According to a U.S Department of Health and Human Services Report, 116 people die each day, on average, as a result of an opioid-related drug overdose. The 2018 report indicated there were 42,249 opioid overdoses resulting in death in 2016, which is more than any previous year on record. More than a third of those deaths—15,469—were the result of heroin use. The opioid epidemic, as it has become known, is estimated to have cost the United States $504 billion dollars in 2016 alone.

The Centers for Disease Control and Prevention noted that the increase in opioid overdose deaths can be attributed to three distinct, yet recent, waves.

The first wave began with the increased prescribing of opioids in the 1990s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and ) increasing since at least 1999. The second wave began in 2010, with rapid increases in overdose deaths involving heroin. The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids—particularly those involving illicitly manufactured fentanyl (IMF). The IMF market continues to change, and IMF is often found in combination with heroin, counterfeit pills, and even .

As a criminal justice professor, I gravitate toward researching and teaching about addiction and its association with, and influence on, trends and patterns—typically in relation to criminal legislation, enforcement, prosecution, confinement, treatment, and ultimately, prevention.

My focus has traditionally been on addicts and their engagement in crime, as well as those impacted by those crimes (i.e., the primary and secondary victims). But one particular “victim” of the opioid epidemic has been largely overlooked and understudied: the children born to opioid-dependent mothers who actively used opioids throughout .

Infants Harmed by Opioid Exposure

The Substance Abuse and Mental Health Services Administration (SAMHSA) reported in 2017 that the past decade has seen a significant increase in the number of infants exposed to opioids before birth. The report noted that between 2000 and 2009, opioid use among women who gave birth in the United States increased from 1.19 to 5.63 per 1,000 hospital births per year.

Source: InPublic Safety

As a direct result, the United States has witnessed an incredible increase in the incidence of neonatal abstinence syndrome (NAS) among newborns. NAS primarily caused by maternal opioid use during this same period went from 1.20 to 3.39 per 1,000 hospital births per year. These are the most recent statistics available; it's likely that these percentages have since increased even further, given that the opioid epidemic has considerably worsened by almost every other measure since 2009.

To compound matters, the SAMHSA report also concluded that heroin use is most common among those who are unmarried, unemployed, under-educated, and uninsured. High-risk lifestyles and social, physical, and mental health problems are, as one could imagine, more pronounced in heroin users. Whether expectant mothers who use heroin are more likely to have ties to the criminal justice system than non-using mothers is unknown to this writer; however, it would be worth examining what percentage of heroin-dependent mothers are under some type of custodial supervision (pretrial, incarceration, probation, and parole).

What is Neonatal Abstinence Syndrome?

Nearly every drug used by a mother during pregnancy, from Tylenol to Oxycontin, passes from her bloodstream through the placenta to the fetus. Though certain medications appear to have no effect when used during pregnancy, in the case of opioids like heroin, drug dependence in the mother can result in drug dependence in the newborn. Neonatal abstinence syndrome (NAS) is a group of problems, mostly medical, that a baby experiences when withdrawing from this prenatal exposure to narcotics, according to Stanford Children's Hospital.

Once the baby is born, its dependence on the substance persists, but since the drug is no longer being passed from the mother, the baby’s central becomes overstimulated, resulting in symptoms associated with opioid withdrawal. Withdrawal may begin as early as 24 to 48 hours after birth, or appear as much as five to 10 days later.

While each baby may experience different symptoms of neonatal abstinence syndrome, the most common symptoms include tremors and seizures, irritability (excessive crying), vomiting, dehydration, and sweating. These withdrawal symptoms can last as long as 4-6 months after birth, and can come with a number of potentially dangerous complications, including poor intrauterine growth, premature birth, and birth defects.

Behavioral Effects Associated with Perinatal Opioid Exposure

A 2014 study entitled "Behavioral Effects on Perinatal Exposure" concluded that children who are born from mothers who are heroin-dependent or those who are using methadone are more likely to develop (ADHD) and exhibit . Additionally, the social environment in which the child is raised seems to play a crucial role in the development of adverse behavioral effects. This aligns well with several prominent sociological theories of crime and deviance.

Our social environment has a powerful influence on shaping and molding the behaviors we embrace and ultimately exhibit. A theory known as " ," when used in a criminological context, states that crime, like all other behaviors, is a learned behavior. Social learning theory has found consistent and robust empirical support within the research literature for more than four decades. In the 2010 research study, "The Empirical Status of Social Learning Theory: A Meta-Analysis," researchers noted that social learning theory has remained one of the core criminological paradigms over the last four decades.

Should Mothers Be Criminally Charged for Using Drugs During Pregnancy?

Is a mother’s use of drugs during pregnancy tantamount to “ "—and if so, would this give child protective services workers and law enforcement officers the legal means to remove the newborn from the mother’s care?

Advocates on both sides of the issue continue to debate whether it’s best to leave a drug-exposed child with the mother, or remove the child from the mother’s care soon after birth and place the child with “clean” foster parents. The issue is a difficult one without a clear or easy resolution. As of 2015, according to ProPublica, the majority of U.S. states did NOT criminalize a mother’s drug use during pregnancy. While some mothers have been successfully prosecuted under alternative criminal laws (some states treat during pregnancy as child abuse, for example), very few states have a specific law that requires healthcare workers to report the mother’s drug abuse, and even fewer states require health workers to conduct a drug test if drug use is suspected during pregnancy.

Policymakers and legislators need to begin a serious discussion—now—about how to address a mother’s drug use during pregnancy, especially since the incidence of neonatal abstinence syndrome cases is clearly on the rise. We cannot afford to ignore the opioid epidemic’s most tragic—and forgotten—victims any longer.

NOTE: A different version of this article originally appeared in InPublic Safety and was co-authored by Ms. Shanna O’Connor, an alum of East Stroudsburg University and the Philadelphia College of Osteopathic Medicine.