Society is dealing very differently with the 0piate-addicted than they did with cocaine using mothers.
As recently as two years ago, as America’s policymakers and public officials were coming to fully understand the “opiate epidemic”—meaning exactly who and where is being hardest hit—several editorials cautioned against demonizing opioid-addicted mothers. Citing a recent increase in laws aimed at women who use drugs like oxycontin and heroin during pregnancy, and low rumblings of hysteria over its impact on their infants, these pieces suggested compassion over criminalization and avoidance of the kind of moral panic that birthed the 1980s crack babies myth. The editorial writers recalled the era’s scientifically baseless, often ugly rhetoric branding countless black children mentally deficient future criminals and the reactionary policies that caused incalculable devastation to the African-American community. Zero tolerance had cost more lives than it saved. Repeating that history, they rightfully predicted, would only exact an even higher human cost.
The social panic those writers feared never materialized. Even as opiate abuse grows at an alarming rate, alongside a concurrent rise in opiate-dependent newborns, the response has not nearly approximated the widespread fear-mongering directed toward cocaine-addicted mothers and their children three decades ago. Instead, there has been a tonal softening in the national discussion around drug addiction, a newfound empathy on the part of even the most conservative hardliners—some of whom helped lead the charge against yesterday’s crack users—toward today’s opiate addicts. In a country that steadfastly refused to admit defeat in the war on drugs despite 40 years of catastrophic consequences—civil, cultural, communal, familial, social and economic—it would be patently absurd to attribute this abrupt change of heart to an historical reckoning. Crack users of the 1980s were mostly black, while today’s opiate users are overwhelmingly white. This is about race, as much now as it was then.
The scale of the current drug crisis is on par, if not beyond, that of the crack era. According to the Centers for Disease Control, sales of opioid painkillers such as oxycodone, hydrocodone and hydromorphone quadrupled between 1999 and 2010. From 2007 to 2013, according to the CDC, the number of heroin users increased 150 percent. Those new users, 75 percent of whom were introduced to opiates through prescription painkillers, were almost uniformly white, as were 90 percent of those who began using heroin over the last decade. More than 9 out of 10 people who used heroin between 2002 and 2013 did so while using at least one other drug, and the CDC estimates that 45 percent were also addicted to prescription opioids. The number of women who began using heroin during that period doubled.
Consequently, neonatal abstinence syndrome—essentially, postnatal withdrawal afflicting babies exposed to opiates in utero—has become an increasingly visible issue as the number of opiate-dependent infants has increased. A 2014 study found opiate abuse among pregnant women more than doubled between 1998 and 2011, based on case reviews of 57 million deliveries in American hospitals. The University of Michigan, in a 2012 study, noted that the incidence of NAS almost tripled between 2000 and 2009. Researchers wrote that symptoms of NAS “have been described in 60 to 80 percent” of infants born to mothers who used heroin or methadone while pregnant. Reuters, in an investigative story released in late 2015, determined an opioid-addicted baby is born every 19 minutes.
Media descriptions of babies with NAS are uncannily similar to those once attached to cocaine-dependent babies. The Reuters story tells of infants “born into excruciating misery,” who “shake, struggle to eat and often sputter and choke during feedings” and have “fits of sneezing and severe diarrhea.” These babies are rattled by even the slightest visual or audio stimuli, “including a mother’s smile.” (Compare that with a 1990 Rolling Stone piece stating that “[c]rack babies aren’t all that fond of faces,” and cautions that “any human contact can overwhelm a crack baby.”) Reuters quotes the nurse manager of a Washington D.C. neonatal intensive care unit who says the cry of a baby with NAS is “a panicked, high-pitched wail, almost desperate, a sound you don’t forget.” (Rolling Stone wrote that crack babies "cry in a high feline wail, sometimes for hours on end, and nothing can console them. That creepy catlike cry is itself indicative of neurological damage.”) Despite the nearly identical accounts of the babies’ sufferings—and the mothers’ drug use—and hard and fast numbers on the rapid increase in opiate addiction, there’s been little of the rush to judge opiate-addicted moms the way cocaine-using African-American women were once judged.
In fact, the myth of crack babies was largely launched by a single 1985 study led by neonatologist Ira Chasnoff, involving just 23 women who had used crack during pregnancy. The findings should have been regarded as shaky and preliminary, but instead proved a sturdy and almost indestructible bandwagon. Though numerous researchers contested the findings of Chasnoff’s report at the time, they were largely ignored in favor of a story that jibes with America’s longstanding ideas about drugs, race, class and inherent pathology. Developmental psychologist Claire Coles recalls attempting to share research indicating most of the behaviors Chanoff attributed to crack dependence were present in all preterm infants, but found herself summarily shut out of the discussion. "I'd never experienced anything like this,” Coles told Mother Jones in 1995. “I've never had people accuse me of making up data or being an incompetent scientist or believing in drug abuse. When that started happening, I started thinking, This is crazy."
By 1989, Douglas Besharov, of the conservative American Enterprise Institute, had coined the term “bio-underclass” to describe babies of crack-addicted mothers. “This is not stuff that Head Start can fix,” Besharov told columnist Charles Krauthammer at the time. ''This is permanent brain damage. Whether it is 5 percent or 15 percent of the black community, it is there. And for those children it is irrevocable."
With that quote in his lede, Krauthammer wrote a 1989 column about “damaged” crack babies, comparable to the “race of (sub)human ‘Epsilon’ drones” from Aldous Huxley’s Brave New World, destined for lives “of certain suffering, of probable deviance, of permanent inferiority.” In a 1990 Newsweek story, Judy Howard of the UCLA School of Medicine stated that what “makes us human beings, capable of discussion or reflection," had apparently been "wiped out” of the brains of crack-dependent babies. A 1989 New York Times piece referenced National Institute of Drug Abuse psychologist Coryl Jones’s observation that prenatal cocaine exposure “interfer[ed] with the central core of what it is to be human.” And a Washington Post story titled A Time Bomb in Cocaine Babies (which, to be fair, was based largely on information provided by authorities in the fields of medicine and education) discussed the pervasive fear that “crack babies” represented “a potential human plague almost too horrible to imagine”:
[A] few years from now, the experts note, those infants won't look so cute anymore. Already, a few of them are turning up in first- and second-grade classrooms around the country, wreaking havoc on themselves and others. Severe emotional damage and even physical deformities not so readily apparent today may mushroom in the near future. The children's irritability and anger—along with their need for love and understanding—will surely grow. Will the thousands of children of cocaine-addicted mothers receive the special attention they need?
The piece indicates the agenda for an upcoming medical conference included pinpointing crack-exposed children for special treatment. “The cost would be high,” the story warns, “but not nearly as expensive as allowing them to grow up to be human tigers.”
Criminologist John Dilulio further solidified the idea that cocaine-dependent infants would likely mature into vicious feral animals with his theory of the rapidly ascending juvenile “super-predator.” Raised by "deviant, delinquent, and criminal adults in abusive, violence-ridden, fatherless, godless, and jobless settings" these soon-to-be adolescent monsters would “do what comes ‘naturally’: murder, rape, rob, assault, burglarize, deal deadly drugs, and get high.”
These hyperbolic premonitions were stunningly off the mark. Dilulio’s assertions about youth ultra-violence “soaring” was paranoid nonsense; crime rates across the board were dropping in the 1990s, and juvenile crime fell by more than 50 percent. Less than a decade later, more and more researchers—including those blocked from engaging in the early days of the debate—were offering solid evidence that countered Chasnoff’s original findings. A 2009 New York Times article noted that research from multiple sources suggested “the long-term effects of [prenatal] exposure on children’s brain development and behavior appear relatively small.” “Are there differences? Yes,” Barry M. Lester, professor of psychiatry and human behavior and pediatrics at Brown University, told the paper. “Are they reliable and persistent? Yes. Are they big? No.”
Perhaps the most definitive and widely publicized debunking of the crack-baby myth came from a near 25-year longitudinal study, released in 2013, that found “no significant differences between...cocaine-exposed children and the controls.” "Poverty is a more powerful influence on the outcome of inner-city children than gestational exposure to cocaine,” announced neonatologist Hallam Hurt, who led the study. As numerous sources have more recently noted, experts now believe the harm caused by prenatal cocaine use to fetuses is similar to cigarettes and far less damaging than alcohol. “The argument is not that it’s OK to use cocaine in pregnancy,” Deborah A. Frank, a Boston University pediatrician told the New York Times, “any more than it’s OK to smoke cigarettes in pregnancy. Neither drug is good for anybody.”
Essentially, the researchers behind the making of the crack-baby myth had neglected to look beyond prenatal exposure to examine the confluence of environmental factors in the home. By the early 1990s, after nearly a decade of witnessing how his study had been used to institute a bevy of retrograde policies, Chasnoff recanted on its findings. "The image of the crack baby really moved out there," he told the Associated Press in 1993. "Politicians really picked it up. It worked into the trend of writing about the underclass. It's sexy, it's interesting, it sells newspapers and it perpetuates the us-versus-them idea….[But] poverty is the worst thing that can happen to a child."
But by then, the crack-baby myth was already culturally embedded. Not only had it been used to propagate the idea that infants should be regarded as potential threats to future public safety, it was successfully employed to fuel the notion that drug-addicted mothers should be jailed. Krauthammer, in a rejoinder to his first column, made light of an ACLU lawyer’s suggestion that criminalization was the wrong path.
“The sang-froid of middle-class whites so addicted to rights and so enamored of victimhood is shocking,” Krauthammer wrote. “The choice is simple. We can either do nothing, or we can pass laws saying that any pregnant woman who takes cocaine during pregnancy will be sent until delivery to some not uncomfortable, secure location (boot camp, county jail, house arrest—the details are a purely technical matter) where she will be allowed everything except the liberty to leave or to take drugs. We should do this not as punishment, nor as vengeance, nor even for deterrence, but purely for the protection of the soon-to-be-born child...This is no solution to the mother's drug problem. But it is a solution to the baby's. There might be a better solution fairer to both, but no one can find it. And until we do, the bio-underclass grows.”
“There might be a better solution fairer to both, but no one can find it” is an odd statement to make in the face of viable treatment options that were being proposed by multiple public health agencies at the time. This kind of thinking, in which crack was a super drug used by a people and a class already presumed both faulty and guilty, was critical to justifying the political and legal establishments’ purely punitive reactions to crack users overall and pregnant crack users in particular. “It was instantly addictive, it created ‘superpredators,’ you became a sexual deviant, especially if you were a woman, it destroyed maternal instincts,” Jeffrey Fagan, a professor of law at Columbia University, told the Atlantic, ticking off a list of falsehoods.
As with the draconian Rockefeller drug laws—the product of overhyped fears of black inner-city heroin use in the late 1960s—legislation was quickly drafted specifically targeting poor, black cocaine users. Under the Anti-Drug Abuse Act of 1986, lawmakers established that the minimum penalty for one gram of crack cocaine would equal the jail sentence for 100 grams of powder cocaine, a version of the drug that differed only in that it was used primarily by whites.
As Jason E. Glenn documents in The Birth of the Crack Baby and the History that “Myths” Make, by 1995, some 13 states legally mandated medical personnel to report indications of prenatal drug use to the police. The laws of nine states categorically defined prenatal drug use as child abuse or neglect. According to Mother Jones, by that same year, many pregnant African-American women and their babies were being surreptitiously tested for drugs. The magazine estimates that “[b]etween 200 and 300 such women [had] been prosecuted...mostly for cocaine.” Then-South Carolina attorney general Charles M. Condon, whose relentless prosecution of pregnant cocaine users earned him a 1998 profile in the New York Times, brushed off criticism, stating, “I can't help the fact that it's the drug of choice for blacks. But, do we do nothing?”
This extreme approach, in addition to filling jails with nonviolent black offenders, also helped splinter families as children were removed from their homes and placed with child welfare authorities. In New York City alone, from 1984 to 1992, the foster care population rose from 16,230 to 49,365. Nationally, during the same period, the number of children living in care increased from 276,000 to 427,000. These children were overwhelmingly African American and Latino; more than in previous eras, many reentered the system multiple times and stayed for longer. Those numbers would continue to steadily climb until the early aughts, when child welfare agencies began focusing less on removals and more on permanency planning and reunification as primary goals.
Without question, there have also been knee-jerk responses to the women who now find themselves coping with opiate addiction while pregnant. In 2014, Tennessee became the first state to specifically make prenatal drug use a crime, punishable with a prison sentence of up to 15 years. In Alabama and South Carolina, under laws already on the books, women who use drugs during pregnancy can be prosecuted. But for the most part, we have not witnessed the pervasive vilification or scaremongering of drug-addicted mothers and their babies that we saw during the crack-baby era, which helped drive the anti-black sentiment at the heart of issues from welfare reform to mass incarceration.
"The story is different, not because the lesson has been learned," Enid Logan, who teaches sociology at the University of Minnesota, told the Huffington Post. "But the profile of the woman or the user is different, and the kinds of social questions that this concern is responding to are therefore very different. I have not been able to get a grasp on what the social questions are yet, but they're not at all the same ones that generated the crack baby narrative."
Unlike their predecessors, researchers acknowledge the dearth of longitudinal studies on the enduring impact, if any, of in utero exposure to heroin and other opiates. The media, which understands the sales potential of stories focused on babies in distress, may offer lurid descriptions of symptoms endured by opiate-dependent infants, but has been loath to extrapolate medically uninformed proclamations about what the future may hold for these children. Reporters have collectively refrained from making salacious predictions, based solely on hunches, that opiate-dependent children, as a rule, will grow into mentally stunted monsters, dumbly prone to anger and violence. Though the distasteful “oxytot” made a brief appearance before being quickly dispatched, no term as equivalently dehumanizing as "crack baby" has been repeatedly used.
Addressing the discrepancies, Sentencing Project head Marc Mauer told the Atlantic, “I don’t think that’s only because we are more thoughtful today.” The hesitancy to treat opiate addicts and their babies as anathema is clearly not just a matter of reasoned restraint or 20/20 hindsight.
"In the case of those black children in the crack baby epidemic, it was very easy for us to demonize the mothers primarily because they were low-income black women," Meghan Ralston, harm reduction manager of the Drug Policy Alliance, told the Huffington Post. "In the case of white women delivering white babies exposed to drugs, that same level of fear and paranoia isn't there. We don't hate those women quite as much, because there's not that racist element that's driving it.”
"There's a very starkly different approach to prescription drug use that may harm children," Dorothy Roberts, a professor at the University of Pennsylvania Law School, told the site. "That is treated with much more sympathy and with some concern about the humanity of the mother and the mother's needs. There was absolutely no concern about the mothers who smoked crack during pregnancy. The mainstream media's approach to black women with substance abuse problems was completely punitive and vilifying, and it was as if these women weren't even human beings."
A 2015 New York Times article, "In Heroin Crisis, White Families Seek Gentler War on Drugs," does a good job of proving what the primary difference is, mostly by letting white parents and public officials speak for themselves. The consensus seems to be that people have changed their thinking about addiction because addicts now look like them, the people they know or can at least imagine knowing. Doug Griffin, a white New Hampshire father whose daughter died of a heroin overdose a year ago, told the paper he once regarded “junkies”—a word he has expunged from his vocabulary—as “the worst.” That changed when Griffin saw how drugs destroyed his daughter’s life and ravaged his own community. “[T]hey’re working right next to you and you don’t even know it,” Griffin told the Times. “They’re in my daughter’s bedroom—they are my daughter.”
“The way I look at addiction now is completely different,” Eric Adams, a white officer who previously served as an undercover narcotics detective, said to the Times. “I can’t tell you what changed inside of me, but these are people and they have a purpose in life and we can’t as law enforcement look at them any other way. They are committing crimes to feed their addiction, plain and simple. They need help.”
Apparently it took drugs flooding white communities for people like Eric Adams and Doug Griffin to have the revelation that drug users aren’t just "junkies," but humans struggling with addiction; that they are actual people (one wonders what Adams thought they were before) with a “purpose” who “need help.” Herein lies the fundamental difference in the way the latest wave of addicts are being discussed. White addicts have committed mistakes and made bad choices, including engaging in criminal behavior. But there is a decoupling of the addiction and the person that goes out the window when the addict is African American. White drug addicts’ lives continue to have meaning, their futures still hold promise, and perhaps most importantly, their humanity remains intact. That last commodity is one rarely granted black folks in any state or condition—even infancy—in this country.
That explains why it was so easy, with the flimsiest of evidence, to paint a generation of black newborns as outlaws-in-waiting. It was a notion that already fit nicely with America’s historic ideas about black personhood. It didn’t actually matter what the numbers said, or if there were numbers at all. Brokenness and criminality, according to white America’s institutions, are fundamental to who African Americans are, and pathology is interwoven with the very fabric of blackness itself. Whatever the toxic life choices of their parents (though today, drug addiction is considered a disease, instead of the "choice" it was seen as for African Americans), white babies will never be viewed solely through a prism of sociopathy, because sociopathy is not considered intrinsic to who white people are, a mark passed down from parent to child. No matter what the research finds, a mainstream publication will never advise caretakers of opiate-dependent white babies to “put [them in a] crib, turn out the lights and keep your distance,” as Rolling Stone did in 1990.
While it’s true that foster care rolls have increased since the opiate epidemic began, there’s been a frenzied push to identify these drug-addicted mothers and take away their children. Partially, this can be chalked up to longstanding institutional bias and racism in both drug testing and child welfare reporting. A 2010 University of Rochester Medical Center report found that black mothers and babies are statistically more likely to be screened for drugs than whites, despite the fact that they are actually less likely to test positive. A separate study found that despite similar rates of drug use, black mothers in Florida were 10 times more likely to be reported to child protection authorities than white mothers. In California, a survey conducted between 2001 and 2007 confirmed that “black newborns were 4 times more likely than white newborns to be reported to [child protective services] at delivery.” And a report from WNYC released last year concluded that in New Jersey, “black children are more than twice as likely as white children to enter foster care when drugs are at least one factor.”
“When families presented a similar set of circumstances, family background, family circumstances, they actually found that workers judged the level of risk associated with those conditions and factors differently for white parents than they did for black parents,” Orande Miller, head of the Alliance for Racial Equity in Child Welfare, told WNYC. “Somehow we think that the impact of the substances on a white mother’s ability to care for and nurture her child is so much different than the impact of substances on an African-American mother’s ability to care for and nurture her child.”
That might explain why the Reuters investigation turned up 110 cases of children who died in the custody of opiate-addicted parents, and concluded “doctors aren’t alerting social services to thousands of [opiate-dependent] infants.” Though the birth hospitals of those babies were aware that prenatal drug use occurred, they had either not reported the cases to authorities, or in a greater number of cases, child protection services hadn’t responded in accordance with federal law. The children recovered from NAS, only to be released to homes where their opiate-addicted parents weren’t prepared for their return. As a result, they died of causes such as asphyxiation, ingesting their parents’ drugs, and in the case of one Oklahoma mother “high on methamphetamine and opioids,” being put in a washing machine along with the laundry. A separate but related article indicates that some providers are hesitant to report drug-addicted mothers for fear they’d end up being punished, which only hurts families and makes those mothers unlikely to seek out needed prenatal care. The reasoning here is completely understandable, but the gulf in concern for these mothers and how the system will treat them, based on statistical evidence in black and white, is revealing.
Politicians have likewise become less fixed in their stance, treating drug use less as a moral crisis and more as an issue of public health. “With the changing demographics, there is the ability to frame this as a public health issue,” Kathie Kane-Willis, co-founder and director of the Illinois Consortium on Drug Policy at Roosevelt University, told Huffington Post, “because many policymakers and law enforcement folks seem to relate to white users who are experiencing heroin use disorders more than people of color.”
Jeb Bush publicly discusses his own daughter’s problems with drugs, and in a recent op-ed, included the improvement of drug abuse treatment and recovery programs as a key part of his anti-drug abuse strategy. Carly Fiorina, whose stepdaughter struggled with prescription drugs before her death in 2009, has now called for de-escalation of the war on drugs. Chris Christie, a firm opponent of drug reform in his home state, gave a moving speech about how we should have compassion for drug users because as we now know—see if you can decode this—“it can happen to anyone.” The speech went viral.
Democratic presidential contender Hillary Clinton, the Times notes, has recently attended and even hosted forums on drugs, saying she was moved to do so after the heartbreaking stories of addiction she heard again and again on the campaign trail. As First Lady, Clinton was a vocal supporter of her husband’s 1994 crime bill, which according to the Justice Policy Institute helped increase the federal prison population more than “the previous 12 years of Republican rule, combined.”
This abrupt rethinking of American drug policy is creating a vastly different national approach to addiction. The Atlantic reports that in recent years, 24 states and Washington D.C. have passed legislation that eases access to naloxone, a drug that works to reverse the life-threatening effects of opioid overdoses. In 2015, Ohio’s Republican governor John Kasich even signed legislation allowing naloxone to be sold without a prescription. Good Samaritan laws, now in place in 32 states, offer protection from criminal prosecution for people who alert authorities if they witness an overdose. Rand Paul, Kentucky senator and GOP presidential candidate, has proposed the Recovery Enhancement for Addiction Treatment Act, a bill that aims to make it easier for doctors to treat opiate-dependent patients with medication that mitigates addiction. All of these steps are a world away from Republican policies of the Reagan and Bush eras, such as the Focus on the User campaign, which specifically focused on “user accountability” and blame. And that’s a good thing.
“This new turn to a more compassionate view of those addicted to heroin is welcome,” Kimberlé Williams Crenshaw, a law scholar at Columbia University and UCLA, told the Times. “But one cannot help notice that had this compassion existed for African Americans caught up in addiction and the behaviors it produces, the devastating impact of mass incarceration upon entire communities would never have happened.”
If only the politicians, police officers and others who have so drastically reformed their thinking had been able to muster even a fraction of the empathy they’re now calling for when the crack epidemic was taking its toll on African Americans. We can only imagine how many people could have been saved—from despair, from ruin, from death. If only drug-addicted black mothers had been seen as people in need of help, and not as misogynist and racist stereotypes of black female hypersexuality and degeneracy. What if their infants had been seen as temporarily drug-dependent—because newborns, by definition, are incapable of being addicts—instead of condemned as irreparably broken and doomed. That the drug war continued to function as it was designed to throughout the 1980s is hardly surprising. What is disgusting about that fact is how few white Americans, despite the calamitous impact it was having on black lives and communities, were moved to call for its even momentary shut-down. I suppose what that really suggests is how sad it is that black American humanity remains unrecognizable for so many white Americans.
Today it seems we’re on a new path. The shift in the focus of the drug conversation from one of punishment to treatment is a desperately needed step in the right direction. Most expert organizations in medicine, addiction and psychiatry in this country agree that prosecution and removal of custody for pregnant addicts and mothers only begets yet more collateral damage. What’s happening now is what should have been happening all along: drug-dependent women and their babies are getting services that address the issues around addiction and trauma, instead of being punished for acting out their symptoms. Universal drug screening—like what’s happening in Cincinnati, at least so far—is also useful as long as it’s used not to punish, but to help drug-using mothers get help and babies get well. With the possible overhaul of so many destructive drug policies on the horizon, here’s hoping some of the newfound empathy toward white addicts has benefits for black drug users, too. It’s just too bad this seems to be the only way they could get it.
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