The Youngest Addicts

The infant in Manhattan's Harlem Hospital was smaller than most newborn babies, and his cry was unusually shrill and high-pitched. Within several days after birth, his tormented wails became incessant. His sweating body shook and twitched. Occasionally he vomited. If his condition had gone undiagnosed and untreated, the baby might have suffered a convulsion, which could have been fatal, or have died a slower death by dehydration. But the signs have become all too familiar to inner-city doctors. The child's mother was a narcotics addict, and he was suffering withdrawal from the "habit" forced upon him in the womb.

In New York City alone last year, there were more than 800 infants born of addicts. Many hundreds of others were born elsewhere, though there is no firm national count because some hospitals do not report these cases. Without proper care, doctors estimate, more than 50% of such cases can end in death. Treatment is effective and relatively simple. Some doctors give paregoric, an opium derivative that satisfies the child's need for a narcotic and controls withdrawal. Others administer depressants to calm the nervous system. While these drugs usually overcome the immediate crisis, experts are concerned that long-range effects on such children may be serious.

Grim Paradox. Until recently, heroin was considered the major villain. As more and more young female addicts have been enrolled in methadone maintenance programs, however, doctors have discovered a grim paradox: methadone is preferable for the adolescent or adult for a number of reasons--in eluding the fact that it does not normally produce the euphoria of heroin--but for the infant it seems to be even more dangerous than heroin.

Methadone, which easily crosses the placental barrier, may impede the fetus's normal development. More than 50% of all children born of methadone mothers are either premature or small for their gestational age. The same is true of the heroin baby, but most mothers on heroin receive minimal prenatal care and often have poor eating habits. By contrast, the methadone mother in a registered maintenance program is usually referred to a doctor for prenatal care. Although physicians cannot yet prove it, some suspect that the underdevelopment and prematurity of the methadone baby is a direct result of the drug. Dr. Carl Zelson, professor of pediatrics at New York Medical College, has performed laboratory studies that indicate definite retardation of cell growth in some methadone babies. He has also found that there is a high incidence of convulsive seizures in methadone babies, resulting in possible brain damage.

At New York City's Albert Einstein College of Medicine, Dr. Lawrence Gartner, director of the division of neo-natality, has found that methadone babies are generally less healthy than heroin babies, and are born with a greater incidence of respiratory distress and jaundice. "Their symptoms of withdrawal last longer and worsen progressively," he says. Gartner has recently discovered a rare and particularly ominous methadone problem. Five babies born at the college's affiliate, Abraham Jacobi Hospital, showed no withdrawal signs until between two and three weeks after birth, by which time the infant is usually away from constant medical supervision. Says Gartner: "We presume that there is a large buildup of methadone in the baby, which he slowly uses up and then begins exhibiting signs of withdrawal."*

Medical symptoms aside, the child born of an addicted mother may have problems far beyond the physical. "Usually an addicted mother is narcissistic, dependent, hostile and often a lesbian," explains Dr. Judianne Densen-Gerber, founder and executive director of the Odyssey House drug rehabilitation agency. "Usually she has no concept of how to be a mother. I've known pregnant addicts who live by prostitution to turn a trick even after the onset of labor pains."

One program to treat the addicted mother as well as the child is conducted at Mabon House, an offshoot of Odyssey House, on Ward's Island in New York City's East River. Here, 23 parents and children (there are currently two fathers in residence) live in a therapeutic, drug-free community. Mothers work in group nurseries and learn about parenthood through weekly discussions. "I used to take a lot out on my daughter Jennifer," says Dianne Carleton, 21, of Fairfield, Conn. "I started taking 'speed' because I wanted to lose weight, and then went to heroin." Although Dianne, currently the only white adult at Mabon House, is now off drugs and better able to cope with herself and her child, there are many who are not so lucky. "Somehow the pregnant addict is harder to treat than the non-pregnant," explains Dr. Antonio Domantay, an Odyssey House psychiatrist. Only 10% stay beyond the first six months at Mabon. Many of those who leave too soon go back on narcotics at a significant risk to themselves and their unborn children.

*At least one doctor dissents. In his work with methadone cases at Manhattan's Beth Israel Medical Center, Philip Lipsitz repeatedly tested 14 children born of methadone mothers and found that they perform as well developmentally and psychologically as normal infants.

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