to ever emulate Portugal, changes will need to be made. https://www.painnewsnetwork.org/stories/2019/8/3/compassion-and-empathy-must-be-included-in-pain-management-education
In January 17, 1920 the Eighteenth Amendment of the United States Constitution effectively established the prohibition of alcoholic beverages in the United States by declaring the production, transport, and sale of alcohol illegal. However, Americans wanted to drink booze so the Twenty-first Amendment to the United States Constitution repealed the Eighteenth Amendment to the United States Constitution. The Twenty-first Amendment was ratified on December 5, 1933. It is unique among the 27 amendments of the U.S. Constitution for being the only one to repeal a prior amendment and to have been ratified by state ratifying conventions.
Supreme court legalizes recreational marijuana, and soon to follow recreational heroin and recreational cocaine.
Americans want more drugs and alcohol.
1
Who highjacked our countries future? Big pharma and others. Absolutely right that prison time needs to happen. The settlements must be spent on addiction treatment and neonatal care for these addicted babies.
Be sure you add Vice President Pence to the honor roll of villains in this story. He is a major force behind cutting Title X support to Planned Parenthood. He did it in Indiana, and the results were disastrous, including an explosion of HIV infection, along with unplanned pregnancies. Many drug addicted women brought drug addicted babies into the world. And many more will in the future as a result of Pence’s push to defund Planned Parenthood.
Don’t expect Pence to comfort babies suffering withdrawal as a result of his vindictive policies. He has his hands full already with Baby Trump.
1
Great column, Nick! The agony is all around us. The reasons people become addicted is irrelevant. The cold hard fact is Big Pharma has created a body count surpassing The Vietnam War, EVERY YEAR. Paying small fines for the CEO’s hadn’t done anything. It’s more like a tax, the cost of doing business. What WILL work is real PRISON TIME for the 3-piece suit crowd. 20 years in prison will get their attention. STOP SETTLING. Juries will convict, and for the justice system to be believable, these criminal must go to PRISON. Confiscate their wealth and lock them up. The Sacklers (Purdue) are now “ Philanthropists” just as the Robber Barons of the nineteenth Century were. 50,000 people per year DIE because of the systematic corruption and greed of Big Pharma. LOCK EM UP
The Pharma problem is the tip of the iceberg, where profits supersede everything. Add to the insult; these same companies buy our politicians and sow disinformation, confusing the public. Lastly, an electoral that is concerned with its welfare rather than society at large completes the circle, a sick society. Trump presidency and his ability to maintain support is a reflection of all of the above.
More death and sickness probably occurs from capitalism gone astray, than fatalities from all the wars that America has fought. Democrats who take money from large companies are equally complicit as the GOP. Unless the public demands the removal of large donations from corporations and demand regulation that benefits the nation as a whole, this problem will continue to fester and get worse.
Although it may not be obvious, these issues affect everyone. Does it make sense to let companies pollute our air and water? Does it make sense to allow drug companies to push drugs that we don't need? Does it make sense to let the food industry lace our food with harmful pesticides and anti-biotics? Does it make sense to let health companies charge exorbitant fees for the most basic care? This problem will only change when we elect honorable and decent people that work in the best interest of all Americans.
1
Let us stipulate, as Mr. Kristof does in what amounts to an aside, that virtually no drug-user was held down and forcibly injected with their first shot. None. Nor would the drug-user, usually coming from a drug-centered culture, fail to know the risks involved and the inevitable result of addiction. It is all around them.
Taking shot #1 probably qualifies, to most other people, as proof of some mental illness. But how is this to be "treated"?
Progressives will wail about the need for "community" mental health services--but what they cannot dal with (or admit) is the necessity to intervene with individuals (and, also citizens with full Constitutional rights) in draconian, intrusive, and largely extra-legal ways. In this, as in so many other areas, progressives are more than willing to build organs of the state that will do just this. They just won't admit it.
2
As another aside - I just had major surgery for cancer. I was only offered Tylenol and had to more or less beg for even a very low dose of opioids. All of this because of a bunch of people who misuse products, steal from pharmacies, but heroin or fentanyl. Yes there are certainly people who became addicted to opioids by using the products as prescribed, but there are many many many more who abused the system, use legal products illegally or went straight to street opioids such as heroin or imported fentanyl. And because of these folks, everyone else has to go through painful recoveries without adequate pain coverage. Great outcome.
5
The comparison of the pharma executives to drug lords is appropriate. So why does our legal system treat them differently? In both cases, the CEO and the drug lord know that their product will kill an untold number of people, and that they both will profit from this. The big difference is that the pharma industry spends a sizable amount of money with state and federal legislators to favor their product. Somehow those lobby dollars make it alright.
This shines a light on why we absolutely NEED government regulation, Planned Parenthood, Title X, and easy access to free or cheap forms of highly effective contraception such as the pill, IUDs, Depo Provera etc. It doesn't help moms, babies, or society to make reproductive care difficult to get.
6
J&J just settled for $250 million. That’s about $25,000 for every death. 2019. The year we decided that the horrific death of a loved one cost less than a Ford pickup. Hell hath frozen.
3
Yes, what you say is true. In 1984 I worked at the Center for Comprehensive Health Practice with Norma Lieff who educated addicted mothers of newborn infants on child development. At the time I was on the way to my PHD in psychology and I now a clinician in Ma. I also have faced personal tragedy because of addiction. So far as I can tell we have not taken advantage of the educational system to teach people the biology of addiction using neuroscience and population studies, it is just not part of the curriculum. It might help as well. Part of the drop in life expectancy in the United States is caused by the misuse of alcohol and drugs, legal and illegal. Harm reduction, treatment expansion and all the rest is imperative. But so is teaching young people, their parents and others about how harm occurs is a channel not well explored in my estimation. It would be my pleasure to develop curriculum for health/science about addition, nutrition and climate change, early cardiovascular disease and drug use, yoga, anxiety and neuroscience and so forth. So many patients I treat, young and old, are clueless because they haven't been taught. JK
2
I have a friend whose specialty is rural health, who took into her house a former employee and her grand baby who was born addicted. It was awful. Constant crying and inconsolable. So clearly opioids produce the tragedy of addicted babies, but so does crystal meth. According to another friend, nineteen years as a public defender in Preston County, WV, and now an assistant prosecutor in Taylor County, WV, who handles abuse and neglect cases, by far the greater percentage of the cases she's deals with involve methamphetamines rather than opioids. Is the reason we don't hear about it money? For as she put it, you need money for opioids. Is it because there are no pharmacy companies to sue? Why isn't meth addiction covered, or even mentioned--even after Breaking Bad?
5
No money in meth for the class action lawyers. They could sue a cartel but that probably would not end well.
1
I have a friend whose specialty is rural health, who took into her house a former employee and her grand baby who was born addicted. It was awful. Constant crying and inconsolable. So clearly opioids produce the tragedy of addicted babies, but so does crystal meth. According to another friend, nineteen years as a public defender in Preston County, WV, and now an assistant prosecutor in Taylor County, WV, who handles abuse and neglect cases, by far the greater percentage of the cases she's deals with involve methamphetamines rather than opioids. Is the reason we don't hear about it money? For as she put it, you need money for opioids. Is it because there are no pharmacy companies to sue? Why isn't meth addiction covered, or even mentioned--even after Breaking Bad?
2
Yes, addressing the causes of addiction have to be addressed. But right now let's help and stop the torture of babies born in withdrawal. How much can an innocent baby cry, writhe until it dies from exhaustion and dehydration. The video is heart wrenching. Do the big pharma and the powers that be have a conscience or empathy? Obviously not. They are directly responsible for the infant's infinite distress and perhaps death.
1
@NNI
The person directly responsible for the infant's infinite distress and perhaps death is the mother who decided that her need to withdraw from society was greater than her need to have a healthy infant.
Big pharma's responsibility is at least one step removed from hers, but they are a more popular villain than drug addicted mothers.
4
@NNI
No, the one person directly responsible is the mother. Beyond facing a charge of felony child abuse, the mother should have undergone an immediate tubal ligation once her newborn baby tested positive for illegal drugs. Given that 85% of these sorts of pregnancies are unplanned, it's the least that society should do to protect both itself and future innocent babies.
6
“Almost 80 percent of heroin users began with prescription pain pills, though not necessarily prescribed to them.”
Obviously most addicts didn’t have prescriptions or if they did, how legitimate were these prescriptions?
As for parental planning, if Planned Parenthood actually did more than just provide abortions and dispensed condoms, then why were these addicts getting pregnant? So if the Trump Administration is limiting funding there wouldn’t be a significant impact since addicts did not take advantage free birth control measures before.
3
@MDCooks8,
First, many addicts don't start out with "street drugs". They are inappropriately overprescribed by doctors and dentists. Once dependent, the addict engages in drug-seeking behavior with other doctors, or buys from the street.
Second, regarding Planned Parenthood, most of their services are NOT abortion-related, but rather related to reproductive healthcare - providing birth control, GYN exams/Pap tests, breast cancer screening, and STD testing and treatment for both women and men. With the cutoff in funding for Planned Parenthood and other clinics like it, expect more neonatal abstinence babies to be born. And, to be clear, Planned Parenthood never received federal funding for abortions. The new restrictions on Title X funding mean that no clinic receiving those funds can even mention, educate, or refer patients to other providers for abortion care. It's a gag order and interferes with the doctor-patient relationship.
2
The Opioid crisis took root under the previous administration. Those officials and agencies should be held accountable.
2
The Opioid crisis was firmly entrenched in the previous administration, but did not start there. There is plenty of blame to go around. Big Pharma and its sales tactics, physicians who should have known better, the despair of an economic downturn that started in 2008 at the end of the Bush administration, the genetic tendency for addiction of certain people, miseducation of the public, lack of government oversight and an Opium industry that thrived in Afghanistan following the US invasion.
We need to move forward to find some workable solutions.
2
Along with treatment programs for pregnant women and continuing federal support for Planned Parenthood and Title X programs, I would be more than happy to see pharmaceutical executives serve long and arduous prison terms.
That newborns suffer so greatly is beyond the pale and to watch this infant struggling is heart-breaking.
While these newborns struggle it is more than fitting that those responsible for these appalling and unwanted hardships also face their own appropriate and long-term misery. These executives, pharmacists, doctors et.al., should not rely on their legal teams for shorter sentences but serve the longest and harshest prison terms possible.
1
These babies are absolutely addicts. No one is suggesting it’s “their fault” but they suffer terribly.
I grew up with a girl who was a few years older than I, the daughter of a close family friend.
I must have been about ten, and she about fourteen, when she died. It was the early eighties. I learned not only that she’d been adopted, but that she must have had a prenatal exposure and neonatal addiction to drugs. Her adoptive mother had not discussed this with her. The first time she tried a drug as an adolescent, there was no “experimentation” phase. I never learned the details around her death (I know that heroin was involved, and that she was a runaway, but not whether it was overdose, suicide, or some other cause). Her mother felt great regret that she had not educated her differently about her risk, though it wasn’t clear what that might have changed. Needless to say it changed my perception of the dangers of opioid addiction.
Mostly, that addiction is forever, and that once you become addicted to opioids, death is always on the line.
5
Where was the federal government oversight if 1 pharmacy in a town with a population of only 400 people sold 13 million pills?
So now comparing pharmaceutical executives to drug cartels is supposed to gain sympathy?
This heartbreaking story barely glosses over the added problem of the simultaneous reduction in family planning services for poor women and the ever tightening restrictions on abortions... together with the ever shrinking horizon of opportunity in America, especially for the poor and uneducated who are thick on the ground in capitals of hopelessness like West Virginia. Blame those feckless victims, blame pharma, just avoid addressing the real problems in America at all costs, that’s our bedrock policy. PS, it doesn’t work.
4
My heart breaks for these innocent babies who are going through withdrawal from the time they are born.
The pharmaceutical executives who are blaming the users of their opioids are the equivalent of those who murder their parents, then claim that they are victims because they are orphans.
If the drug manufacturers and the doctors who accepted kickbacks are not prosecuted to the fullest extent of the law, not only will they have gotten away with murder, with ruining the lives of countless victims, and for causing the agony of their tiniest victims, who start going though withdrawal from the time the umbilical cords is cut , but also will embolden the other drug manufacturers who are selling drugs which they know are harmful, or plan to do so in the future, just as the manufacturers of opioids were emboldened by the failure to prosecute prior drug manufacturers ,including the ones who kept the DES to which I was exposed in utero on the market long after they knew that DES caused cancer in those exposed to DES in utero.
Innumerable" DES Babies " have died of cancer due to in utero exposure to DES.cancer. Others, including my sister, have DES induced cancer now. Some have T-shaped uteruses. Some have had miscarriages and stillborn babies. The rest of us are ticking time bombs.
Those responsible must be prosecuted to the fullest extent of the law, both as punishment & as a deterrent to their fellow executive .to protect others, including unborn babies.
2
My heart breaks for these innocent babies who are going through withdrawal from the time they are born.
The pharmaceutical executives who are blaming the users of their opioids are the equivalent of those who murder their parents, then claim that they are victims because they are orphans.
If the drug manufacturers and the doctors who accepted kickbacks are not prosecuted to the fullest extent of the law, not only will they have gotten away with murder, with ruining the lives of countless victims, and for causing the agony of their tiniest victims, who start going though withdrawal from the time the umbilical cords is cut , but also will embolden the other drug manufacturers who are selling drugs which they know are harmful, or plan to do so in the future, just as the manufacturers of opioids were emboldened by the failure to prosecute prior drug manufacturers ,including the ones who kept the DES to which I was exposed in utero on the market long after they knew that DES caused cancer in those exposed to DES in utero.
Innumerable" DES Babies " have died of cancer due to in utero exposure to DES.cancer. Others, including my sister, have DES induced cancer now. Some have T-shaped uteruses. Some have had miscarriages and stillborn babies. The rest of us are ticking time bombs.
Those responsible must be prosecuted to the fullest extent of the law, both as punishment & as a deterrent to their fellow executive .to protect others, including unborn babies.
1
I have tremendously mixed feelings over seeing the video of the newborn in withdrawal. On one hand, I have never seen such tremors or the situation of withdrawal, newborn or not, and the video is definitively powerful in a way words are not. On the other hand, I feel as though the baby and yes family and mother's health privacy is being invaded and perhaps even exploited. Mr. Kristof often takes care to protect people facing health crisises in developing countries, including refugee camps. Was equal care considered or taken in this situation within American borders? How was this decision made?
2
There is an answer to the opiate crisis. It is to offer traditional opiates like oxycodone, oxymorphone and hydromorphone through out patient clinics similar to methadone clinics. Methadone was only originally chosen as a maintenance opiate because of it's long half-life. But it is not ideal as an analgesic or maintenance opiate. Many do not feel quite right on methadone or buprenorphine and ultimately return to full mu-agonist opioids. My idea to offer full mu-agonist opiates through out patient clinics would both decrease overdoses, decrease the use of fentanyl, allow pain patients access to opiates. Doctors would no longer have to be concerned about drug seekers, patient could be referred to clinics. Opiate user could take opiates indefinitely, or slowly taper down, it would be their choice. There is no downside to this idea. This is something that will actually help resolve the crisis and help users and pain patients alike, as opposed to crucifying pharmaceutical executives, which is not helpful in any meaningful way.
1
@greg
Good idea, greg. and the pharmaceutical companies should be forced by our government to supply it to clinics at their 'fully burdened cost' + 10% only!
2
@greg Greg, the downside is that easy access to full mu opiates will cause more people to be addicted. That's what caused this in the first place. When Perdue and others started pushing this "easy access" idea in the 80's and 90's, I bought into it. It was wrong. Opiates should not be easy to get.
@kitanosan Its for those who are already addicted or need long term opiates. What are you talking about?
What we really need is medication assisted treatment, with methadone, picked up once a week.
Imagine if 80% of cardiac patients went untreated. How is this different?
3
@dr. c.c. Why methadone? Why not oxycodone? Oxycodone is a better drug in several respects. Methadone was only chosen as a maintenance opiate because of it's long half-life.
@greg Long acting medications are superior to short acting ones in the treatment of addiction, because there is less opportunity for inter-dose withdrawal.
Methadone is the tried and true standard of addiction treatment.
What are these advantages of Oxycodone? As a psychologist treating addiction since 1972, I know of none.
2
@dr. c.c. Less sedating than Methadone and satiates opiate users better. Long acting form of oxycodone could be used. As a psychologist treating addiction since 1972 you are set in your ways and not open to new ideas.
I'm amazed that these hospitals are using methadone, instead of Buprenorphine, to treat newborns with this symptom. You write that the hospitals then try to wean the infants off the methadone over "2 to 3 weeks." But methadone is notorious as being the hardest opioid to wean off off, due to its very long half life.
"Methadone withdrawal symptoms are reported as being significantly more protracted than withdrawal from opioids with shorter half-lives." Wikipedia (and lots more research on PubMed says the same.)
I don't think that 2 to 3 weeks would be time enough to wean the infants at all, so no wonder they're distressed--they're in methadone withdrawal!
Starting them instead on Buprenorphine, then allowing a much longer taper off, which--unlike methadone--can be done at HOME, would be a much more humane way to treat this.
I don't know if there are FDA restrictions on prescribing Bupe to newborns, but if so, they should be reconsidered ASAP and dropped!
5
@PNRN There are some places that use bup. A recent NEJM RCT found it decreased length of treatment when compared to morphine. There aren't head-to-head trials of methadone vs. bup, however.
That said, treatment at home is problematic. Often, infants are discharged to providers who are not comfortable tapering which leads to very long exposures to a developing brain.
Many hospitals now, are treating outside of an ICU, keeping mom/baby together. We only treat about 20% with a med (We use morphine).
2
This reminds me of a cohort of newborns I saw 50 years ago at an inner city hospital. A strikingly large number of infants in the newborn nursery were-- like these described-- in methadone withdrawal. Their mothers were former heroin- addicted prostitutes who had gone on methadone when the pregnancy made their source of income untenable. Many also had a history of other polydrug sporadic use while on methadone. Beyond the withdrawal, most of the babies had another problem-- the mothers (once delivered) had soon checked out of the hospital and vanished back onto the streets to resume their addiction and the trade that supported it. Given the damage, the babies were not great prospects for adoption. Their plight was horrifying.
7
Mr. Kristof,
I appreciate you focusing on this issue, but have concerns. You cite our team's research in the article (1 infant born every 15 min). I'm a neonatologist and a public health researcher. My work focuses on how the opioid crisis has affected pregnant women.
Babies cry for drugs, not milk - Milk is better treatment than drugs. For moms in recovery on meds like buprenorphine, breastfeeding is safe, reduces withdrawal severity, promotes bonding. In our program, only 20% of opioid exposed infants are treated with morphine - 80% of eligible moms breastfeed.
Babies cannot be addicted - Using terms like "born addicted" is not accurate and stigmatizing. Addiction is continued use despite adverse consequences, babies don't continue to use ... terms like withdrawal, dependence are better.
Suffering - Babies who are at risk or have withdrawal don't have to suffer. If you treat them. First step, keeping them out of an ICU with their moms. It works.
Treatment - Medications for opioid use disorder work, see recent report by the National Academies, but pregnant women can't get access. We know that meds for OUD decrease risk of relapse, death & increase chance infant will be born at term. So, we are trading a sick infant born months too early vs. one who is at term with withdrawal - that's a good trade. 50% of US preg women in treatment don't get these meds.
There's much work to do. We need comprehensive, public health approaches for mom/baby.
Stephen Patrick, MD
23
What specific crimes did pharmaceutical company executives commit that they could be charged with?
5
@Steven Herbert Mr. Kristof thinks patients should manufacture their own opiates in their basement I guess.
Hello Mr. Kristof,
I am a full time nurse in a Neonatal ICU and a current Neonatal Nurse Practitioner student, I am first hand witness to the opioid crisis every day. Like you stated, majority of these women do have tremendous guilt and are very well meaning. Being guided towards methadone or subutex treatment is the right thing to do during pregnancy. It is very dangerous to the mother and the developing fetus if the mother attempts to stop using. In fact, better prenatal care typically involves an increase in one of those maintenance drugs do to the altered pharmacokinetics in pregnancy.
Prenatal, in hospital and post partum support and education is crucial for these mothers. I realize that the ultimate goal is to stop this problem at the top with the big pharmaceutical companies. While we are trying to figure out a way to do that, we need to educate and support not only the mothers but the healthcare workers that are caring for these mothers and their babies.
Thank you for your piece,
SFS
13
The sequelae continue after the nursery withdrawals. Teachers know which students suffered from neonatal abstinence syndrome. They are the ones with behavior and learning disabilities, needing social and psychological support - the very services being eliminated in state budgets. Any pharma settlement money needs to also address this continuing issue.
6
Many of the comments I've read below show a complete lack of understanding of addiction. I'm not surprised. Most people believe addiction is a choice and if only the addict had willpower, they could stop. As a nurse, as well as a child of an alcoholic father and mother of a child who struggled with addiction, I have seen what addiction does to the addict and their loved ones.
Addiction is a disease and can happen to the best and worst of families, it knows no gender, race or whether you're rich or poor, or a bad or good person. People can abuse drugs and do so for various reasons but are capable of stopping, but true addicts need their drug of choice whether it's alcohol, cocaine, heroin, meth or any other mind altering substance. It is a life long struggle and it is not so simple to just say "no".
As a society we need to rethink our treatment of people struggling with addiction. People need to be educated on the physiology behind addiction, treat it like the disease it is and remove the stigma around addiction. Punishing the addict is not the solution. We have to have compassion just like we do for people with other health problems. Otherwise babies will continue to be born and suffer withdrawal, families will be torn apart and people will continue to overdose and die.
19
@eksmom
Very well done, eksmom. I'm a retired physician and neuroscientist and could not have said it better than
you!
3
@eksmom
I agree with all of what you have said, but one thing you did not explain is the initial choice to start the drug, before the patient is addicted. I doubt that there are many people in the US who do not know that there is the possibility of becoming addicted to heroin, meth, or whatever. Deciding to take that first dose is playing Russian Roulette with one's life, yet thousands of people do so every day.
This is the point of choice and free will, and this decision can be blamed on the individual, not society, big pharma, or anyone else.
6
"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."
A major reason we have this problem and other problems impacting health care in America is money and greed. Not certain that government control of all aspects of health care, including the medications that are made available for treatment, is the answer, but the system we currently have is certainly not working. Thanks fo this op-ed.
5
Demonizing pharmaceutical opiates will only make things worse. Pain patients that need them will not be able to get them. No one seems to care about them. They cannot make their own opiates. A qualified drug manufacturer has to produce the opiates. How else is it suppose to work? Ultimately this will only lead to more overdoses as those who are opiate dependent will have no choice but to turn to dangerous street fentanyl. During prohibition, alcoholics went blind and dies from drinking sterno and wood alcohol. The answer isn't to further restrict opiates.
1
Millions of pills were dispensed from a pharmacy in Kemit, WV, population 400. I understand where you are coming from, because my West Virginia mother had a full spinal fusion, and had difficulty getting the pain medication she needed during Nancy Reagan's Just Say No days. However, the pendulum has now swong too far the other way. We need to find a balance.
6
@Lisa Mann
You're absolutely correct, and I speak from more than 50 years experience as a physician and neuroscientist.
The pendulum has swung too far the other way. But even worse, we've known for a very long time that not only can opioids be very addictive, they're also very ineffective in
alleviating severe pain -- especially that from
spinal pain and from many other neurological causes.
There's a crying need for non-opioid drugs
to be developed to address this reality, and the medical community and pharmacological
industry have been unforgivable lax in responding to it.
4
This is a multi-faceted problem.
First, without demand, there would be no supply. The demand exists, so entrepreneurial - and predatory - suppliers, both legal and illegal, exploit it.
As a nurse practitioner for 25 years, and a professor of health policy, here are my recommendations:
First, decriminalize being a drug user. Yes, selling drugs is definitely a crime, but pregnant mothers who test positive for drugs in certain states, are arrested, jailed, and lose custody of their infants. All this does is drive them away from prenatal care, resulting in even worse outcomes.
Second, that 5th vital sign. Pain. We now know that was counter-productive. Some patients are stoic, and will not admit pain, while others over-report, and beyond that, factors like anxiety, fear, and fatigue alter perceptions of pain. We need to present realistic expectations to patients on how pain can be reduced and managed without opioids, e.g. NSAIDS, physical therapy, massage.
Third, prescribers bear responsibility. Commenters reported receiving Vicodin after a tooth extraction. This practice is not recommended, but dentists still do it. Other prescribers still order opioids for a sprained ankle. Why? That is not what evidence-based practice guidelines recommend. Some prescribers flaunt the guidelines, as if they know better.
Lastly, the suppliers. Sue them, jail them, but understand that, without addressing all factors, we are doomed to seeing articles like this far into the future.
3
@JE
Spot on, Professor JE!
One of my grandchildren was born with cocaine in his bloodstream which clearly evidenced recent maternal drug use.
The baby went through minor withdrawal symptoms.
Social workers from the local child services agency, all mandatory reporters, DID NOT call the police or the prosecutor.
The hospital's professional staff, all mandatory reporters, DID NOT call the police or prosecutor.
The mother was never prosecuted for drug abuse or injury to the then-unborn child.
My demands for law enforcement action were disregarded.
Explain this situation to me sometime as I don't understand it.
5
So exactly what positive outcome you expected? What should the police do? Unlikely that they have the training, resources, or time to attend to this.
Fortunately or unfortunately, family and relatives on their own, hopefully with access to treatment and healthcare, can best handle situations like this one.
@Pat Cocaine is not teratogenic. Should a woman be arrested for taking doxycycline during pregnancy?
In a truly "free market", producers of products would bear the societal costs of their products as well as enjoying the profits.
This should apply to prescription drugs as well as fossil fuels, plastic packaging, assault weapons, and so forth. The linkage of costs to profits would discourage a lot of toxic human behavior. If Purdue, J&J, etc. had to pay for the mess they caused, would they have peddled those pills with such enthusiasm? They knew how addictive they were.
Next time you meet a free market advocate, ask them about societal costs, and who should bear them.
We desperately need accountability, but it goes far deeper than the behavior of a pregnant woman. It goes to the root of our free-for-all winner-take-all economy.
5
As always, I'm grateful to Mr. Kristof for bringing a heartbreaking injustice to light, this one in our own nation. While we reform our drug and drug treatment policies, I hope more of the media will also explore (as the NYT has begun to do) the economic and social policies that have fueled the rise in America's "diseases of despair."
3
There were so many people involved in the creation of this drug epidemic, I don’t know what the benefit of sending a handful of executives to jail will do beyond providing a sense of vindication.
So far the only thing that seems to have worked (in my lifetime) in getting the population off of a very addictive drug was the campaign against tobacco. Perhaps there are lessons to be learned there.
2
Hmmmm... perhaps prevent the next epidemic? And justice?
If there is no justice why would citizens obey any laws?
One potential solution for discouraging profiteering from others’ illicit activities is to impose a 100% tax on profits for those earnings. If we know that a percentage products are being sold illegally, the manufacturer should be required to return those profits. This would likely have positive ramifications across multiple preventable epidemics afflicting the US. I.e. opioids, guns, vaping, etc. The moral rot across executive board rooms in the US likely stems from complete abdication of our elite business universities who chase money as “nonprofit” institutions themselves . It will take a generation to fix, but if we never start it will never happen.
2
I teach special education to students with cognitive and emotional disabilities resulting from substance abuse from drugs and alcohol during pregnancy. I witness the consequences of substance abuse on these children every day and for the rest of their lives. These are broken children who will grow up to be broken adults. Women whose babies test positive for drugs should not be allowed to destroy the lives of more children, because they often have more babies under such circumstances. They should be sterilized and then do whatever they want to only destroy their own life. Yes, I am punishing the women. This will never happen, but it should, because I live the consequences every day at my school with my students, and it is heart breaking.
5
@dba The pain of what you see every day clearly comes through in your reply. Sterilization is an extreme suggestion though. There is a sad history of young women being placed in "mental institutions" and forcibly sterilized. Years later there were lawsuits and massive judgments. Would it not be better to properly fund treatment programs and to provide access to birth control and abortion services. As Mr. Kristof points out many of these women are heartbroken and guilt ridden about the results of their addiction. I expect many of these women would choose to terminate a pregnancy rather than bring an addicted baby into our seriously messed up world.
2
Keep in mind, the GOP is doing all they can to make it as hard as possible for women--especially poor women--to get long-acting birth control or abortions. So women who have the misfortune of an unplanned pregnancy--even from rape--are increasingly facing no choice but to carry the pregnancy to term. Addiction treatment is not readily available in many places, and getting off opioids during pregnancy is itself dangerous. In many places in the US pregnant women using opioids, even with a valid prescription, are prosecuted for child abuse. So none of us should be surprised when drug addicted women avoid prenatal care. Even if you don't support a woman's right to control her own body and reproduction, we should all agree that babies have a right to be born only to people who want them and are equipped to care for them. Birth control and abortion are as much about supporting children's rights as women's rights.
32
Nicholas Kristof, you have a beautiful soul. You write so powerfully and with such empathy on behalf of the needy, the downtrodden, those without a voice, the desperate children and babies. You are a gift to us all. Thank you.
9
@Marian Jarlenski hits on something very important - with excellent care, addicted babies can have bright futures. One reason that is so critical? The audience for this column could be potential foster parents to babies in need. Show that these children can make it through this horrific stage with medical care - and as one commenter wrote - and live a sparkling life with full developmental capability. Let's please open up that fostering avenue wider instead of shutting it down with the bang to all but the most incredible, saintly, giving people.
7
I am a family nurse practitioner practicing 35 years. It is all true that pharmaceutical companies'advertising and mouthpieces, the salespeople, called reps, told us that opioids would not cause dependency in people who had pain. In fact, dependency can develop after only 1 week of taking opioids. Dependency is different from addiction; a person is dependent when symptoms of withdrawal occur. Addiction occurs when a person seeks more drug, seeks higher doses of the drug and when their occupational and social roles are disrupted.
In the late 1990's and early 2000's, I was offered free dinners and pricy restaurants with "lectures" about opioid prescribing nearly every month. Sales pitches. I could have become a paid presenter, and would have been flown to Puerto Rico to be trained in how to give a sales pitch "lecture" or "educational CME" to other nurse practitioners about opioid prescribing. I could have been sent to cities around the US, all expenses paid (plane fare, hotel, meals, plus payment for giving the "educational" talk) by pharma, to give a 40-50 minute opioid sales pitch.
There is so much that is unethical about pharma advertising. And there are lots of sources of more objective information about medications and their prescribing available to me.
I agree that the pharma reps need to do prison time.
37
@Deborah Wolen
Very eloquently said, Nurse Practitioner Wolen.
I'm a retired physician and neuroscientist with
more than 50 years of experience and couldn't
agree more every SINGLE word of yours.
4
When I was in nursing school at the same time, we were specifically taught that people would self wean from pain medications as they recovered from surgery or illness. Because of that, pain medication was NOT addictive when medically prescribed.
I remember being surprised by that information, but wanted to believe it.
I don’t know specifically how that information was infused into the nursing curriculum. If it was directly from Big Pharma, it just shows deeply embedded the misinformation was.
1
We have three crises in this country that pose an existential threat to individuals and, tangentially, to the nation. Climate, drugs and guns. Each of those dangers are promoted and directed by way of greed. Climate and guns are more abstract but drugs are easy to see and define. Those at the top of that food chain that act in their self interest without regard to the damage to life, lives and the health of our society are the most heinous of criminals and deserve the same treatment as the garden variety gang members they so willingly support committing to prisons for acts far less damaging than their own.
14
@PG
I agree about the 3 dangers. But climate change
is the big one. It has arrived and threatens all of us, even those who don't believe it exists.
The wildfires, increasing hurricanes, crop destroying torrential rains, tropical diseases moving north; high nighttime heat.
We need to prioritize that. All of us need to get out the vote for the next election.
Doctors who fall for the advertising, marketing,and kick back techniques of pharmaceutical companies are equally complicit in the opioid crises.
14
@MK
You're absolutely right, MK, and as a physician
and neuroscientist who considers it unthinkable
to prescribe any drug -- much less a very
addictive opioid, for goodness sake -- unless it's absolutely indicated, I think any and all doctors
who have any degree of collusion or cooperation
with the criminal pharmaceutical companies who share responsibility with them for causing this
crisis should go to prison with executives of those companies who were involved in this unforgivable
activity.
The greedy and corrupt so-called "Doctors" and
the greedy and corrupt pharmaceutical executives
would make jolly cellmates!
1
Fetal Alcohol Syndrome
Alcohol hinders the supply of oxygen and nourishment to the fetus.
When the fetus is exposed to alcohol it effects the development of tissues and organs, and can cause permanent brain damage to those babies.
My son is a resident in Psychiatry. He would disagree with the concept of the pharma companies creating the Opioid crisis. He has seen numerous persons with drug or alcohol problems. Crack is particularly scary. It's illegal, but easily available. People with little money would rather use crack than eat.
He's mentioned that, persons born with personality disorders or some other form of mental illness are at great risk for drug and alcohol problems. Bad parenting is responsible for most of the rest.
Drug addiction problems may begin with alcohol abuse. The parent's abuse!
6
@Texan
Your son is a Resident, not a full fledged physician with many years of experience. There is enough blame to go around and so called “bad parenting” is just one factor in a myriad leveled problem. Plenty of people with opioid additions have excellent parents but bad physicians who poured narcotics on them after knee surgery for a soccer injury....it’s just easier to “blame” the so called “crack” heads.
Maybe your son will change his tune after he’s had 30 years in healthcare and sees that there is plenty of blame for all....
1
Yet more reasons to make birth control free and accessible. It won't stop people from making careless, irresponsible choices (yeah, I know, they have a "disease") but it might mitigate some of the peripheral damages of addiction. Many of these kids, in addition to the moms, will be very expensive wards of the state for years to come. The taxpayer is, as usual, the forgotten victim in these sad cases.
11
I am the illegitimate son of an alcoholic mother and heroin addicted father.Born in the fifties when we as a nation would put shameful behaviors out of sight rather than face them.When I started medicating my pain in adolescence little did I know what lay ahead of me.Jails, institutions and death are the consequences of addiction. With much help and compassion I was able to break the chain of addiction thirty plus years ago.My children are well aware of my path and have productive lives and careers.Addiction rarely surfaces in a family randomly.Awareness and grace can transform us. I am proof of that.Thank you for shining a light on a dark topic Nicholas.
70
@bryan lemay
I, too, thank Nicholas Kristof for shining such a bright
light on a dark topic. And I thank you as WELL, Mr.
Lemay for sharing your astonishing story with us.
As you must be painfully aware, far more often than not, babies born into the tragic circumstances you were never can overcome the continuing traumas following their births. Yet against virtually all odds,
you did and are to be blessed and congratulated for it!
And while what I did professionally isn't really material to my comments, you may be interested to know I'm a retired physician and neuroscientist formerly on the staff of the Division of Child Psychiatry of a major U.S. medical school.
6
@bryan lemay Bryan, your comment is inspiring. There is hope after all. Thank you for being a heroic model for those who are victims - and those who are not - of a disease called addiction.
8
There may be a larger problem here that needs to be considered. Admissions to foster care in suburban and rural America are higher today than 20 years ago by 50 to 60 percent in some places. As of 2018, 12 percent of children admitted to foster care were less than 31 days old. That's right - 12 percent, under 31 days.
The trend toward a younger foster care population has gone unnoticed largely because foster care populations in urban areas are down substantially from where they stood two decades ago. That's important to recognize but only if doing so doesn't draw our attention away from what is happening in other parts of the country.
Opioid use and the growing reliance on foster care are symptomatic of larger issues that speak to one of the central problems of our time. Even a short drive through rural parts of our country reveals the profound economic challenges facing our communities and the families who live there. It isn't so everywhere and the exceptions are important. Nevertheless, when families struggle economically, they struggle in the most basic ways - starting and sustaining families. Doing that well takes resources they may not have.
The drug abuse is insidious; drug company profiteering shameful. But let's acknowledge this: a scourge like drug abuse cuts through a community when the social fabric is weakened by despair. The babies need cuddles; the communities where they live need prosperity restored. We all need a President who understands that.
11
As a recovering alcoholic with many friends who are recovering drug addicts, I can tell you the issue is very complex and comes down to human nature and the horrendous power of addictive substances. Some recover from addiction (I'm one of the fortunate ones), but most do not. I'm convinced we will always have this type of suffering in the world. The minute we try something that sounds reasonable to end opiate addiction, a new addictive horror will arise. The true challenge is to care for the addicted the best we can as a society, encouraging recovery for those willing to try it, and humbly accepting that there is no policy in the world that can eliminate addiction.
16
The de-funding or possible elimination of planned parenthood is a part of the problem but not the only one. If women don’t have access to or knowledge of birth control through planned parenthood then they are in a difficult position. Of course the religious right and others don’t want to give help to women for any reason. As for the opioid producing companies their CEO’s should be treated as strictly as the heroin dealer on the street: put them in prison for life and force bankruptcy on the companies they run.
30
Blessings on the nurses, doctors, nurses’ aides and volunteers who are helping these infants struggle with an addiction they were born to. I can imagine the many lonely hours spent trying to soothe these infants. Mr. Kristof, you mention the Planned Parenthood clinic in danger of closing. The gag order has forced clinics to refuse Title X funds if they wish to counsel women about abortion, or to provide this service. These funds were never used for abortion, but for all the important healthcare that the organization provides: prenatal care, birth control, screening for cancer, etc. Refusing this money has also taken away all the affordable medications that were purchased with these funds. The de-regulation of corporations, the lack of funding for addiction treatment, our under-funding of mental health treatment and now the removal of funding for clinics providing essential health services to women are dealing a serious blow to the health and well-being of our citizens. Do we need more proof of the disregard this administration has for us?
41
No, these babies are not “drug addicted.” A fine point, perhaps, but they are not the addicts. It is called neonatal abstinence syndrome, and they are totally innocent, so no calling them drug addicted, please. I am a CASA who has had cases involving NAS babies. It is severe child abuse. Most mothers do not seek prenatal care, for various reasons, including laws that criminalize drug use while pregnant. Most continue to use drugs, lots of drugs, the entire pregnancy. Here, morphine is used to relieve the babies’ distress. Most of these children will have life long problems. Sometimes the state will allow mothers to the chance to get clean and perhaps regain custody, but in my experience, the drugs win, and the babies are adopted by loving families, families who know that there will be physical, occupational and perhaps speech therapy, problems learning, and behavior problems related to their mothers’ drug use.
Drug company executives should be jailed.
43
Why aren’t more physicians held accountable. They knew the amounts of opioids they were prescribing was unreasonable and yet they caved into their patients requests. Don’t forget the Cardinal Healths who shipped the jaw dropping amounts. They knew.
13
You Are so correct. Too many physicians disregarded their oath and were willing helpers to the drug companies, their distributors, and sales people. All complicit. And yes, not all patients were innocent, either. But the patients did not create, aid, and abet this disaster. My fundamental question is whether any fundamental lessons have been learned and anything put in place that would prevent it from happening again in a different manner. Oh, and let’s not forget the FDA folks who were also complicit.
3
@Susan Parker
Good points, but as I understand things, the average opioid addict was not prescribed the drugs they got hooked on, but obtained them outside the usual medical system route. This does not let over prescribing doc or over producing pharmacy companies off the hook, but does mean there is a choice involved, just like alcohol, which is never prescribed.
2
@Susan Parker
There is no valid reason for holding not just more
of them accountable, but ALL physicians who committed flagrant malpractice by illegally prescribing opioids, period.
As a physician myself, I consider it a further disgrace
to my profession that most of the rogue so-called
"physicians" who are guilty of doing this aren't even
disciplined by their very lax state medical boards,
let alone not sent to prison as they richly deserve.
As a Nursing student in Manhattan in the late 70s, I held one of these babies during my Obstetrics rotation - I've never forgotten that infant. Bravo! Mr. Kristof for addressing big pharma's role in all of this. The fact that they testified to the innocuous administration of opioids is nothing less than abhorrent. And where is a woman to go in West Virginia if she KNOWS she cannot raise a child and finds herself pregnant? This is a national issue since we will all pay the price for what's happening.
28
Please stop blaming the pharmaceutical companies for addiction it is a personal choice wether or not to do drugs,no one comes down with addiction ,it is not a disease it is a choice and by labeling it as a disease you enable users to not have to take responsibility for their own actions an diminish the struggle of people who truly are sick.
14
The pharma companies and doctors share responsibility for the increase in prescriptions of opioid drugs, which has lead to more addictions because opioids are highly addictive drugs. People can take them exactly as their doctor has prescribed and end up addicted. I know I have been prescribed opioids many times without asking for them or even wanting them. Personally I never use them and take ibuprofen instead, but I won’t cast full blame on people who start taking prescribed opioids and end up addicted.
14
@EAH
Actually, many people become addicted while taking opioids as prescribed by their health care providers. The pharmaceutical companies promoted the myth that one couldn't get addicted as long as one took the meds "as prescribed," but that has been proven false. Please educate yourself before so callously condemning all addicts.
4
The babies didn’t have much choice
5
This is heartbreaking to read about (and see, in the video clip), but thank you for writing about it, because its effects are rippling through this country, and the criminal behavior of the businesspeople who brought this on, the health care system that prescribed it into existence, and the current administration's worsening of the problem cannot be ignored.
I've just finished reading Beth Macy's "Dopesick," and I'd recommend it to anyone as a deeper examination of the opioid crisis and call for action.
11
All true. But until we begin asking why so many Americans use these poisons, we will get nowhere. How many of the newer addicts were victimized at the onset of their addictions by the pharmaceutical companies? Fewer and fewer as that source of drugs closes. Yet, young Americans continue to seek this lifestyle -- why? Heroin and fentanyl are not in the air around us and infecting us. Injecting drugs cannot be easy. But still people become users and then addicts. Why?
6
@Robert Bisantz Blame The victims, that’s always easy.
I am a retired OB nurse. Here in Oklahoma the sourge isn't just opioids, but meth also. There was a nursery on the floor refered to as "Baby Betty Ford" where we worked on weaning and comforting infants after birth. But even if successfully weaned from the drugs injested during their gestation, we as a society must come to grips with the generation of children whose nervous systems have been damaged en utero. They enter our school systems with severe learning disabilities and frequently behavior issues, all as a result of being drug exposed before their births. Prison is not the answer, for mothers or the children that grow up as a result of their exposure. I don't pretend to have the answers, but investing in our people and not prisons must be the first place to begin.
48
Mothers who are addicts need to encouraged to get treatment not be made afraid to. It is important that people realize that with proper care before giving birth and for babies afterword, both mother and baby can thrive. I only know one such child born addicted, but he received excellent care, is a 4.0 high school student, an All American athlete, and headed toward the ivy league, despite being "poor."
Articles that only talk about withdrawal remind me of the "crack baby" scare and will frighten mothers from seeking treatment for fear of reprisal (as is happening too often now).
5
I want to point out that kickbacks for prescribing are illegal in their own right and should be prosecuted. Most Pharma companies have not and do not do this.
7
@Carly
Direct monetary kickbacks are prohibited, but Pharma has plenty of work-arounds to reward their biggest prescribers. I've seen a variety of cushy perks bestowed, including private plane travel to conferences and meetings in luxurious vacation destinations. And I am constantly bombarded with invitations to attend "informational dinners" (free) at which doctors (and occasionally nurse practitioners) promote drugs. For this, they are paid handsomely. While the public is becoming suspicious of such ties, most prescribers who accept money from Pharma defend the practice as appropriate compensation for their time and expertise. They also like to claim they are helping Pharma improve patient care. For many, their ties to Pharma are considered evidence that they are smarter and more valuable than their colleagues who eschew ties to Pharma. You should see how they chuckle with condescension when they have to disclose those conflicts of interest. For what it's worth, I emphatically refuse to attend any events at which a prescriber is paid to talk about a drug. I told one pharma rep to let me know when a prescriber is speaking for free, simply because she/he wants to share useful information. In my 12 years in practice, I've yet to see this.
9
I would posit that executives in three-piece suits are far more guilty than drug lords: el Chapo never pretended to be working for doctors and hospitals. Or, to put it another way: wolves hiding in sheep's clothing are far more dangerous than wolves - because we know to stay away from wolves.
50
I have worked with opiate addicted babies for 30 years. For most of them, withdrawal is a 5 to 7 week process using morphine or methadone and sometimes phenobarbital. Trying to speed it up just drives the babies into full withdrawal. It takes as long as it is going to take - newborn physiology is what it is. Neonatologists are sometimes afraid to prescribe opiates for these kids, fearing the DEA or not understanding the process.
34
We need a general acknowledgment that businesses do things like the pill-pushers are getting caught doing unless they judge that they cant get away with them. It is not because some of the businessmen are bad (although some are bad) but because bad things are rewarded by the system.
We will not get accountability and deterrence until we know that the nature of business makes them needed and why this is so.
6
@sdavidc9
You are quite right. Robert Reich has articulated this very well. As long as corporations are expected to maximize share-holder profits, that is exactly what they will do, in every way possible, even unethically and illegally, if they think they can get away with it. And occasionally getting caught and "punished" is just considered a cost of doing business. We need to make laws and regulations to address this, and fully fund the necessary oversight and enforcement.
5
All this talk about how awful the pharmaceutical companies are with no discussion of the politics that exist in West Virginia. First, let’s remind everyone that the state that supported Trump the most was Wyoming, but second was West Virginia. They have been dominated for decades by the Republican party that is constantly in pursuit of lower taxes and less regulations. I have worked in West Virginia a few times. It’s all adult book stores, churches and strip clubs. There’s little opportunity, and to alleviate the void that creates, they are filling it with opium in various forms. This story is sad, but even sadder would be to live in that state under the tyranny of Republicans. And yet, West Virginians will probably vote Trump in even more numbers than last election. What’s the definition of insanity again?
90
@Josue Azul: Doing the same thing over and over again, expecting different results. Nowadays it's also known as "self-inflicted misery."
Didn't Trump promise them the return high-paying coal mining jobs?
1
I knew this could be made to be Trump's fault!
2
@Josue Azul Actually, WV was a Democratic stronghold for decades until the early 2000s. As recently as 2008 both senators were Democrats, and Clinton carried the state both times in the 1990s.
Here in New Zealand the Chinese who came to work the depleted gold fields a century ago apparently smoked opium.
We have a street named Haining Street that was infamous for what few Chinese opium smokers who lived there. Many of the later generation of Chinese born in NZ had some of this stigma attached at schools etc and at one stage the Chinese were designated the Yellow Peril.
However, as the years passed the Asians were less targeted as new drugs came to fore that were embraced by the indigenous Kiwis, Cannabis being one of them.
Now it tears at my heart to read the Nicholas Kristof article that babies at birth are opium addicted and tearful nurses have little to control their agony except with more drugs .
The once only Chinese habit that was forced on to them at the point of English cannons in exchanged for Chinese silks and other wares has devastated the US if one person is dying every 7 seconds of this poison.
The huge production companies that urged the use of their 'harmless' opioid drugs have a lot to answer for and it appears their day of reckoning is coming.Whilst enriching themselves they caused death and misery but money and fines cannot compensate for the agonies and destruction of the lives they have destroyed.
Stan Chun
Wellington. NZ
8 Sept. 2019.
10
@STAN CHUN
Mr. Chun. Having gone through that horror show myself and with an understanding of the pain involved, I'm reminded of the post war Chinese whose government thought the best way of dealing with the problem was shooting the addicted Chinese. Tough, but quick and effective, and had totally recouped a drug free population in a short period of time.
6
My son, at twenty years old, had four wisdom teeth removed. Typical for a young adult. What wasn’t typical was the Vicodin he was prescribed. Truly, I understood his pain - but Vicodin ? We had no idea.
He was kept on it for ten days. Then he weaned himself off. But it was truly a weaning off.
Now I hear that Darvocet, or even Tylenol is appropriate for post wisdom tooth removal. This is a frightful national plague. Dosing narcotics indiscriminately. Without a bare thought about the addictive side of these medications.
25
I had wisdom teeth removed in the dental chair and was told to take ibuprofen and paracetamol. Yes it ached for a few days, but what did I expect? What is going on in your country?
29
@Leslie Monteath I was also prescribed Vicodin after my wisdom teeth were removed at 19. I took it as directed and then stopped. It wasn't hard.
3
I was prescribed it and didn’t take it.
1
While addicted mothers and babies in withdrawal are certainly terrible problems, the answer is not a sweeping ban on opioids. Some of us have incessant pain that is only partially relieved by prescription pain medications, even narcotics. My chronic pain is caused by degenerative diseases and will only get worse even as options for relief become less available. Where do I turn as opioids become harder to get due to restrictions on prescribers?
Perhaps if more research would be done to find strong, effective, non-addictive pain medications and less time, effort and money spent on ways to lose weight or make eyelashes longer, we could help those suffering from chronic pain without creating more addicts.
Taking opiates away from everyone, even from those for whom they are practically miracle drugs, still leaves illicit drugs like heroin, methamphetamine and bootleg Fentanyl widely available to those seeking to get high or self-medicate. And it leaves few non-surgical options for those with chronic pain who are not helped by cannabis, injections, acupuncture and other treatments.
In this country, it seems the standard answer for most problems is, "Make it illegal." That doesn't help in most cases. It takes more effort to come up with workable solutions. We need to demand more and better solutions as well as funding for treatments that have been shown to work.
37
@Country Girl
Yes. The answer is NOT a sweeping ban on opioids. As you correctly point out, there are many people living with chronic, intractable pain for whom relief can only be found through the correct application of opioid medicines.
There needs to be more and better avenues to treatment for addicts. Empathy and compassion are the two qualities most needed.
Unfortunately, these seem to be in very short supply under a right wing, “conservative” government, both in the US and in my country, Australia. Unless and until addiction is treated as a medical and mental health issue, many more people will die.
One in five babies are born into withdrawal in VA? This is a staggering statistic; what an awful way to begin life.
9
I have been on prescription methadone, 10mg twice a day, for post-herpetic neuralgia and degenerative lower back pain for 10 years or more. I have never abused my medication and have been at this same dose for all these years. I don’t know what I would do if my medication was discontinued - I wouldn’t be able to work, keep up my house, or enjoy any of the other activities that I love. I guess what I don’t understand is why people make the decision to abuse these medications and then end up on street drugs or dead. I also suffer from depression and anxiety, so it’s not like there aren’t other issues in my life that might push me in the direction of abuse. It just never occurred to me to take “just a little more” than I was prescribed, maybe because I knew that there would be a very heavy price to pay if I took that step. Also, my physician keeps close track of when I can have a refill, right down to the day.
Maybe the reason so many people get in trouble with these drugs is because, evidently, they are so readily available to abuse. I don’t know whether to blame the drug companies, pharmacies, or doctors for that. Maybe all three. Why don’t we have better control on access to these drugs, or is it too late to put that particular genie back in the bottle? So many questions, and evidently no good answers.
7
@Country Girl
I was in Mexico last year near Cancun and tried to fill a Tylenol-3 precription. No pharmacy anywhere had any, nor anything close to an opiate. I mentioned to the pharmacist that no wonder a black market flourishes in places like this; it is the only one open. Those of us with chronic pain from accident, etc., will seek remedy no matter what the law says. We don't want to be lawbreakers, but neither will we be pawns in some bigger game.
Mr. Kristof brings up the misleading statistics that 80% of heroin users started with prescription opioids.
It's worth noting that the best research we have has shown that less that 3% of people who use prescription opioids for non-medical reasons, i.e., illicitly, end up using heroin.
And there are several reasons why so few patients with drug addiction get treatment. First is that most people in this country still view mental illnesses including drug addiction as character weaknesses not real diseases. Second insurance companies don't wish to pay very much to treat these illnesses. They will pay tens of thousands of dollars to pay for surgery so someone can play tennis or golf more easily but don't want to a few thousand to save the life of someone who is suffering with a mental illness. And, finally, because media like The Times frequently denigrate psychiatrists as simply being hand maidens to Big Pharma without any real concern about their patients along with the poor insurance reimbursement to them has resulted in a severe shortage of psychiatrists.
15
Respectfully, Mr Kristof, hospitals and physicians don’t steer patients to Methadone programs during pregnancy just because overcoming addiction is difficult. It is because drug withdrawal in pregnancy is dangerous and can cause preterm labor and delivery. Relapse is also risky in pregnancy and infection rates are higher when using street drugs. It may be counterintuitive, but methadone is safer than unknown drugs.
When women with opioid addiction have good prenatal care and are monitored closely, they can achieve a normal term delivery with maintenance therapy. Stigmatizing their addiction makes it more difficult for women to admit there is a problem and get the appropriate care.
84
@Jane K Yes, I agree on both counts. Reducing the stigma, not just for pregnant women and not just for those on opioids, but for all people with substance use disorders or mental health issues would be a huge advance. And the stigma tends, as you say, to impede treatment.
44
@Nicholas Kristof, You're right about the negative effects of stigma. But, as Jane K. accurately points out, stopping chronic narcotic use during pregnancy may lead to the fetus going through withdrawal in utero, when help is not available. Recommendations for pregnant women with narcotic dependency are to continue use with medication assisted treatment (Methadone or Suboxone) until the birth. Then babies are observed for signs of withdrawal and treated if those signs appear.
9
Thank you, Mr Kristof, for your comment and to Lynne for clarification of my comment in regard to infant health under the conditions of a pregnancy combined with opioid addiction.
5
Nick:
Cuddling and detox end the effects of opioid exposure during pregnancy.
Far worse is the life-long disability caused by Fetal Alcohol Syndrome, which doesn’t occur just in children born to alcohol-addicted mothers, but to anyone, exposed as a fetus, to alcohol at just the wrong time during development.
The effects are often not recognized because it is not typical to track whether, or when and how much alcohol a woman consumed during a pregnancy - it and smoking-related problems are possibly the greatest cause of controllable harm to people during pregnancy.
Almost anybody capable of becoming pregnant can obtain legal alcohol or tobacco.
Almost anyone who seeks them can obtain illegal opioids.
But it is nearly impossible for a pregnant woman to obtain legal opioids - or for someone prescribed opioids in sufficient quantities for sufficient time to cause addiction to carry a child.
Think about why opioids are prescribed in addiction-causing quantity - agony - raw, raging, indescribable agony.
The kind there’s no getting away from. Twentyfour hours a day, 365.25 days a year.
And the doctors who cannot issue more than a month’s legal supply are going to write for a pregnant patient?
Sorry, but the infants you saw were almost guaranteed the result of addiction to illegal opioids, who started them for reasons other than physical pain - possibly psychiatric self-medicators, but NOT caused by legal med-makers.
Please think through the rhetoric as you usually do so well.
12
I’m sorry to disagree with you, but why do you suppose “legal drug makers” have been issued huge fines, and in the case of Purdue Pharma and the Sackler family, made to get out of that business and pay part of the fine out of personal funds? It is because these companies actually pushed those drugs, particularly in poor rural areas such as Appalachia. This is fact. Read Dopesick and some of the hundreds of investigative articles in publications such as this paper and the Washington Post.
1
The penalty for using these drugs should be revised. An opioid dependent baby should be permanently removed from its mother. Big Pharma should be saddled with the child support payments. A repeat offense should result in prison time for the mother.
While I agree that most users should not serve time, I believe that the penalties for dealing should be increased. Since the death penalty is politically incorrect, even for those who transport obscene quantities, let’s substitute life without visitation rights, a total blackout of information to or from families for the length of the prison term.
5
@The Ghost of G. Washington
Please understand that at some small rural hospitals there’s are drug addicted babies born every day. This is a terrible situation for the babies but working intensively with their moms ideally in a mother baby unit caring for addicted moms and their babies together post delivery works. Education and treatment and decreasing the ridiculous amounts of these drugs both prescribed and illegal is essential.
22
@Maria Saavedra
While the results of such programs are encouraging, wouldn’t it still be much better if the moms used long lasting birth control until they had their addiction under control for a significant period of time?
34
Yes, and in drug court in my county, those are offered free to mothers willing to take them. Most of them have lost several children to adoption by that time.
2
As long as white-collar criminal CEOs of huge companies and banks have the option of paying a fine without admitting wrongdoing, things like this will continue. They either have to do hard time or (My preference next.) face execution. Perhaps if one or two of them were shuffled off this mortal coil, the rest would pay attention.
10
@Vesuviano Absolutely! And if some people's opinions were followed, we will start punishing and criminalizing the moms only instead of attacking this much bigger problem where it begins.
Time to focus on some facts. Under the ACA, treatment of addiction is considered an essential service and thus covered. If you live in a state that opted into expanded Medicaid coverage, your state rates of addiction have likely gone down, depending on how many years ago the Medicaid expansion began. The news is: treatment works. It is never perfect and we need to do so much more but when we start treating people like they have a disease, not a character flaw, we can start some of them on the road to recovery. It is arduous and torturous, full of relapse and disappointment but overall, it is the best option we have at present. And many people recover. Women may be especially motivated to seek treatment once they discover that they are pregnant if it is readily available without censure.
29
Big Pharma's CEOs will get their daily media briefing from their head of Communications. They won't actually see this video of an addicted newborn, which brought me to tears in an instant. But, they all need to see it.
13
No one made their mothers take opiods. They either bought them illegally, or asked their doctors for prescriptions.
The pharmaceutical companies and distributors supplied orders from the pharmacies. The worst than can be said of the manufacturers is that they underestimated the addictive potential in their FDA filings. But this is not something that can be quantified---it is subjective. The FDA did not challenge these statements in the filings, but approved the drugs and the package inserts that are supposed to contain appropriate warnings.
The manufacturers bear some blame, but the chief blame lies with the prescribing doctors and dispensing pharmacists (some of whom were running "pill mills"), and with the mothers who demanded and took, during pregnancy, opiods for which they had no medical need.
14
@Jonathan Katz When in doubt, blame big pharma.
@Jonathan Katz Would you say people with cancer don't have an illness or deserve medical care? Do you blame people for having celiac disease or schizophrenia? Drug addiction is a mental illness. It needs to be managed as a health problem, not a morality or law and order problem.
1
@Jonathan Katz: typically addicts STEAL or buy their opioids.
A common situation is that Grandpa gets opioids for pain -- legitimately -- maybe he is dying of cancer.
His kids or grandkids steal his pain meds and take them (or sell them).
Or they buy drugs on the black market.
Most addicts are not dying on LEGAL drugs. They are dying from illegal drugs or street drugs or because they moved from Oxycontin to Heroin (it's cheaper!).
It is a mistake to stereotype who is dying and why.
1
'I wish those executives had to cuddle these infants who, partly because of their reckless greed, suffer so much.'
All due respect Mr. Kristof, the execs still wouldn't develop a conscience.
The pathology is hardwired.
20
@Astrid Who is supposed to manufacture opiates? I don't understand who you want to make them, if not a pharmaceutical company.
Regarding Barbara from SC's comment "the zeal with which these drugs were marketed has led to the current opioid epidemic" - clearly branded opioids were culpable for some of the U.S. opioid epidemic, including pregnant women. The ARCOS data from the DEA's database has shown the vast majority of opioids dispensed over the past 10-12 years were generic opioids; generic opioids were not promoted during this time. The only way anyone could legally access generic opioids was from a licensed medical provider to which the drugs were NOT promoted. It is easy to look for a simple cause of the opioid epidemic. It is a complex problem with multiple causes. Don't overlook the prescribers and the end users as causes of the epidemic.
10
Chronic Pain is indeed a tremendous problem for some patients --and it should be considered a vital sign. It is as important, often more, to the patient's well-being than other vital signs. That many patients and individuals in hospice need these medications is something that should acknowledged in a discussion about the opioid crisis. (Perplexingly, chronic pain sufferers become far less addicted to these medications and are very aware of their many side effects, and wish to be well, generally, and this means them stopping these meds and the side effects they bring).
However, this does not mean that pain killers should be prescribed to individual patients who are suffering pain that can be best addressed by non-narcotic pain medications with far less side effects, some over the counter --and which can be prescribed in higher doses by a healthcare provider after a surgery, root canal, etc.
And the actions of big pharma's executives, who absolutely knew their products were feeding addition, who knew the drugs were being miss-prescribed, and that clearly knew as well that their product was being acquired by drug lords as only the illicit drug trade could result in those sale volumes, should be pursued both in civil and criminal court.
Still, the reasons for addiction are far deeper than trying a pill and drug companies pushing pills --the reasons are complex, and involve economic and social insecurity, a lack of support networks, a transformation of work...
13
I will not vote for a presidential candidate who does not declare this a national emergency.
6
@Liberty Apples
Agreed!
Some months ago there was a long article in the NYT about the unfairness of blaming women for mishaps in pregnancy. The main thrust was that you can't blame a woman and punish her for a natural miscarriage or an accident, for example, and that the far right was trying to criminalize these things.
But one of the more dubious points made in that article--which sought to exonerate all pregnant women regardless of the circumstances-- was that women who give birth to drug exposed babies aren't causing the baby any harm. I brought up in the comments section that drugs do in fact hurt a baby (once born, not a fetus, the results are there, just as they are with fetal alcohol syndrome) and many commenters attacked me for saying that because, after all, the far left article had explicitly said that drugs don't harm the baby.
Women who are addicted to drugs should be treated with the best methods available AND they should also be required to have Norplant or some other contraceptive method on board if they are of reproductive age. Society, if not morality, has an interest in preventing the suffering of innocent lives. They are not political or religious footballs.
Pregnancy is preventable. Drug addicted women, however remorseful they are after they give birth to a suffering and probably impaired baby, shouldn't be having babies unless and until they have kicked their habit.
61
@BG and should that addicted mother be permitted to take that child home after it is stabilized after withdrawal ? There needs to be some continued protection for that infant. The mother should be offered to be involved in her child’s hospital care and be given the opportunity to bond with them under supervision if she refuses that child should be legally placed for adoption.
8
@BG - You said "... AND they should also be required to have Norplant or some other contraceptive method on board if they are of reproductive age"
Watch that policy slide into Eugenics and political policy designed to lessen the number of undesirable voters. Women sterilized from a botched operation forced on them after a false positive drug test resulting from a poppy seed bagel, etc. Fortunately I think your suggestion would not get past the Supreme Court based on it being cruel and unusual punishment.
Nicholas
The opioid crisis is now very public and we’re all aware, very aware of it.
My question is, has the volume of prescriptions gone down? Are the medical and pharmaceutical industries still creating as many new addicts as they were a couple years ago? I think this is an important answer for us to know.
8
The number of prescriptions has greatly decreased, making it more difficult for people with legitimate need to obtain them. Many users have moved on to heroin and meth.
@Chip James Yes, and now pain patients have to suffer in horrible pain thanks to anti-opiate hysteria.
Thank you so much for writing this piece. My family and I have fostered 18 children/babies. 12 of these babies were born drug dependent. You have seen first hand how heart breaking it is to see these little nuggets of love struggling fiercely to survive through no fault of their own. What is the most heart breaking to me is all of my foster babies had siblings already in the system who were also born drug dependent. I am appalled that they want to close/defund planned parenthood. There are no easy answers, as you point out, but helping these mothers not to get pregnant would be a blessing to the mother and to society. The costs to treat these babies is astronomical and supplying birth control minuscule in comparison. I am quite certain none of these mothers, or fathers, set out to give birth to a drug addicted baby...
251
@molly parr
Thank you for this... raising the sibling issue. After birth immediately or whenever feasible the mothers must have access to some birth control device, IMO it should be mandatory-- I know how that sounds.
This is the dystopian "The Handmaiden's Tale." Life is Appalachia is bleak often... hateful weather, no jobs, no transportation out of town ( no more Greyhound buses in most places only big cities), can't hitch hike -- no one gives rides. (Bicycle on a highway -- very dangerous even motorcycles and the hills can be very steep.) So they drink less now that they can take a pill or have a shot.
Of course, by having babies they do support Walmart and myriad other companies whose business is "to return a decent dividend to the stockholders," as many a comment proclaims Many of us are to blame -- we members of the investor class.. It's not just Trump. sadly..
Warren, Yang. And impeachment hearing now.
29
@molly parr
I’d they already have siblings who were removed, it’s hard to imagine their doctor and/or case worker was not strongly suggesting long lasting birth control after the first drug addicted birth. While I too oppose defunding Planned Parenthood, I’m not sure lack of access to birth control is the issue here. As bad as it sounds, perhaps it needs to be mandated in these cases for the sake of the innocent children.
19
@Forest
I couldn't agree more. I once took care of a young child with severe fetal alcohol syndrome. Her mother had 5 other children, also all born with severe FAS, and all removed from her custody. Unforgettable, and heartbreaking. How in the world could someone argue against mandated sterilization in a case like this?
31
Big Pharma executives could not care less about visiting babies experiencing withdrawal symptoms from their drugs. Long ago, they reduced the value of a human life to a number on an accounting balance sheet, and to them that value is next to zero.
What is the lesson here? Greed is bad. Often lethally so. Empathy is good. It is our only way out.
We need to hold corporations responsible for what they do. And we need to take care of one another.
It is the same story, again and again. When will we ever learn?
30
@Blue Moon
Let's also hold the mothers and doctors responsible. No one is forced to take opiods.
My mother suffered from Lewy Body dementia. It makes people hallucinate and become angry and sometimes violent. My dad couldn't take it anymore and swallowed an entire bottle of OxyContin and washed it down with a glass of vodka. Even though my mother had dementia, she said when she saw his skin turning gray, she called 911. He was saved, spent about a week in the hospital, and that's when I moved in with them to take care of them.
So, that is another problem with unlimited access to opioids. They make it easier to commit suicide than doing violent harm to oneself. Opioids are everywhere. We are drowning in them and they are killing us, accidently and intentionally.
21
Our adopted daughter, now four, was born addicted to opioids and spent a month withdrawing in the NICU before going into the foster system. She is now doing great with us, and we all feel really lucky. Our other adopted child was born to an alcoholic mom and he now struggles daily with the effects of alcohol exposure -- a far worse drug to be exposed to in utero. Does Big Pharma need to be held accountable for their role in the opioid epidemic? Absolutely. But a reckoning will be facing the alcohol industry as well.
136
@Alison
I totally agree we should be looking at alcohol as well. I knew a mother with eight children, four of which were developmentally delayed. Both parents were alcoholics when these children were born. They did stop drinking, but after having children. It was so sad to see what happened to half of their children who were all at various programs in the state. Thank you for bringing attention to alcohol as well.
6
@Alis
Been there...
"Yes" he said in a superior tone, answering a question that was not in the mind of the listener, "She is not going to have an abortion." The sad six year old child unliked by the parents and many others in special ed in school with problems behavioral and muscular (hypotonia), possibly some learning issues. Parents drinking heavily at time of unplanned conception.
Addiction to substances can happen very quickly -- it seems immediately in those with the "right" receptors. including sugar.
2
Being on methadone can be life-saving and its appropriate use should not be disparaged as not counting as recovery. Women who are already feeling shame and guilt do not need more judgment. Yes, they are probably experiencing trauma and/or mental health disorders... Methadone frees them to live productive lives. Methadone should not be stigmatized. It saves lives. Please help people to seek MMT (methadone maintenance treatment) rather than feeling hopeless. The data show that it is similar to any other treatment for a chronic disorder (like diabetes or hypertension). People lead productive lives in recovery thanks to methadone. If you want mothers and babies to be well, advocate for acceptance of methadone treatment... It works.
39
@Suzanne
Oh nice. productive life in Appalachia.. No/few jobs; no public transportation, no TV without cable, possibly a violent boyfriend or girl friends, can't afford the AC on hot humd days -- over 90 by 10 AM, lots of trees -- moisture helps them grow, cheap food -- possibly can't get to the store with fresh fruit and veggies -- and you get used to bologna sandwiches and cokes -- tastes pretty good in fact. (We all are addicted to sugar.. Lactose in milk!) BTW how do they get their methadone and after taking the pill then what? (We don't sew, knit, can, bake, iron, mend anymore. Heat the food up in the oven or microwave... and decent food costs money, takes effort and training to prepare.
PS lots of people make lots of money from the suffering of other people... !!! Brave new world.
2
The opioid crisis took 4 lives in Westfield, NJ since June.
Heart-breaking and seemingly endless stories of kids trying pills and then moving on to heroin because it's so much cheaper ($5.00 versus $40.00) are the norm in most suburban towns across the country.
I just met a young man today at the market who was trying to raise money for an organization in New England to end addiction; he has been sober for 1 year. He has an 80% chance of remaining clean for five years with one year under his belt.
The newborn babies, who are so helpless, deserve to see the money in the lawsuits paid back to them for care until they reach 21, in my opinion.
Our young people also need a stronger message to NEVER take a pill for pain in any sport at any time- as well as for the rest of the kids, who just want to see what the high is like. It is deadly.
18
@mainesummers
It would be easy to undercut the illegal market with generics. Generic morphine is available, and if the market were big, competition would reduce the price and put both heroin and Oxycontin out of business.
The problem isn't addiction. It is accidental overdose and drug use during pregnancy. Addiction was much more common in the post-Civil War period, with large numbers of wounded soldiers, and morphine was legal and over-the-counter. Addicts remained productive citizens.
3
You are right, of course. And bank execs and heads of some of the investment companies should be in prison after the collapse in 2008-- but as long as capitalist greed is allowed to run unchecked (See NRA, Energy Cos like Exxon, etc) nothing will change and in the end, our planet might not be able to sustain human life as we know it. I wish it weren't so but I've stopped believing in "our better angels".
15
I left neurology practice years ago and wonder had I stayed whether I would have added my voice against the idea of pain as a 5th viral sign and the addictiveness of Oxy-Contin, which was a no-brainer. However, the sheer volume of chronic pain I had to see as a neurologist was stressful, since I couldn't fix it. What I knew was that if my patient perceived themselves not at fault from an injury, they would tend to hurt more and longer. I had numbers to prove it. And I never once saw a workmen's comp patient go back to work after back surgery. I'm sure some do. I just didn't see any. I'm not saying these people were faking. I'm just saying what I saw. And I wonder if blame is toxic to healing.
46
@Mike S. -- "I wonder if blame is toxic to healing." I think it is.
I totally agree. As an attorney, I handled many Wk Comp cases. I'm completely convinced that you are correct. While insurance carriers and defense lawyers argue that Wk Comp benefits encourage claimants to exaggerate their symptoms, I'm convinced that the real story is this: The abandonment & betrayal by the employer is a major factor in the continuance of pain on the employee's part.
A personal injury client might get better after an auto wreck, but not after a workplace accident with the same apparent symptoms -- even AFTER the case is settled, when the worker has no more $$ interest in feeling pain. The only explanation, IMO, is that the injury is perceived differently when the responsible entity is a person or company to whom the employee gave loyalty, perhaps for many years.
And this is reasonable. And it should be expected. And the pain is very, very real. And the law should recognize this.
31
@Mike S. You said "And I never once saw a workmen's comp patient go back to work after back surgery. "
Back injury is very common, so even as a layman I've met and talked to a lot of people who had back surgery. Without exception I've never met a person whose back surgery "cured" them, it only left them in a slightly better place, and for the rest of their lives they are balancing the risk of aggravating their back against the physical requirements of making a living.
So if someone injured their back through lifting on the job - very common - they should not do that job any more, regardless of workmans comp. Yet they will probably continue until it is unbearable - and only then get back surgery, when it is already too late.
Whereas someone who hurts their back in a non occupational scenario has more freedom to avoid behavior which does not aggravate their back problem.
I'm not saying people don't fake it. I'm sure some do. But repetitive strain injury is a real problem. I'f we're smart about it we'll analyze the job movements that cause those injuries and provide mechanical assistance. Prevention is better than cure, especially when cure may not even exist.
2
@Joe Very well put. Thank you.
2
I have a family member who was born addicted to opioids. She was fostered from birth by her adoptive parents, who knew before she was born what her situation would be. She was in neonatal intensive care from birth for several weeks and was medicated to help her through her godawful withdrawal. When she came home, she was on anti-seizure medication for quite a while and they had to take other precautions with her. Early on, she was tested to see whether she'd have developmental difficulties. She's now a wonderful, lively sparkling 4-year-old, a daily joy in our lives, and we are blessed to have her. But what she had to go through is unconscionable.
I don't blame her mother -- who had children before and after our little girl -- because I'm in recovery (not from opioids) and know how easy it is to become addicted and how hard it is to stop. Her mother also was born into a situation where that path was so very predictable.
But I believe very strongly that we should have affordable, easy-to-access, non-judgmental programs to help these opioid-addicted mothers and to care from birth for these addicted babies who are born into agony through no fault of their own. It's a huge public health problem and if we don't help them now, our society will end up paying for it later.
82
@karen b.
But if she was struggling with addiction, why did she get pregnant? It’s hard to imagine she was prescribed drugs during her pregnancy and one would hope she didn’t try illegal drugs for the first time while pregnant. I’m all for comprehensive, insurance funded drug treatment programs without judgement. But I’m also for people not getting pregnant while they are struggling with addiction. That should be the first priority of any treatment program.
14
@Forest
Her pregnancy clearly wasn't intentional. I doubt that any of them were. She was already addicted and I doubt, too, that her opioids were prescribed. She was part of a drug culture, as so many addicts are. And she wasn't ``struggling with addiction'' -- her addiction took priority, as it does with most addicts, no matter what substance they're addicted to. When you're using, contraception doesn't even come into the picture, and focusing on the ideal situation if you decide to try to get help does come across as judgmental and is a real deterrent.
2
Because she was high when she had sex. Because her life is chaotic. Because sex is a natural instinct. Because birth control is expensive, and it needs to be passive and long lasting, because she can’t be depended upon to take pills. Because she wants a child, perhaps hoping that this time, she will be allowed to keep it.
1
You ask, "How is it acceptable that we treat only 17 percent of those with a life-threatening disorder?"
The answer is simple: a substantial number of people who are addicted do not want treatment. They will tell you they aren't addicts; that they have pain and need the narcotics for their pain.
I'm a registered nurse. I left my job as a cardiac care nurse when I reached 50 years of age. I sought a job that was less stressful and less physically demanding.
I worked in a residential treatment unit (RTU) for substance abusers for less than one year. I returned to the cardiac care unit.
Why? The majority of patients in the RTU are not there voluntarily. Some are ordered into treatment by a judge, although they have a choice: treatment or jail. Some are brought for treatment by their desperate families. Very few come for treatment willingly. The majority of patients return within a year; many return again and again.
The majority of addicts are not concerned with their babies, older children or their families. They are concerned with getting drugs and spending their lives as they choose.
I am often tired when I go home from work. But it's good to be tired from caring for cardiac patients, who want to get better.
It's depressing to leave a drug treatment unit knowing that the majority of patients are serving their time in the RTU rather than jail, or planning what to say to family members when they call to tell them "I'm cured, come pick me up."
121
@Azalea Lover
I have 2 family members that have been long term addicts. I agree with you wholeheartedly. Sadly they refuse treatment and always have. They both are cared for and supported by family members. I think they would have died had the family not provided housing for them.
Some say it’s enabling which I suppose it is. There is no solution which is the hardest part of all.
Thank you for the work you do.
54
@Azalea Lover: my nephew died in 2017, at 29, from an opioid overdose.
He'd been an addict most of his life, starting with the Ritalin his bored, tired mother put him and his siblings on at 11 because "they were easier to handle and did better in school".
By 14, he was selling his Ritalin to classmates, to raise money to buy pot and other drugs.
At 18, his mother put him on SSI, so he'd never had to hold a job and always got welfare, food stamps, a monthly check and Medicaid. This gave him oodles of time to get high every day.
His mom and step-dad were VERY co-dependent -- they paid all of Nephew's bills, legal expenses, etc. They brought him groceries. They got him a huge HDTV and Xbox because "it is his only pleasure in life".
He graduated to harder and harder drugs -- sold drugs. He got arrested and thrown in jail. They took his car because he used it to sell drugs (the car his parents bought him) and his Section 8 apartment ($40 a month) threw him out for dealing drugs.
At the end, he was in a halfway house for addicts, with an ankle monitor for parole. Despite this, he found drugs there easily. He died from a batch of heroin laced with fentanyl. They did not find his body for 3 days.
6
I am an expert in maternal and child health, and I currently lead a large research project on how to improve the quality of treatment for women with opioid use disorders in pregnancy. The framing of this opinion piece -- particularly the headline -- is extremely alarming and misleading. It is very hard to witness neonates going through withdrawal, yes; but recent studies (Kaltenbach et al) suggest that if children receive good treatment, their long-term health is within normal developmental ranges. The important question is how to help women engage with the treatment they need for the chronic disease that is opioid use disorder. This opinion piece is shamefully reminiscent of the so-called "crack baby" epidemic perpetuated by media and some researchers in the 1980s-90s. We now know that there is no such disease as "crack baby" and that children exposed to cocaine in utero did not suffer long-term health consequences because of the cocaine exposure. Let's not further the stigma already faced by women with substance use disorders.
65
@Jarlenski...hard to witness? Seems quite dismissive of the true victim...the infant. Witnessing and being the one actually suffering are miles apart. Needing to recover (if they ever truly do) from something like this does not provide an advantage, and the crack babies you speak of surely did not thrive because they were subjected to the addictions of the host...which included malnutrition and chaos.
25
@Marian Jarlenski
Yes, no lasting harm, no foul, right? We wouldn't want women who thoughtlessly become pregnant while drug addicted to feel any stigma or responsibility, would we? It's so much better to do nothing about curbing pregnancy in this population so that they can go about having suffering babies that they have no capacity or interest in caring for, if it means forgoing their next fix. The tortured life of that baby, particularly if left with the "well-meaning" addict mother, is no big deal. Let's not be alarmist or misleading.
25
@Marian Jarlenski, I respect your work; however, I feel compelled to disagree with almost every assertion you have made in this comment. First, you establish a straw man, in that your comment implies that Kristof asserts that children exposed to opioids in utero will suffer long-term effects akin to those ascribed to victims of the 'crack-baby' epidemic. In fact, the author makes no such claim. Moreover, his piece is highly sympathetic to both mothers and infants who have fallen prey to an epidemic fueled by greed and indifference. The only group to which he is unsympathetic is executives who have profited from the suffering of their compatriots. Second, your assertion that individuals exposed to cocaine in utero suffer no long-term health consequences of that exposure (based on a single review whose authors make no such claim) is simply incorrect. While it is notoriously difficult to isolate the independent effects of cocaine exposure on the developing human fetus, research with animal models demonstrates a raft of pathophysiological changes associated with prenatal cocaine exposure. Furthermore, in studies involving human subjects, prenatal cocaine exposure has been identified as an independent and moderated contributor to deficits in executive function, abnormalities in stress response and cortisol production, growth suppression, and metabolic disorders -- and it is implicated a host of other physiological, neurological, and behavioral problems (Lambert & Bauer, 2012).
28
Medication-assisted treatment can be part of overcoming addiction.
“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.”
Saying that taking methadone means that the women aren’t trying to overcome addiction is stigmatizing to the many people who are in recovery from substance abuse disorder thanks to medication.
54
@L Brown, and in stabilizing the woman, the pregnancy is stabilized as well. With the stability of the pregnancy, other adverse health issues are avoided and helping the neonate through withdrawal is the focus, rather than other health issues in addition to addiction.
6
@L Brown Oh, yes, i should have said something like "try abstinence" rather than just "try."
13
Family planning needs to be an integral part of addiction treatment for women. The woman isn’t just an addict; she has a life outside of that. Any other health issues should be part of the addiction treatment as well.
101
@Denise McCarthy
Good luck with family planning in jurisdictions controlled by anti-woman hypocritic lawmakers.
I appreciate your concern with the whole person who is dealing with addiction.
37
I just read about opioid settlements in two Ohio counties, even on a county level it seems ridiculously low. After what these companies did which was outright drug dealing for the sake of money, they should not be allowed to stay in business, crushed under the legal weight of what they did. Likewise the people within the businesses who were knowingly negligent should face prosecution. Only in America can corporations get away with things like this. Also having Congress on the side of Big Pharma, in some cases passing legislation which disabled in part the DEA should have consequences. America is not set up this way, unfortunately, not like the EU where there can actually be consequences beyond money. America is about making money, not the public good or sufficient regulation by people we have trusted to actually regulate in a way that can put the fear of the god's in them. Instead we have a revolving door and a Congress on the payola system.
22
That video is heart-breaking, my first impulse wanting to turn away from a suffering, addicted newborn. But I watched and watched again because I want that image to stay with me and haunt me. Any decent and compassionate person would ask: What can I do to stop this? Prayer is not enough; it is never enough without proaction. And Nicholas has hit on one crucial way of assuaging if not eliminating a problem that should not be in our democracy, or for that matter, even in a third-world country. That is the availability, affordability, and accessibility of prenatal care for all pregnant women. Yes, we have an opioid crisis and epidemic that must be tended to...before a Wall and other preposterous schemes of this administration. And yes, the blame is shared among greedy pharmaceutical companies and negligent, unethical physicians. But we can not overlook the place that politics has within this horror. I hold accountable Mr. Trump and his Republican Party, from his Cabinet and Congress to his MAGA supporters. It's the squeaky wheel which gets greased. We are not making enough noise; we are not doing enough. We have to do more.
38
@Kathy Lollock writes, "I hold accountable Mr. Trump and his Republican Party, from his Cabinet and Congress to his MAGA supporters."
Perhaps you are not aware of the number of addicts during the last three decades. This is nothing new and President after President, Congress after Congress, has addressed the problems.
Billions of dollars has been spent on treatment for addiction.
The problem is simple: In order to stop using drugs, the addict must want to stop using drugs. The magic drug to make the drug-addicted man or woman WANT to stop using drugs hasn't yet been developed.
16
@Kathy Lollock
A woman has to choose to access prenatal care, just as a woman has to choose to use effective birth control to prevent pregnancy if they are an addict. Pregnant woman in the US do have care covered by Medicaid if they don’t have insurance. Certainly we could expand special programs for addicted pregnant women, but pregnant women are probably the most covered group in the US. Almost half of births in the US are to mothers on Medicaid.
As much as I dislike Trump, I don’t think he’s to blame for the current situation. However, if pregnant women stop accessing Medicaid due to concerns about effects on their immigration status, then the blame is squarely on him and his supporters and enablers.
5
@Kathy Lollock: you think this problem just occurred THREE YEARS AGO????
1
Reading this heartbreaking column, I recognised a similar situation that those of us in the airline industry call the 'error chain.' An aircraft rarely crashes due to a single mistake by one individual. It gets there due to compounding errors that are not identified or rectified until they compound into a disaster. Nibbled to death by ducks, not eaten by an alligator.
These errors are usually unforced and due to complacency, tiredness, lack of knowledge, inadequate procedures or training and a corporate culture of profit over a perceived tiny risk. Individually, they are not catastrophic - sequenced one after the other they are.
The catastrophic result here is a child born with an addiction but the errors here are not unforced. They are deliberate. One can trace that back through criminalising drug users instead of treating them as part of a wider health crisis, removing medication for incarcerated addicts (would you deny a diabetic prisoner their insulin?), removing family planning access and prioritising profit over genuine healthcare.
If you trace it back to the source, it's 'for profit' healthcare, where doctors are incentivised to prescribe unsuitable pharmaceuticals to pay off their crippling tuition debts (there's a link to be broken) and, for some, to fund that beach lifestyle when they retire.
Society cannot entirely do away with drug addiction any more than we can entirely do away with airline accidents. What we can do is make both less likely to occur.
86
@NicholasKristof, thank you for shedding light on a incredibly tragic consequence of opioid addiction that hadn't dawned on me. Pieces like this where you address the cruelty and neglect suffered by the most vulnerable and exploitable of our society is of incredible importance for the paper of record to promulgate.
13
"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."
Perhaps this is the reason that the corporate executives are not being held accountable?
It reminds me of the joke in "Annie Hall" about the chicken and the eggs. Of course, we don't hold them accountable. We still need them.
If we really wanted to help these babies, we would provide in-patient care for the mothers through childbirth. We would also insist that BOTH parents remain sober. Men, too, cannot parent when high.
How to pay for in-house treatment, jobs programs, childcare, healthcare? Instead of trying to imprison corporate executives - who will always find a way out of it and cost taxpayers a fortune in the meantime - take it from the corporations and the executives.
20
@india
In most of these cases the biological father isn't married to the mother, isn't even around, and wouldn't fulfill his parental responsibilities (No. 1: Marry the mother) even if sober.
1
Although there are some physicians who accepted kickbacks from the pharmaceutical companies, more often physicians, specifically ER physicians, were told by hospital administrators that they had to increase their patient satisfaction scores or risk their job or pay. That frequently meant prescribing opioids for pain that could have been treated in other ways. I have been involved in EMS and ER medicine both as a paramedic and as a nurse for nearly 40 years. We all saw this coming over 20 years ago. Pharmaceutical companies pushing opioids, hospital administrators pushing patient satisfaction, and regulators pushing pain as the 5th vital sign (and we were told that pain is whatever the patient says it is) all share blame for this crisis.
163
@Laura Wallin
Except that a major issue is opioids for chronic pain and no ER doc should be prescribing opioids for this unless he or she intends on having an ongoing treatment relationship with the patient which none of them will.
And you left out the one who had the prescription pad: the docs who actually prescribed the opioids. Any doc who wrote opioids for patients for whom they questioned the need for the meds shouldn't be practicing medicine. I don't recall anything in the Hypocratic Oath saying I must obey hospital administrators.
7
This is what happens when medical professionals have no say in how they treat patients.
6
So true and as this problem developed treatment options were few. It took the switch to heroin and death of young white people to finally acknowledge some action needed to be taken. The baby is the only innocent in this tragic saga.
1
"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."
What a day that would be when a wealthy executive or shareholder in the US actually goes to prison for placing profits above human life! Unfortunately, that seems like a pipe dream based on what I've seen lately.
We have examples of what works in curtailing drug addiction and unwanted pregnancies, but we're doing exactly the opposite. The reason is quite simple: we're stuck in our post-WW2 fantasy land of good vs. evil. In this nostalgic world view, corporate leaders and wealthy shareholders are hard working job providers with high moral character, while drug addicts and women who have unwanted pregnancies are lazy, immoral freeloaders. For many Americans, this is a world view as unimpeachable as the virgin birth and the second coming.
Time and again we see programs like effective sex ed for teens, ready access to birth control, treatment programs that deal with addiction from a public health standpoint instead of criminal behavior - and instead of recognizing the amazing success rates of these programs, the focus is on the "immoral" approach to dealing with these issues.
Perhaps one day average Americans will begin to accept the science, support effective programs, and demand accountability from the perpetrators. That day can't come soon enough.
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@TL Mischler
Those "amazing" success rates are mostly around 0%.
The fact is that it is not known how to solve these social problems. Demonizing "corporate leaders and wealthy shareholders" (who would be the first to get into the business of selling these programs, for a profit, if they worked) isn't a step to solving them.
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Katz, Sex ed for teens has proven to work. I don’t see big corporations vying for these contracts. Because sex ed is taught by health teachers, paid for by taxpayers. The community benefits but certainly the school isn’t making huge profits. The free market doesn’t solve everything.
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What liberals call social "accountability" is really responsibility-transference. Depict the horrors of any social problem, seek to stir emotions, then when people ask, 'what is to be done?', answer that society as a whole is responsible. What's needed is more government spending, more regulation, more income re-distribution (higher taxes). What is called for only in faint tones wreathed in soft excuses is: More Self-Responsibility.
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@Ronald B. Duke
Don’t the people who make these have a responsibility to ensure that all the cons as well as the pros are well understood and not promote them as safe and non-addictive?
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@Ronald B. Duke
West Virginia, the state featured in this op-ed, is deeply Republican, and residents’ political leanings have no bearing on addiction. Likewise, Mr. Kristof and his (largely) liberal readership would like to help those suffering. Please don’t turn something so universally important into a political war.
I am glad if you have neither experienced nor witnessed substance abuse. But maybe read up on what drugs do to the body and how addictions are formed before casting judgement on those who are addicted. Morality and ideology have nothing to do with this. It could happen to anyone.
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So what is needed is higher taxes, greater regulation and more government spending? That sounds pretty liberal.
The article states; "There’s plenty of blame to go around, encompassing opioid-abusing moms and opioid-prescribing doctors."
However, if there is a pharmacy in a town of 400 people that sold over 13 million pain pils, as the article also states, shouldn't some of the blame be on government agencies that could oversee prescription rates. I believe there are systems in place whereby the government regulates (or should regulate) the numbers of prescriptions going through individual venues.
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@lucky13
There was clearly irresponsible action (lack thereof) with the wholesaler who provided these pharmaceuticals. Any distributor with half a brain would realize there was something not right about such quantities. Therein lies the problem and part of the solution.
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@lucky13 And those pharmacists, and the physicians writing the scripts, should be in jail.
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My heart breaks for such babies. It also breaks for mothers who were addicted when they became pregnant and could not get birth control beforehand and/or addiction treatment during pregnancy. To the extent that they have underlying mental illness, no doubt they couldn't treatment for that either.
There is no doubt that the zeal with which these drugs were marketed has led to the current opioid epidemic. Traditionally, only the most addicted would use opioids because they had to be snorted or injected. Now it's easy to get the drugs and just swallow them.
I am a former addictions treatment program developer, manager and counselor. I believe it will get worse as the current administration takes funds from social programs.
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@Barbara Thanks for reading my column on a topic that you know so much more about than I do. I think that the numbers of overdose deaths may slowly drop (now down to 68,000 a year from 70,000), but I agree that in other respects the crisis will worsen. And while we're focused on opioids, it's notable that the meth crisis is worsening as we speak. There are no simple solutions, but we do know what works--a public health approach focusing on treatment rather than incarceration. One exception, I believe, is for corporate executives who enriched themselves by lying about the risks of opioids and then paid kickbacks to get doctors to write unnecessary prescriptions. I do think that they should face prison along with other drug lords--and my visit to these nurseries in West Virginia confirmed me in that judgment.
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@Nicholas Kristof Drugs of choice cycle in and out of favor. Meth was about due for a comeback and has been rising for a while now, as I understand it. Cocaine and opiates will slowly fade for a couple of decades and then come back if we don't change how we deal with addiction and mental illness. We need comprehensive mental health inpatient, day hospital and step-down programs for dually diagnosed patients who are also addicts. I developed and ran one in 1987 and it worked well, but it was eventually closed after I left. Hospitals like these programs if they are profit centers because they offset cancer treatment which is a loss center, for example. A lot of people get hooked on opiates when they have pain, but we must ask why they get hooked when others like me take a few pills when needed and then take Tylenol as the pain recedes. When we learn how to distinguish between these two types of pain patients, we will make progress. At the same time, of course, doctors must be trained and retrained not to prescribe opiates. I personally have refused them many times even though I have chronic pain. Thanks for the great work you do bringing these matters to the public arena.
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@Barbara
I should also have mentioned that alcohol never goes out of style, partly because it mitigates the crash after doing uppers as well as anxiety and symptoms like restlessness. That's another reason for a more comprehensive approach of treatment. Incarceration allows people to keep taking drugs rather than getting treatment.
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The plight is clear but I fail to see a solution in "corporate regulation". First, damage has already been done and those persons responsible need to be held accountable. State Boards and local prosecutors can act against physicians who prescribed and the pharmacist who dispensed irresponsibly.
Perhaps our federal laws need to be fortified to criminalize the blatantly egregious shipment of drugs by anyone. The federal government already has a strong system for the interstate control of explosives.
More needs to be done to provide medical and social services to reduce demand for drugs. And finally, yes, the protection that the corporate structure offers needs to be re-examined for ways to prosecute its officers and employees who knowingly cause great harm.
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There are legitimate uses for opioids, but they should be few and far in between, and extremely strictly monitored by independent organizations. Then we have this. How can you not get an iron grip of sadness and anger around your heart, when you read about people caught up in the opioid epidemic, of the mountain of problems of newborn children, of women who are not only pregnant addicts, but also have no support system to turn to when facing their demons, getting help or bringing a new life into the world. Some of them have multiple children. Some of them are ostracized by their families, communities, by the fathers of their child/children. Some turn to the only option available to them, which is get more drugs to ease the pain of their body and soul. The fewest among them get real help and redemption. And it all goes back to GREED, pure and simple. And to a head-in-the-sand government which is utterly incapable of being there for the people, all of them, not just some select few. Anyone who ever worked on any of these meds must go and help these babies and their mothers get through to health, hands on, no excuses. This is not some third world, backwater country, this is the USA. We know all about the dangers of opioids. We have failed our country in a massive way, but it's still fixable. Take responsibility, pharma and government, and do the right things. You have the money, put it to good use and be real mensches. I know that you can do it. I hope that you will do it.
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The wealthy seldom go to prison.
Especially if they are corporate 'Leaders'.
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@Lost In America Thanks for your comment on my column, and I completely agree. In the course of the war on drugs, we imprisoned millions of people who were struggling with addiction--even as we enriched the corporate executives who paid kickbacks to doctors to prescribe drugs so as to get people addicted. Look, the opioid crisis is complicated, and it's not all about pharma companies. But there are reasons that the overdose mortality rate is many times higher in America than in Europe, and one is that companies weren't allowed to wreak such havoc by promoting opioids, and another is that there are better support systems abroad for those prone to turn to drugs. That can mean medical treatment, but it can also mean job training programs. The U.S. failed at each turn.
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@Nicholas Kristof
I know quite a bit about real life addiction and addicts. I have used Dr Rx Norco. Fortunately I am a not an addictive 'type'. My Rx got me back on my feet literally and gave me the ability to learn to walk again. I am grateful for that as I was in a wheelchair. Been walking for years now. I had no insurance after 2008. Now Medicare. PTL
I have lost at least 5 friends to opioids over decades. I got real mad at my 'friends' covering up what happened with the last. A very good friend that always denied using AND drank a lot of booze. He left behind a preteen son.
Most of us don't have to look far at all to see the damage done.
We need to be truthful with each other, one by one.
I try
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@Nicholas Kristof I have watched how you have responded to various comments and appreciate your thoughts, thanks!
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Everything starts and ends with accountability (actual enforcement, deterrence and jails terms for executives), but it also starts with regulatory procedure before things come to markets.
The government is there to protect society/the consumer and in this aspect (and many others), it has failed to do so. That is because certain political pockets have neutered anything the government may do as far as an regulation.
Then on the back end, we need the science and the infrastructure to help with the problem, so that is does not become an epidemic of extreme proportions. That means studies that deal in reality and are not constrained. That means a single payer health care system that can mitigate the problem and actually help people.
Babies do not come with bootstraps.
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