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Decades Later, Drugs Didn't Hold 'Crack Babies' Back


Now we'd like to talk about another body of research that's also challenging assumptions, very old assumptions about the effects of cocaine addiction. During the crack epidemic of the 1980s and '90s, healthcare workers feared that children born to addicted mothers had little hope for a healthy future. But a newly released study suggests that initial concerns about so-called crack babies may have been misplaced, and that the biggest issue that could hurt these kids was not drug exposure, but poverty.

We're joined now by the lead investigator for this study. Dr. Hallam Hurt is a neonatologist and professor of pediatrics at the University of Pennsylvania's Medical School, and she's with us now. Welcome. Thank you so much for joining us.

HALLAM HURT: Well, hello.

MARTIN: So tell us how you conducted the study, briefly, if you could.

HURT: Back in 1988, we initiated a study looking at children who had been exposed to cocaine in utero and children who had not. And the children were all from the inner city and all of the mothers were receiving medical assistance - so were of low socioeconomic status.

MARTIN: And all were carried full-term and then you found what?

HURT: Well, we began looking for immediate problems. As soon as the babies were born, it was anticipated that there might be more bleeding in the brain, they could have kidney abnormalities, higher risk of sudden infant death. So we looked at all of those issues and we didn't find any difference between the exposed and the non-exposed.

MARTIN: Let me just play a clip from a young woman who participated in the study. Her name is Jaimee Drakewood. She's now a 23-year-old college student. Her mother struggled with addiction in her pregnancy and through a good portion of Jaimee's childhood, and she remembers this. But she also said her childhood was largely happy. Let me just play a clip from our short conversation with her.


JAIMEE DRAKEWOOD: We lived, I guess, a quote, unquote normal life. My mom had a great job, really nice car. So, to me, I was living a good life. It wasn't until my sister had to step in and come and take us 'till I realized that my life wasn't what I thought it was.

MARTIN: I think the question a lot of people might have, though, is Jaimee the exception or the rule?

HURT: Jaimee, perhaps, is the exception, in that she certainly has a very positive attitude and has been able to deal with the issue of having had her mother suffer with problems of addiction. I think many other participants in our cohort have had a more fractured upbringing and have experienced more problems with socioeconomically challenging environments than Jaimee did.

MARTIN: To the point, though, the study concluded that cocaine exposure in the womb did not have a significant negative effect on the children that you were studying, but what did have a significant negative effect was poverty. Can you talk a little bit about that?

HURT: We evaluated our participants every six to 12 months, when they were young infants and children. What we found was that the cocaine exposed and the non-exposed didn't differ from each other on this evaluation - something we had fully anticipated. And we did additional evaluations, looking for differences in how the children played, were they creative, and then we looked at IQ tests.

And over and over and over again, what we found was that the exposed and the non-exposed did not differ from each other, but they lagged behind on the standardized tests and were performing quite poorly. So over the years, it became increasingly clear that something bigger than gestational cocaine exposure was at play.

MARTIN: Obviously, you don't want to go out and encourage people to use cocaine...

HURT: Exactly.

MARTIN: ...Crack or otherwise...

HURT: Just rush in in saying that.

MARTIN: ...Or powder while they're pregnant or any other time...

HURT: Right. Right.

MARTIN: ...Clearly. But it does really challenge, you know, the health professionals and the public to not be so quick to make assumptions about people based on one set of issues. But it does raise some real indictments about the things that kids are exposed to, period.

I mean, you talked about the kids' exposure to violence and that how many kids in the study had seen someone killed in the course of their very young lives, and things of that sort. So what would you most want people to draw from this study?

HURT: Well, that certainly is one thing I'd like for them to draw from it. And the other really important thing we found was that when we did the IQ tests, we found that exposed and non-exposed, the vast majority were performing at a below-average range. But there were 32 children who were average and one was above average. And so, rather than being, sort of, desperately sad about that, we thought, well let's look at the children who are performing well and see what factors into their performance, which was higher than their colleagues.

And we went into the homes of the participants and did a survey. And what we found was that the more enriching the home environment, the better the child performed on the IQ evaluation. The one fact that holds up in virtually every evaluation is that the more enriched the home, the better the child performed.

MARTIN: Whether the parent was using drugs or not?

HURT: Yes, and that's also very interesting. And again, we have to thank our grandmothers, and a lot of these children were in extended families. And so, somehow, whatever enrichment could be provided by whoever, it made a difference.

MARTIN: Do you worry, though, that a whole generation of kids - or cohort is, I guess, the word you would use - was written off essentially because people believed that they weren't capable of very much? I wonder if you ever think that maybe more kids could've achieved at a higher level, if people had not been so quick to believe that they couldn't do anything.

HURT: I absolutely believe that. And I think that one of the most deleterious things is when a child might have been identified as quote, that pejorative term, crack kid, in school. And often they were written off. I think we're improving. We have a ways to go to get rid of that label.

MARTIN: One of the points that I think a lot of the reporters have made in covering this study is that, you know, children were taken away from their parents because they were known to be drug exposed. In some cases and some places, that women were even arrested. And I wonder whether in fact this kind of created an aura of suspicion around pregnant women of a certain background that was not deserved.

HURT: It absolutely did. And I would say that sometimes, you know, there are people in middle- and upper-middle class who use drugs and they're not tested with nearly the frequency as the families and mothers with challenges. So I think that it absolutely was a problem.

And in Philadelphia, when we began our study, we had an early study called "A Thousand Babies." And when we looked at those babies born in Philly, there were one in six moms was using cocaine, but six in six were from challenging environments. So that's a much bigger problem to solve. It was really, I think, relatively easy to be more condemning regarding the moms who used drugs.

MARTIN: Before we let you go, though, I do have to note that the study did focus on children who were born full-term. And I think that some might wonder whether the results would have been different if you had included children who were born preterm, and whether the cocaine exposure might have increased the incidence of kids who were born preterm.

HURT: We avoided that in order to see, if you will, sort of, the more highly defined category, if there were effects. And certainly, cocaine in pregnancy can lead to preterm birth and changes in blood pressure and predispose babies to have bleeding. So that, again, comes back to what you said earlier. We definitely do not condone the use of cocaine.

MARTIN: Dr. Hallam Hurt is a neonatologist and professor of pediatrics at Perelman School of Medicine at the University of Pennsylvania. She was kind enough to join us from member station WHYY in Philadelphia. Dr. Hurt, thank you so much for speaking with us.

HURT: Well, thank you. Transcript provided by NPR, Copyright NPR.

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