Category Archives: News

FIFTH ESTATE: Motherisk hair test evidence tossed out of Colorado court 2 decades before questions raised in Canada


By Lisa Mayor, John Chipman, CBC News

A U.S. court laid out extensive problems with how hair-strand tests were being done at the Motherisk Drug Testing Lab at the Hospital for Sick Children in Toronto more than two decades before similar issues were uncovered in Canada.

A joint investigation by The Fifth Estate, CBC Radio’s The Current and the Toronto Star uncovered a capital murder trial in Colorado in which Motherisk’s tests were found to be “not competent evidence” and thrown out in 1993.

But the lab’s work continued to be used in Canadian courts and relied upon in thousands of child protection cases, including ones in which children were permanently removed from their parents.

From 1991 until 2015, Motherisk was performing what have now been determined to be unreliable and inadequate drug and alcohol tests on thousands of members of vulnerable families across Canada, with the results in some cases leading to child welfare decisions to separate children from their parents.

Child welfare agencies in five provinces across Canada paid for Motherisk’s hair-strand tests, believing they were hard scientific proof of substance abuse.

The Ontario government appointed retired Court of Appeal justice Susan Lang to investigate the lab’s procedures and protocols after a series of investigations by the Toronto Star revealed problems with the tests. Lang’s inquiry was completed in December 2015.

Through that investigation, it was determined that Motherisk’s results were unreliable and inadequate opinions from scientists who operated without any forensic training or oversight.

Colorado case

Two decades before the Ontario government launched its investigation into Motherisk’s hair-strand tests, Julia Klein, Motherisk’s de facto lab manager at the time, testified at an admissibility hearing in a 1993 death penalty case in Colorado.

Allen Thomas Jr. had been charged with raping and stabbing to death the grandmother of his ex-girlfriend. He faced the death penalty if convicted.

One of the defence strategies if Thomas Jr. was found guilty was to argue that he was so high on cocaine at the time he was incapable of committing intentional, premeditated murder, which was required for the death penalty in Colorado.

The defence would need to prove that he was taking cocaine at the time, and Motherisk was one of the few labs doing hair tests for drugs and alcohol in North America.

The Motherisk hair test results appeared to show Thomas Jr. was taking 55 grams of cocaine per month at the time of the killing.

Sick Kids hospital sign

Questions about the science of hair testing began after serious shortcomings were found at the Motherisk lab at the Hospital for Sick Children in Toronto. (CBC)


This case is the earliest known example of Motherisk’s hair tests being used in a criminal court.

The defence in the case wanted to introduce the hair test Motherisk had done on the defendant, but Justice Donald Marshall wouldn’t allow it. In his decision, the judge laid out many of the same deficiencies at the lab that would be uncovered in Ontario more than two decades later.

Marshall ruled Motherisk’s tests results were “not competent evidence.”

“He found that it was not reliable,” said Eva Wilson, district attorney on the case.

“I really appreciated his analogy: this reminded him of someone shooting at a target with a bow and arrow, and that Miss Klein shot the arrow, the arrow landed and she then drew the bulls eye around the arrow, a big round circle, to show it met its mark.”

Klein declined repeated requests for an interview and wouldn’t answer specific questions sent to her.

Red flags

The Colorado case arose in the joint investigation by The Fifth Estate, The Current and the Toronto Star during a review of a 2009 court case in Toronto. In that case, comments were made by Dr. Gideon Koren, the founder and longtime director of the Motherisk lab.

In that case in Ontario’s Superior Court of Justice, Tamara Broomfield was convicted of assault causing bodily harm, aggravated assault endangering life, failing to provide the necessities of life and administering a noxious substance with the intent to endanger life after allegedly feeding her two-year-old son near-lethal doses of cocaine.

Koren told the court the lab’s expertise and Motherisk’s tests had been “accepted by the courts in different jurisdictions,” including Canada and the U.S.

“About 10 years ago, Your Honour, we were asked by the Colorado court in a case of murder to test hair for cocaine in an individual who claimed to being addicted to the drug, and to the best of my knowledge, our results, not were just accepted, but had an impact on the judgment,” Koren testified.

Eva Wilson

Eva Wilson was the prosecutor in a 1993 Colorado murder trial where Motherisk lab tests were deemed inadmissible. (Jack Dempsey/Toronto Star)


The Fifth Estate, The Current and the Toronto Star scoured legal databases and contacted Colorado district attorneys and criminal defenders, but were unable to find any Colorado criminal proceeding in which Motherisk’s evidence was accepted.

Daniel Brown, a Toronto criminal lawyer who represented Broomfield in the early stages of her appeal, reviewed the Colorado hearing.

“Dr. Koren’s testimony in the Broomfield case appears to be a deliberate attempt to mislead the presiding judge about the widespread acceptance of Motherisk’s hair testing procedures in criminal courtrooms throughout the continent,” said Brown, who is a Toronto region director with the Criminal Lawyers’ Association.

“Dr. Koren wasn’t the doctor who testified in Colorado but you would have thought that he would have been keenly aware of what had happened,” Brown said.

“The fact that he would come to court 20 years later and suggest that that evidence was accepted in that Colorado courtroom was surprising. It seems to be misleading and it certainly warrants a perjury investigation if he deliberately tried to mislead the judge about the scope of the Motherisk evidence and how it’s been accepted across the continent.”

Koren did not respond to emails seeking comment for this story.

Broomfield was initially sentenced to seven years in prison.

In October 2014, after new evidence surfaced that questioned the accuracy of Motherisk’s results, Broomfield’s cocaine-related convictions were overturned.

Ontario investigation

Later that year, the Ontario government launched the investigation into Motherisk’s lab procedures and protocols headed by Lang.

“I considered it a tragedy that it’s not good for our justice system that we’re relying on forensic evidence that is unreliable and inadequate,” she said in an interview with The Fifth Estate.

“It’s a tragedy for the families, it’s a tragedy for the parents who may have lost temporarily or otherwise contact with their child, it’s really a tragedy for the children.”

Dr. Gideon Koren

Dr. Gideon Koren, seen in 1999, retired from SickKids in 2015 when the hospital closed the Motherisk lab. (Rick Madonik/Toronto Star)


In Klein’s testimony in the Colorado case, it appeared she didn’t understand what constituted forensic testing.

Wilson, the prosecutor, was shocked.

“She talked about forensic labs, [saying] their test samples come from dead people,” Wilson said.

“That’s not true. There’s a lot of living people whose blood and urine and semen, and body tissues and fluids, are being tested by forensic labs, thank goodness, otherwise we wouldn’t be able to charge people with driving under the influence of drugs unless they were dead.

“She was really off base with all of that.”

The Motherisk lab has always insisted its tests were meant to be only clinical in nature and not forensic.

Clinical tests are mainly meant for patient care — accuracy is important, but so is speed. Forensic labs do tests for legal purposes, such as DNA or fingerprints, and do this for more than just criminal matters.

Justice Susan Lang

The Ontario government appointed retired justice Susan Lang to investigate the procedures and protocols of the Motherisk hair test lab. (Bernard Weil/Toronto Star)


“They need to be right,” Lang said. “They don’t just need to be right in criminal law; they need to be right in family law. And a lot of people didn’t see family law as forensic work.… That isn’t good enough.

“Losing your child is the capital punishment of child protection law. You need to have these test results done right.”

Koren has been named in at least 11 lawsuits, including a proposed class action suit.

In his statement of defence in one of the lawsuits, Koren said Motherisk’s hair tests were “adequate and reliable for their intended purpose” and were meant to provide “information relevant to the medical care and safety of children.”

For its part, the Hospital for Sick Children has apologized for the Motherisk tests.

“We deeply regret that practices in and oversight of this particular program did not meet SickKids standards of excellence,” Dr. Michael Apkon, president and CEO of SickKids, said in a public statement on its website.

“We remain resolved in our efforts to ensure that we have effective oversight and the highest standards of quality and safety in all of our programs.”

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Message from the Minister of Health – International Fetal Alcohol Spectrum Disorder Awareness Day 2017



International Fetal Alcohol Spectrum Disorder (FASD) Awareness Day is marked annually on September 9 to raise awareness about the risks of drinking alcohol during pregnancy and about the challenges that individuals with FASD and their families face.

FASD is a brain injury that can occur when an unborn baby is exposed to alcohol in the womb and the result is a lifelong disorder with effects that include physical, mental and behavioural disabilities. FASD is the leading known cause of preventable developmental disabilities among Canadians.

Children and adults living with FASD, often encounter a great deal of stigma and judgement. This stigma can keep women from openly discussing alcohol consumption with their health care providers, preventing them from accessing the programs, services, and supports they need.

Many factors can contribute to FASD, and there is no single solution to preventing it. That is why the Government of Canada is partnering with provincial and territorial governments, communities, Indigenous organizations and experts to support a variety of education and prevention initiatives.

For example, we are funding five projects that focus on developing knowledge and skills among health professionals on how to screen, counsel and discuss alcohol use with girls and women. The goal of these projects is to help prevent alcohol use during pregnancy and to promote behaviours that set the conditions for lifelong health. We are also supporting the Kids’ Brain Health Network to provide health care professionals, policy makers, caregivers and families with tools and information to promote earlier diagnosis, better treatment and optimal outcomes for children with neurodevelopmental disorders, including FASD.

In order to increase awareness of FASD among First Nations and Inuit communities, as well as educate front-line workers, our government is also developing culturally appropriate prevention and intervention programs that educate and raise awareness about the impacts of FASD. We  are also exploring opportunities to advance the Truth and Reconciliation Calls to Action #33 and #34 related to FASD by working in collaboration with Indigenous people to implement preventive programs that can be delivered in a culturally appropriate manner.

By working together, we can encourage healthy pregnancies and support those living with FASD. This month, learn more about FASD prevention and join the conversation on social media by using the hashtag #FASD.

Ginette Petitpas Taylor
Minister of Health

During Fetal Alcohol Spectrum Disorders Awareness Month, experts underscore danger of drinking while pregnant


Kris Rife adopted her son as a baby more 20 years ago but didn’t find out until he was 14 that he had probably been exposed to alcohol in his birth mother’s womb.

In retrospect, the diagnosis of a fetal alcohol spectrum disorder made sense, she said. His fifth-grade teacher suspected he might suffer from fetal alcohol exposure. But Rife shrugged off the teacher’s concerns. Her son had none of the distinct facial features associated with fetal alcohol syndrome, such as a flat nose bridge or a thin upper lip. His doctors didn’t think he was at risk.

But he did struggle behaviorally and developmentally. He had trouble remembering things and controlling his temper, grasping concepts involving space and time. He would forget to think through what he said before he said it. That’s why Rife and her husband, who live in Mount Pleasant, thought their son might have autism.

Then, during an autism evaluation at the University of Utah, a birth defects expert noticed that his head was a little small, which is another, more subtle sign of fetal alcohol exposure.

That expert also noted that Rife’s son, a teenager at that point, was very personable, even among strangers, a personality trait at odds with some autism spectrum disorders. All of those clues informed the final diagnosis.

“It was horrible,” Rife said. “They’re still babies at 14.”

Nearly a decade after her son’s diagnosis, Rife now pours her time and energy into advocacy. She is trying to raise awareness about the dangers of fetal alcohol exposure through the S.C. Fetal Alcohol Spectrum Disorders Collaborative, an undertaking made more difficult by the fact that the state government invests little money to address the problem. One state employee at the Department of Disabilities and Special Needs spends about 15 percent of her time working on fetal alcohol spectrum disorders, Rife said. She thinks the issue deserves more attention.

“When people think it’s not a big problem, it’s because it’s not recognized,” she said.

Rife specifically wants to sound a call to women that no amount of alcohol is known to be safe during pregnancy. But she conceded that her message is different from the advice of some doctors who assure their pregnant patients an occasional drink won’t harm their babies.

“It is very frustrating,” Rife said. “There is not the science that says you cannot have one drink during pregnancy. You can’t prove that. But we can tell you that you might have a problem with a child if you have one drink. Do you want to take that risk?”

Last year, leaders at the Centers for Disease Control and Prevention posed the same question.

The agency told health care providers that they should warn their patients of child-bearing age “not to drink at all if she is pregnant, trying to get pregnant or sexually active and not using birth control.”

Agency officials explained that most women expose their unborn children to alcohol in the womb before they even realize they are pregnant. Nearly half of all pregnancies in the United States are unplanned each year. Often, when a woman first finds out she is pregnant, the damage has already been done.

But unanticipated backlash to the CDC advisory was intense. One critic, in Time, called the recommendation a “scare tactic” and accused the CDC of prioritizing an unborn fetus over a “woman’s right to her own body.” Professors from Harvard and Yale wrote in the Boston Globe that the agency’s advisory “damages its credibility as a source of clear, balanced advice about health risks.”

 Dr. Connie Guille, a reproductive psychiatrist who works with pregnant patients at the Medical University of South Carolina’s Department of Psychiatry and Behavioral Sciences, said conflicting information regarding what’s safe and what’s not can be confusing for patients.
“It’s one of those controversies that will just continue to cycle through,” Guille said.

Scientists will never be able to study fetal alcohol exposure in a randomized, controlled clinical trial, the industry’s gold standard, because such a study would be unethical, she said.

“What we’re kind of left with is looking at studies that do demonstrate very clearly that there is risk associated with alcohol use in pregnancy,” she said.

The general public may not realize fetal alcohol spectrum disorders are so problematic and so prevalent because the majority of cases are never diagnosed, Guille said. And most people who suffer from one of these disorders do not have any of the distinct facial features associated with fetal alcohol syndrome, she said.

The American Academy of Pediatrics estimates that fetal alcohol spectrum disorders may affect up to 4.8 percent of all children. And Guille cited studies that have shown, for example, the rates of these disorders are quite common among prisoners.

“The impact goes well beyond the individual,” she said. “This has a big impact on our society as well.”

September is Fetal Alcohol Spectrum Disorders Awareness Month.

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Partnership aims to reduce alcohol harms on Canadian campuses


Thirty-six universities and colleges have teamed up with the Canadian Centre on Substance Use and Addiction and Universities Canada in an effort to curb high-risk drinking. The Postsecondary Partnership – Alcohol Harms (PEP-AH), as it’s called, is connecting students and administrators with health experts to create campus programs to reduce harms related to binge drinking.

While Canadian universities have individually been grappling with the issue for decades, this partnership represents a more collaborative approach, said Scott Duguay, co-chair of PEP-AH and associate vice-president, enrolment management, at St. Thomas University. “We’re offering resources and ideas and best practices but allowing a lot of space for individual members to build their own plans,” Mr. Duguay said. “We strongly encourage institutions that are partners to have a campus team that oversees alcohol harm reduction programming.”

A 2016 survey of 43,780 students from 41 Canadian campuses affirmed the challenges institutions face with the prevalence of binge drinking. More than a third of students surveyed reported having five or more drinks the last time they partied or socialized, and many reported physically injuring themselves (18 percent), having unprotected sex (24 percent), forgetting where they were or what they did (29 percent) and doing something they later regretted (38 percent) due to alcohol.

“PEP-AH is not concerned with the drinking per se, but the harms associated with it,” said Catherine Paradis, co-chair of PEP-AH and senior research and policy analyst with the Canadian Centre on Substance Use and Addiction, which has received funding from Health Canada for this initiative. Ms. Paradis led the creation of a framework for campus programs to reduce alcohol harms. She recommends that institutions adopt at least one recommendation in each of five strategic areas, depending on the needs and structure of their campus. “Drinking is a social behaviour that happens in a larger context,” she said. “Each university or college has its own history and its own culture and policies.”

PEP-AH grew out of discussions since 2013, when former Acadia University president Ray Ivany rallied the support of university presidents to look at campus drinking culture. Mr. Ivany became passionate about the issue after having to deliver news of 19-year-old Acadia student Jonathan Andrews’ death following a night of binge drinking in residence. It was an event after which “our campus changed forever,” Mr. Ivany had said.

This past June, student affairs staff, administrators and students met for a one-day conference during CACUSS, the national conference of student affairs professionals across Canada, to share best practices and challenges. The dialogue will continue into 2018 and includes four student symposia in Western Canada, Ontario, Quebec and Atlantic Canada in advance of the national meeting. It was recognized that “students were at the heart of this if it was going to work, but we needed presidential level approval and support,” Mr. Duguay said. “At the end of the day, students are the experts in the experience itself.”

Cam Yung, PEP-AH’s student representative for Ontario and rector at Queen’s University, echoed that sentiment (the rector position at Queen’s is held by a student and is elected by students). Queen’s has had an alcohol working group for almost 20 years and recently hosted PEP-AH’s Ontario student symposium. “Students react better when they have peers there to lead and provide guidance,” Mr. Yung said. “When we have students educating students, and not a top-down approach of administration trying to educate students about alcohol harms, that is a way more effective solution.”

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HEALTH REPORT: Concurrent mental and substance use disorders in Canada

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Individuals who have both a mental and substance use disorder at the same time are more likely to experience poor psychological health, use more health services and report unmet needs than a person with only one type of disorder.

These findings are from a new study on the prevalence of concurrent disorders in Canada, released in today’s Health Reports. The study is the first to use the 2012 Canadian Community Health Survey—Mental Health to examine the demographic and socioeconomic characteristics, health status and health care service use of people with concurrent disorders. The study estimates that 282,000, or 1.2% of Canadians aged 15 to 64, experienced mental and substance use disorders concurrently in the previous year, that is, at least one mood/anxiety disorder and at least one substance use disorder.

Almost all (91%) of those with concurrent disorders reported high psychological distress, significantly more than those with a mood/anxiety (79%) or a substance use (34%) disorder alone.

Overall, individuals with concurrent disorders were more likely (76%) to use health services, such as care for mental health or substance use, compared with those who had a mood/anxiety (67%) or substance use (21%) disorder alone. Despite higher use, these individuals had greater odds of reporting unmet or partially met needs for mental health care after controlling for demographic and socio-economic factors and number of chronic conditions.

For more information please visit:

Concurrent mental and substance use disorders in Canada” is now available in the August 2017 online issue of Health Reports, Vol. 28, no. 8 (Catalogue number82-003-X).

This issue of Health Reports also contains the article, “Needs for mobility devices, home modifications and personal assistance among Canadians with disabilities.”

Steering pregnant women away from substance abuse


Amanda Seymour at the James Bay Community Project: “If we’re able to prevent one incidence of a child from having fetal alcohol spectrum disorder, it’s a lifetime of that child living with that condition.”   Photograph By DARREN STONE, Times Colonist

Victoria program is changing lives by helping pregnant women deal with substance-abuse issues. HerWay Home, run out of the James Bay Community Project, started in January 2013, said program co-ordinator Amanda Seymour.

“Really, our goal is help women improve their own health, so that they have healthier pregnancies, healthier births, so that children can stay with their moms and that the moms can quit or reduce their substance use,” Seymour said.

One hundred women benefited from the program in 2016.

A current participant is Aurora, who was 22 and newly pregnant when she was encouraged to try the program by her sister, who raved about her experience with it.

“I felt kind of shy and I didn’t know if I would want to,” she said.

But she relented and decided to show up, and has been going ever since.

“Honestly, without HerWay I wouldn’t have made it this far, I don’t think,” Aurora said.

“As capable as I think I am as a mother, I definitely need this resource more than I can put into words.

“Especially as a single mom it can be difficult to find help.”

She said she is doing well in recovery, and can talk to other mothers about addiction concerns.

“No one’s going to understand the situation I’m in except another recovering mom.”

HerWay Home offers additional services, as well, Aurora said.

“They helped me fill out my B.C. Housing application, which seemed really daunting to me because I didn’t know how to answer a lot of the questions.” Sarah, 27, said she was steered to the program by an addictions counsellor.

“I was a couple of weeks pregnant when I went to treatment and so I needed the supports when I came out.”

Program staff members have also helped her in other ways, Sarah said.

“I don’t have any family or a vehicle, so the support worker actually drove me to my midwife appointments.”

An evaluation report on HerWay Home shared another participant’s view of the program: “It’s a priority shift from money for drugs to money for rent and food and life and children.”

The report said the program is filling a “critical niche” by working with high-risk women, and has welcomed 50 per cent more women than was expected at the outset.

HerWay Home was favourably compared in the report with other successful programs –— Sheway and Maxxine Wright Place on the Lower Mainland, and Breaking the Cycle in Toronto.

Seymour said that most women come to the program when they are pregnant, but some connect when they have infants.

Referrals and word-of-mouth provide a steady flow of clientele.

“Women can just come in, they can come in through a drop-in group, they can call us,” Seymour said. “Often it’s people in the community like other agencies that hear about us.

“They might call if they come into contact with a woman and ask us to go meet with her.”

HerWay Home was created using a number of other initiatives as models, Seymour said, and it was a long time in the making.

“The community spent years working on it,” she said. “It was led by a public-health nurse at the time, Betty Poag.”

Poag brought together community agencies, Island Health, the Children’s Health Foundation of Vancouver Island and researchers to help develop HerWay Home, Seymour said. The concept is beginning to expand across the country, she said.

One major positive coming from the program is that it can be a key to preventing fetal alcohol spectrum disorder, Seymour said.

“If we’re able to prevent one incidence of a child from having fetal alcohol spectrum disorder, it’s a lifetime of that child living with that condition.”

Reducing the need for children to be placed in the care system is another good outcome, Seymour said.

“The more we can keep families together and keep them healthy, our hope is that those kids can do something different with their lives,” she said. “They may not end up in the same situation when they have kids.”

Plans call for HerWay Home to move this year to Saanich Neighbourhood Place, along with the Young Parents Support Network, to be part of an early-years hub.


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The AP Learns to Talk About Addiction. Will Other Media Follow?

266524_9d4d244cd88045faa08c8e214afb8b18-mv2_d_4000_2656_s_4_2FOR YEARS, people with addiction have wondered when the media would recognize our condition as a medical problem, not a moral one — when they would stop reducing us to mere “addicts” and speak of us in the more respectful and accurate “person first” language that has become common for people with other diseases and disorders.

Last week, The Associated Press took an important step in that direction. The new edition of its widely used AP Stylebook declares that “addict” should no longer be used as a noun. “Instead,” it says, “choose phrasing like he was addictedpeople with heroin addiction or he used drugs.” In short, separate the person from the disease.

The style guide clarifies other important language to maximize precision and reduce bias in addiction coverage. There are new entries on “alcoholic,” and an array of substances, from bath salts and cocaine to PCP and synthetic cannabis.

Unlike many matters of style, these changes aren’t mere semantics or political correctness. Widespread media misunderstanding of the fundamental nature of addiction has led to some deadly misconceptions about how it should be managed. The AP provides news to around 15,000 media organizations and businesses, and its stylebook is highly influential in setting standards for usage. If its more accurate terms are adopted and understood by institutions like The New York Times and CBS News, it could genuinely help improve drug treatment and policy amid an overdose crisis that shows no signs of slowing.

“Around the beginning of the year, in January, we noticed that there was a hole in our guidance on addiction,” says Jeff McMillan, an AP enterprise editor who was the lead author of the new section. He adds, “As we began talking to experts, we learned that the language that was traditionally used is changing, and we thought it would be good to give people a vocabulary.”

The new language is being widely welcomed. “It’s very good — really well done,” says John Kelly, an associate professor of psychiatry at Harvard and founder and director of the Recovery Research Institute at the Massachusetts General Hospital. Kelly was the lead author of a study published in 2010 that showed that even doctoral-level professionals take a more punitive stance when patients are described as “substance abusers” rather than “people with substance use disorder.”

The stylebook directs its users to “avoid words like abuse or problem in favor of the word use with an appropriate modifier such as risky, unhealthy, excessive, or heavy. Misuse is also acceptable.” Notably, it adds that not all risky use involves addiction — a distinction that has been clear to epidemiologists for decades, but has not often been noted by the press.

And perhaps most important, the new style specifies that journalists should not use “dependence” as a synonym for addiction. In fact, “substance dependence” was dropped as the official diagnosis for addiction by psychiatry’s diagnostic manual, the DSM, in 2013, in part because it erroneously implied that the two are the same.

While the AP doesn’t spell this out, journalists and readers should understand why it matters. In essence, “dependence” means relying on a substance to function normally. People who take certain medications for blood pressure, depression, and addiction will suffer withdrawal if these medications are stopped abruptly, but that does not mean they’re addicted. This is true even for those taking opioids like methadone or buprenorphine to treat addiction. When people are stabilized on an appropriate individualized dose of either addiction treatment medication, they are not impaired at all because of the precise way this specific class of drugs affects the brain and causes tolerance.

By contrast, addiction is a medical disorder marked by compulsive drug use despite bad consequences like impairment. So while addiction is always a problem, dependence may not be. Understanding this is critical for good pain care. Patients taking opioids over a long period of time are often physically dependent, but unless they experience negative consequences and compulsive use, they are not addicted.

Similarly, babies exposed to opioids in the womb may suffer withdrawal symptoms from dependence after they are born, but they aren’t addicted either. Addiction requires persistent compulsive drug use, and such babies don’t even know that what they need is opioids, let alone have the ability to obtain and use drugs to support an addiction.

Yet the media has often failed to recognize these differences. Headlines about “addicted babies” abound and this stigma can itself do great harm. During the crack years, exposed children were subject to abuse and neglect by caregivers and others who misinterpreted normal behavior as malicious.

Recently, The Washington Post surveyed chronic pain patients on opioid therapy, asking them whether they were “addicted or dependent” but without defining those terms. Not surprisingly, one-third of the patients answered yes. While that made for a scary headline, it didn’t tell readers how many actually had substance-use disorders. And that is what you really want to know: Stopping effective pain treatment when you mistake it for addiction can be deadly.

At The New York Times, there are no plans to update the paper’s style manual along The AP’s lines. “I definitely understand the arguments and the sensitivity,” Philip B. Corbett, the paper’s associate managing editor for standards, wrote in an email, adding that “language evolves, and we will continue to think about these terms and consider changes as they seem warranted.” But about dependence and addiction, he said he thought  “very few readers would immediately understand or pick up on the distinction.”

Yet an unhappy result of conflating addiction and dependence is to undermine the only treatment we know that cuts mortality from opioid addiction by 50 percent or more: long-term treatment with methadone or buprenorphine. Too often, these treatments are mischaracterized as merely replacing one addiction with another. If the AP’s guidance can help members and their readers stop making this error, it could end up saving many lives.


OF COURSE, how the news media talk about addiction is only one aspect of a deep-seated cultural problem. In 12-step groups, which are used in at least 80 percent of American addiction care, people are encouraged to identify themselves as “addicts” or “alcoholics.” They often use what the AP’s McMillan calls this “almost self-punitive language” when speaking to the press, even if they don’t publicly identify themselves as group members.

This could be seen as a way of trying reclaim stigmatized terms by an oppressed group, just as other marginalized people have sometimes done with slurs against them. The AP suggests similar guidelines for using “addict” as a noun. It’s all right when used in a quote or in the name of an organization, but not otherwise.

Language is complicated and often slow to change — and for a group that has been criminalized, fighting stigma and misinformation is a constant struggle. But when the media start treating people with addiction with the same respect that they use for other patients, perhaps the rest of America will start to accept that addiction is a medical problem and that moralizing and punishment have failed.

By Maia Szalavitz: author of the best-selling “Unbroken Brain: A Revolutionary New Way of Understanding Addiction,” which was just released in paperback.

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