I will share some thoughts that I left at a discussion at a ‘linked in’ group about addiction.  I was responding to someone who was equating addiction and physical dependence in a baby born to an opiate-addicted mother.  My feeling is that such women are given way too much of an attitude by the nurses and others who care for them, and that was the motivation behind my response.  As for withdrawal in newborns: lay off the guilt trip!!

Read on:

There are many differences between physiological dependence and addiction to substances. For example, people who take effexor are dependent– and will have significant discontinuation-emergent side effects– but they are not ‘addicted’, which consists of a mental obsession for a substance. The same is true of beta-blockes, in that discontinuation results in rebound hypertension, but there is no craving for propranololol when it is stopped abruptly.

We have no idea of the ‘cravings’ experienced by a newborn, but I cannot imagine a newborn having the cortical connections required to experience anything akin to the ‘cravings’ experienced by opiate addicts, which consist of memories of using and positive reinforcement of behavior—things that are NOT part of the experience ‘in utero’.

It is also important to realize that the withdrawal experienced by addicts consists of little actual ‘pain’ (I’ve been there—I know). Addicts talk about this subject often, as in ‘why do we hate withdrawal so much?’ It is not physical pain, but rather the discomfort of involuntary movements of the limbs , depression, and very severe shame and guilt. The NORMAL newborn already HAS such involuntary movements as the result of incomplete myelination of spinal nerve tracts and immature basal ganglia and cerebellar function in the brain. And the worst part of withdrawal—the shame and guilt and hopelessness—are not experienced in the same degree in a baby who has no understanding of the stigma of addiction.

Finally, if we look at the ‘misery’ experienced by a newborn, we should compare it to the misery experienced by being a newborn in general. I doubt it feels good to have one’s head squeezed so hard that it changes shape—yet nobody gets real excited about that discomfort—at least not from the baby’s perspective.  I also doubt it feels good to have one’s head squeezed by a pair of forceps, and then be pulled by the head through the birth canal.  Many hospitals still do circumcisions without local, instead just tying down the limbs and cutting. Babies having surgery for pyloric stenosis are often intubated ‘awake’, as the standard of care– which anyone who understands intubation knows is not a pleasant experience. And up until a couple decades ago—i.e. the 1980s – babies had surgery on the heart, including splitting open the sternum or breaking ribs, with a paralytic agent only, as the belief was that a baby with a heart defect wouldn’t tolerate narcotics or anesthetic. I don’t like making a baby experience the heightened autonomic activity that can be associated with abstinence syndrome, but compared to other elements of the birth experience, I know which I would choose.

My points are twofold, and are not intended to encourage more births of physiologically-dependent babies. But everyone in the field should be aware of the very clear difference between physiological dependence and addiction, as the difference is a basic principle that is not a matter of opinion—but rather the need to get one’s definitions right.

Second, the cycle of addiction and shame has been well established, and there is already plenty of shame inside of most addicted mothers. If there are ten babies screaming loudly, only the whimper from the ‘addict baby’ elicits the ‘tsk tsk’ of the nurses and breast feeding consultants. My first child was born to a healthy mom years before my own opiate dependence, and he never took to breast feeding; he his mother been an addict, his trouble surely would have been blamed on ‘addiction’ or ‘withdrawal’. Unfortunately even medical people see what they want to see—and sometimes that view needs to be checked for bias due to undeserved stigma—for EVERYONE’S good, baby included.


Shreddi · February 3, 2010 at 12:44 pm

No intentions to justify or minimize the nightmares a newborn goes through when withdrawing from opiates. Everyone knows a mother will throw themselves in front of a train for their child. The love is that strong and Unselfish. You mention the fact child birth is traumatic anyway while being born. Yes very true, but very irrelevant. What IS true is the fact ask any mother if they could take the pain away from their baby by enduring it themselves they would ten times over. What has to occur naturally is minimized by every means available. What trauma their is should never be used as some sick instrument to justify the torturing of newborns.
A mother willing to put her child through nightmares unnecessarily should not have children, plain and simple. No shame, no guilt, be smart, careful, think, etc. etc. Have an abortion if your not giving up drugs. If an accident and no alternatives, Find the best damn medical or otherwise “provin” help possible to minimize any trauma your not willing to sacrifice pain for the sake of your baby. Call it what you want, over 3 decades of experiencing first hand the feeling countless times, It is PAIN! worst then physical, You can not minimize that.
Better yet. Best advice ever received after asking a lawyer if i needed one. He told me to “go to court, sit through the first session, take note of how the judge handles every dui first offense”. So, “Lawyer or not” the judge said. “This is what you will receive” and pointed to a board with a list of fines, etc.. The guy saved me a ton, while the rest told me I never have to show up. They didn’t want me to hear the truth.
So… Go to a hospital where you can visit and talk to the nurses who care for the addicted children, addicted to your drug of choice of course. Plain and simple. That is all you have to do. See it for your self. Please if you do. Let others know how it goes. More importantly any advise to others through your experience. That’s all we have is personal experience, I doubt anyone has been born addicted and remembers it. Next best thing is see it for yourself. More than one, you have to get a number of samples to avoid any fluke occurrences that could taint your opinion. Actually, turn an opinion into fact.
Until I can prove it myself, it’s only an opinion. Opinions can or can not make a decision for someone else. Get all the facts before making any decision. More advise someone gave me. Think about it, how can it hurt? Amazing how many will “drink the punch”. People need to think for themselves.
Nice try, OP, where is the message fetal alcohol babies live wonderful happy lives?

caracutro · February 19, 2010 at 8:54 am

Thanks Doc! I was sober when my son was born and because of my drug history some of the nurses thought he might be having some kind of drug withdrawal because of his crying. I had one nurse tell me that the behavior of a normal infant and an addicted infant can look the same. It was scary, but, I had the support of my family and my son was perfect. He had nothing wrong with him at all. In the end, the nurses knew that.
I have a friend who just had a baby on 8mg of Sub, which I thought seemed like an awfully high dose, not to mention that it was Suboxone instead of Subutex. Her baby is perfect and about 3 months old now. The infants withdrawal amounted to some sneezing. I find that so exciting!! I know there isn’t enough research out there yet on the subject, technically speaking but, my gut tells me that Subutex or Suboxone is a better alternative for a pregnant mother than methadone if at all possible.
I am truly grateful for the advances in opiate treatment! I hope we continue to find out new ways of helping opiate addicts through harm reduction and tapering methods. Your blog is great! I know more about Suboxone treatment then most doctors who prescribe it!
Thanks again!

unattainable · February 23, 2010 at 6:47 pm

Thank you, SuboxDoc. Very well put, indeed. The stigmatization of those poor women is despicable. How are women or men ever encouraged to get help or treatment when treated so poorly? I was very pleased in your description and clarification of physiological dependence and addiction too. Thank you indeed!

caringrecovery · April 1, 2010 at 8:13 am

Unfortunately the fetus and newborn cannot tell us how it feels to be born to a drug dependent mom? Why would the physical withdrawls be any different for the newborn than the mother? A caring and responsible mother would taper off suboxone before considering pregnancy. And an active suboxone patient should either be on birth controls or else abstain from having unprotected sex.

    Jeffrey Junig MD PhD · March 13, 2017 at 4:54 pm

    And, of course, a child usually lacks the insight to say how it feels to have a self-righteous mother, but we still allow you to have kids! Maybe someone with the gall to lay judgement on others should abstain from having kids as well?!

      Robert Branton, D.O. · July 18, 2018 at 5:23 pm

      New to the forum but love your response to Shreddi.

SuboxDoc · April 3, 2010 at 1:29 pm

Some very interesting and self-righteous replies! I become lost in some of them– I don’t understand most of the post by ‘Shreddi’, for example, and I’m not sure whether the writer is trying to be sarcastic or not. I would say in response to that post that a mother’s love for her baby is not directly translated into behavior- during addiction as well as during a number of other situations when impulsivity is more likely to reign supreme. I’m not saying that is a good thing– but I AM saying that a mother caught in the grip of addiction is not always in a position to behave the way she otherwise would.
The comments by ‘caring recovery’ make the self-identified moniker an oxymoron. The comments are also easy to dismiss as those of a simpleton. ‘Why would the physical withdrawals be different?’ Well, duh, how about an immature nervous system that responds to every sensation completely differently than that of an adult? How about the incomplete myelination of nerve fibers in the newborn? Or how about the well-known effects of guilt and shame on physical pain, that are not present in the case of a newborn but that are very active in a withdrawing adult!
The comments about ‘tapering off Suboxone before considering pregnancy’ are about as good an example as I would find for the battle that patients have against the forces of ignorance and self-righteousness. THESE are the idiots that patients on buprenorphine must deal with– and why education is so desperately needed.

seekingserenity · August 26, 2012 at 8:33 am

I know this is an old blog post but I just can’t help posting. I am a mother of two. I was a heroin addict for quite a while. I was able to quit cold turkey. Then I got into a bad car accident and was on numerous narcotic pain meds for a few years. I tried millions of times to quit. I really really wanted to quit. I wasn’t using to get high anymore. I went through detox programs each 5-7 days. But no matter what I still felt horribly sick after getting out. So I would go back on drugs. I finally got on methadone. I didn’t want to but I felt I had no choice. I just could not handle the sickness from withdrawals. And until you have gone through drug withdrawals I could really give a shit about anyone’s “opinions” on how it’s easy to quit, “just stop taking it!”. Yea you try and let’s see how you feel after that. Anyways my fiancé and I got married. He knew all about my past and that I was on methadone. We both wanted a family but wanted to wait until I was off all substances for atleast one year. Previously with my ex I had gotten pregnant twice on birth control but had miscarriages. And yes I took my birth control exactly as directed.
So after a year of being married we found out I was pregnant. But I was already 3.5 months along. Before I knew how far along I was I really contemplated abortion. But I knew I just couldn’t do it. We used birth control and condoms but I still got pregnant. And now I was too far along even if I wanted an abortion. I consulted with many doctors and was told that if I stopped taking the methadone or tapered down my baby would die. So I felt I had to stay on methadone. I did taper down to a safer dose. I wish I would have known about suboxone back then. But I had never heard of it. I ended up having my baby boy and yes he had withdrawals. But he only went one day in any kind of discomfort. He was put on medication to help him. I was looked at, talked about, and shamed by most of the medical team at the hospital. I was there every single day visiting my son. I was told a social worker had to come check out my house to make sure it was safe for my baby. I was made to take drug tests randomly. I didn’t mind but it would have been nice to not be treated as such a low class citizen.
My son is now a healthy almost 5 year old. He was the smartest kid in his PreK class and still gets so many compliments on how well mannered he is. So instead of condemning mothers and being incredibly self righteous why not do some research. Help us!! Get more awareness out there. I’ll step off my soapbox now.
I really hope none of you have any addicts in your lives. Because I would hate to be judged by some of you. It’s hard enough to live with this disease let alone be looked down on by so many.

Jeffrey Junig MD PhD · March 13, 2017 at 4:56 pm

This is an even older response- but I hope things are going well. Congratulations on your decision- and for not letting other people define your life.

Brittney · August 28, 2017 at 12:58 pm

I wish I could just copy and paste this entire article into a post on an addiction and recovery group I’m part of on another site.
The way women are STILL treated for choosing to continue suboxone/subutex maintenance treatment during pregnancy, the way they’re spoken to and how they’re belittled… well it amounts to abuse in my opinion. I’ve been told that my baby would’ve been better off had I weaned off my medication. Some women stand by their decision to risk miscarriage over choosing to remain on this medication and it is mind boggling. I so appreciate all of the info you continue to try and get out there to dispel much of the rumors and inaccurate information surrounding suboxone treatment.

    Jeffrey Junig MD PhD · October 4, 2017 at 1:03 pm

    You certainly have my permission to use the post, if you find it helpful. The word is finally getting out to doctors that the standard of care is to continue protective medications– either buprenorphine or methadone. But there are many layers to the ‘care team’ during pregnancy, and much more education is needed. I remember the same when epidurals were becoming popular in the 1980’s and 1990’s, when the breast feeding educators told women that babies born to breast-feeding mothers can’t feed well.

Julie · June 18, 2018 at 8:05 pm

Thank you for this blog it has given me hope. I am 6 months pregnant and I had to switch doctors a few times until I found a doctor that did not treat me like a terrible person because I am prescribed subutex while pregnant. He works with my doctor that prescribes my medication to plan for the upcoming little one. I am on 6 mg a day of the subutex/ buprenorphin a day. He is also recommending I see a high risk physician a little later in the pregnancy. I feel very comfortable that I will not be treated badly by my doctor what so ever while giving birth and after, hopefully the nurses and the rest of the team are as educated as him.

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