The woman had been using oxycodone for almost ten years, but she told the doctors she was sober for two years. She never touched a narcotic during her pregnancy, she said, and she completed her rehab.
But her newborn son had withdrawn: nervous, screaming and requiring infusion of morphine to stay alive. Children have longed for drugs, but why?
In the case of an opioid epidemic, the doctors did not blame the heroin, fentanyl or other illegal substances. Instead, they said that the baby grew in a controversial herbal supplement: a short time.
"False feeling of safety"
According to a case report published in the Pediatrics Center, both an unnamed woman and her child have gone through urinary tract medications that looked especially for oxycodone and other opioids. But these tests did not look for a short, legal drug that has high opioid effects in high doses.
The plant, which originates in Southeast Asia, is usually used to treat pain and suppress opiates. If these are the same brain receptors as morphine and similar drugs, some treat it as a solution to an opiate epidemic, but the US Food and Drug Administration considers it a potentially dangerous psychoactive drug.
The mother denied any substance during her pregnancy – legal or otherwise – but her husband told doctors that he had drunk a tame tea daily to treat her withdrawal symptoms and help sleep.
"I am afraid that women who have genuinely committed themselves to overcome their addiction can develop a false sense of security by using a substance that is advertised as a non-opioid alternative," says Dr. Whitney Eldridge, a neonatologist for the BayCare Health System in Florida, who was the lead author of the case report.
The mother could have been well-intentioned, but because the tests did not show any other drugs in her and her baby, her doctors said she might have caused the condition of her son, clinically known as a neonatal withdrawal syndrome. On his eighth day of life, after the opiates were taken and observed without drugs, the boy was released to his parents.
It's rare, but FDA Commissioner Dr. Scott Gottlieb said in his statement that "this case is not unique." He said the FDA "is aware of four other cases involving neonatal infants exposed to in utero who after delivery of the neonatal withdrawal syndrome."
Gottlieb, whose agency has issued a series of warnings on shorts, called a new report, "a tragic case of harm", and said it "further illustrates the FDA's concerns about the short, including the possibility of abuse and addiction."
And while Eldridge hopes that further research will help legislators better regulate their shorts, they believe that doctors today "need to advise women who are pregnant because of the risk of being short, as if they had any other legal substance that could have harmful effects on their newborns."
Experts call for caution, they question
Some experts hesitate to draw conclusions from the report. They note that although the use of maternal bladder can theoretically result in neonatal abstinence syndrome, the case does not explicitly refer to the symptoms of child abstinence.
"I'm not surprised that it's possible," said Dr. Andrew Kruegel, a Columbia University scientist, "because he has definitely opiate effects and can induce tolerance in users, especially at higher doses."
But Kruegel, who studied the plant for seven years, remarked that doctors could not test the alleged shortness itself. "The main limitation is that we do not know anything about the benefit that her mother used," he said. "Without this information you can not extrapolate too much."
And the mother may have had little to do, said Dr. Edward W. Boyer, a lecturer at the Harvard Medical School, and a doctor at the Brigham Department of Emergency Medicine and the Women's Hospital.
"She's a husband who reported the use of a brat," he said. "The woman who actually absorbed the product, who thought she was short, and the case writers reported that none of these people actually believed they were accepting a shortcut."
Kratom's rock past and uncertain future
Despite the FDA's warning, it is easy to buy and sometimes sold as tea in cafes. The American nonprofit association Kratom estimates that 3 million to 5 million Americans use a cloth, and the group claims they are available for short-label warning labels.
"We are convinced that as with many add-ons, it should be a warning that pregnant women should not take this," said Dave Herman, president of the association. "No, because we think it's harmful, it's because it's a security measure."
Short acting on opioid receptors, which the FDA says, is evidence of its potential for abuse. The agency points to 44 fatal deaths, but Kruegel said that "if you look at these 44 deaths, the overwhelming majority of them include other substances, including other powerful opioids."
Boyer said he may have other risks, such as seizures, but noted that he could be safer than most opioids because "there does not seem to be a depression of breathing when using the sore alone."
Respiratory depression – slow and inefficient breathing – is what makes opioid overdose so fatal. That's why Boyer believes that a well-regulated short-sighted one day could be used to combat opioid dependence that will drive users from more dangerous drugs.
"If you do the right thing and do a rigorous study, there is no reason why [kratom] should not be a prescription drug that serves as a bridge to formal drug treatment, especially for individuals who can not get into therapy, "said Boyer.
Challenges to the development of drugs based on shortness
The American Association Kratom says that there is little incentive for pharmaceutical companies to study as a potential prescription drug, especially because they can not patent the raw material.
"If I'm a drug company, I think it costs somewhere, depending on who you are talking to, between $ 1.2 and $ 1.8 billion to bring a new drug to the market," Herman said. "Who would have spent such a kind of money when another man could get on the boat, ride the river and take him out of the tree?"
Since the product is considered as a nutritional supplement, manufacturers do not need FDA approval for sale if their products do not claim to cure or treat specific conditions or symptoms.
Some companies have done this when they scared the FDA's face for saying that their products can "mitigate the withdrawal of opiates" or "cure a myriad of illnesses." The association says these are anomalies.
"The reality is, our belief is that this is America," Herman said. "And if the product is useful for your health and well-being, you should have the right to take it unless it hurts you, and we have not seen any evidence of the damage."
The FDA, however, continues to warn of shyness, even suggesting it could worsen the epidemic of opiates.
"Kratom has never been studied in humans," Gottlieb said in his statement. "What consumers and healthcare providers need to understand is that there is no proven medical benefit for the shorter. Instead, as warned by the FDA, it can cause serious damage and contributes to the opioid crisis."