Ever the optimist, I long for the day gratuitous personal attacks in the public sphere become passé. But, alas, yesterday was not that day. When our First Lady Melania Trump revealed her “Be Best” campaign would focus on children, a vital aspect of her three-prong program was neglected uniformly throughout all broadcast and social media fronts when it is in such need of increased awareness.
Mrs. Trump aims to among other concerns, "bring attention to neonatal abstinence syndrome." When a pregnant mother is chronically using opioids, the severing of the umbilical cord at birth results in the abrupt cessation of them to the baby; and like any other chronic opioid user, the newborn suffers withdrawal - neonatal abstinence syndrome (NAS).
Babies exposed to opioids in utero who develop NAS have a range of symptoms: jitteriness, low birth weight, irritability, poor feeding, seizures, difficulty gaining weight, inadequate suck, breathing issues, impaired sleep, vomiting, diarrhea, sweating, fevers, excessive crying, fussiness, hyperactive reflexes, prematurity, birth defects. Unfortunately not much has changed since my December 2016 article Opioid-Addicted Babies on the Rise (read here). In it, I address a research letter in JAMA Pediatrics claiming “Incidence rates for neonatal abstinence syndrome (NAS) and maternal opioid use increased nearly five-fold in the United States between 2000 and 2012.”
Though the term “opioid epidemic” is publicly mentioned nonstop, the nuance and multifactorial nature of the problem are largely ignored (e.g. polypharmacy, self-medicating, prescription sharing, synthetic opioids, addiction, childhood trauma). The preferred narratives include relentless outrage condemning the pharmaceutical industry, pill mills and ignorant physicians. In keeping with those narratives politicians have threatened prosecution, usurped medical practice through legislative fiat and have sequentially moved the finger of blame from one perceived cause to another. But little is heard from these "leaders" about how to tackle breaking the cycle of addiction or even highlighting its adverse impact on children. In a culture of Twitter and soundbites, analysis let alone thoughtful consideration are lost. You have to ask yourself, do you want more fodder for exploitation or do you want to try and shape our future?
It is refreshing that an emphasis on a root cause and identifying contributing factors to the opioid abuse problem is forefront for the “Be Best” platform. But instead of "killing the messenger" because you dislike the message, you kill the messenger because of her husband or because of some archaic belief that grace and intelligence are incompatible and you ignore the message completely.
As I wrote recently in The Forgotten Children of the Opioid Epidemic, just published work in the journal Pediatrics explores the trends associated with the rapid increase in the annual rate of pediatric opioid-related hospitalizations. Between 2004 and 2015 the authors calculated a 35% increase in pediatric intensive care unit (PICU) admissions for opioid ingestion. Admissions that required children to be placed on mechanical ventilators to breathe for them or medications given intravenously to simply support their life until the opioid poisons cleared their systems.
Much of the pediatric problems arise from accidental ingestion of the opioids of their parents and caregivers. Ask yourself who is more important Stormy Daniels or the collateral damage of the opioid crisis, the children? When mention of opioid abuse in children by the First Lady is glossed over, do you really care about children?