The Epidemic That Wasn’t

The Epidemic That Wasn’t (The New York Times: January 26, 2009) reports on the outcomes of children born in the 1980s and ‘90s who had experienced prenatal exposure to crack cocaine, which was a prevalent issue at that time. Researchers have been following these children through adolescence and beyond to monitor the long-term effects of fetal exposure to crack on their brain development and behavior. The surprising results of this research indicate that, although the harmful effects are present, consistent, and measurable, they are subtle and have less of an impact than had been predicted.

Cocaine does slow fetal growth. Infants are smaller at birth and their head size is smaller, but this is a temporary effect that normalizes as these children grow. The largest of several studies of the IQ scores of cocaine-exposed children showed that the exposed children averaged 4 points lower on IQ scores at age 7 than unexposed children. However, a pooled analysis of studies of more than 4,000 children did not reveal any significant effect on IQ or language development in cocaine-exposed children aged 4 to 13. Cocaine-exposed children can have difficulty focusing on and performing tasks, particularly if visual attention is required. Behavioral effects of fetal exposure to cocaine include increased frequency of defiant behavior and misconduct, more so in boys than girls. However, experts point out that these children are not distinguishable from “normal” children in a group and that some of these effects are more likely related to socioeconomic factors, such as stress in the home, substandard education, inadequate access to healthcare, exposure to violence, and poverty.

There is no doubt that in utero drug exposure is harmful to developing fetuses. But, as pointed out in the article, the problem may have been handled as a moral versus a health problem. During the 1990s many women were prosecuted and jailed for illegal drug use during pregnancy and it is common for women who use illegal drugs during pregnancy to lose custody of their children. According to 2006 and 2007 Department of Health and Human Services data, 5.2% of pregnant women reported illicit drug use; however, the same data showed that two-to-three times as many pregnant women used alcohol and tobacco (11.6% and 16.4%, respectively), both of which are legal and have well-documented evidence of their effect on fetal development and lifetime health effects. In contrast, the long-term effects of cocaine on children’s cognitive development and behavior appear relatively small when compared to the effects of alcohol. The effects of cocaine and tobacco are comparable. So far, no link has been established between prenatal cocaine exposure and predisposition to drug use, although such a link has been reported in the case of prenatal tobacco exposure.

Children who have been exposed to cocaine and their mothers are often stigmatized and vulnerable to negative expectations from society. Numerous evidence-based interventions and resources are available to help mothers regain custody of their children and start a new life, including drug and alcohol recovery programs, halfway houses, parenting classes, counseling, vocational training, financial and life coaching, and Head Start programs for the children. As unfair as the treatment of crack-addicted mothers appears in comparison to that of alcohol- and tobacco-addicted mothers, these salutary interventions might not otherwise have been available to them

I remember when crack babies were a topic of conversation. Heartbreaking stories abounded of little babies born to crack-addicted mothers—inconsolable infants who required constant holding by volunteers in the nurseries of hospitals. These highly irritable newborns were expected to mature into a generation of problem children and sociopaths, a future burden on society. My initial reaction to this article was one of surprise, and fear that cocaine use might somehow be viewed as benign in terms of its long-term effects on development and behavior. But my deeper reaction was in response to our moral judgements about what is legal and illegal, regardless of the real impact of harmful behaviors. Tobacco companies continue to flourish and market their products to young people in spite of the well-documented long-term effects of tobacco on the smoker, prenatally, and as a result of second hand smoke inhalation. In contrast, cancer patients and those with chronic pain continue to fight for access to medical marijuana, which is still illegal in most states. I am relieved and happy that the crack-exposed children are doing better than expected. I am also hopeful that this new information may put a fresh perspective on the dangers of prenatal alcohol and tobacco exposure and how we, as a society, deal with these issues.