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Submit a 2-**** reflection on the Myths and Facts activity. In your reflection:
- Identify at least one myth that you had previously believed to be true. Is it challenging for you to now accept the true information, and why?
- Describe the information on which you based your answers (e.g., prior knowledge, past experiences, media portrayals).
- Explain how you plan on ensuring your information is accurate as a social worker.
Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th ed.). Cengage Learning.
- Chapter 3, “Substance Misuse, Dependence, and the Body” (pp. 91–149)
EDITORIAL Open Access
Preventing sensationalistic science and fake
news about substance use
Stephan Arndt1,2,3* and De Shauna Jones1
An accurately informed public is vital to creating ra-
tional substance use, prevention, and treatment policies.
Unfortunately, the general public neither has the train-
ing nor the time to conduct intensive investigations.
Most people get their information via the news media,
newsletters, and as sound bites. People often accept
what they read as true, especially if it comes from a rea-
sonably reputable source and do not question the infor-
mation however astounding or alarming. It is easy to
forget the adage, “Extraordinary claims require extraor-
dinary evidence.” To make matters worse, people may
tend to repeat the more remarkable information, regard-
less of how accurate it is.
I recently investigated two remarkable pieces of infor-
mation regarding substance use issues. These both per-
tained to opioids, but might be equally enlightening no
matter what substance was involved.
I recently read that 14–22% of all pregnancies in the
United States were complicated by use of prescription
opioid medications. This was in a newsletter [1] referen-
cing a paper in the BMJ [2]. The newsletter description
goes on to say that an infant showing signs of opioid
withdrawal is born every 25 min. Despite their proxim-
ity, the two statistics represent different things.
A reader might easily take this statement to suggest
that about one in five births are complicated by opioid
use. We were reasonably surprised by that and so read
the original article. Interestingly, results of the refer-
enced paper by Huybrechts et al. [2] indicated no such
thing. Instead, the statement in the newsletter referen-
cing 14 to 22% was in Huybrechts et al’s [2] introduction
and was attributed to two previous papers (reference
numbers 3 and 4). One of the first source papers
suggested that 14.4% of women were prescribed opioid
medication at some point in their pregnancy [3] while
the other reference found that 22% of Medicaid women
were prescribed opioids at some point in their pregnancy
[4]. Note that these first source references suggest the 9-
month prevalence of receiving an opioid medication dur-
ing pregnancy and do not propose that the resulting
birth suffered opioid withdrawal or that there were any
complications.
The article, referenced by the newsletter [2], found
that only 2.3% of births from women receiving opioid
medication during their last trimester suffered discern-
able withdrawal. Therefore, the actual percentage of
births suffering from withdrawal would be 0.023 times
either 0.14 or 0.22 depending on whether we used the
first sources’ estimates of 14.4% or 22%. Either of these
calculations result in an estimate of less than 1%
(0.3312% or 0.506%) and not 14 to 22%. Given that the
periods of prescription were different for the source pa-
pers (9 months) and the article reference by the newslet-
ter (3 months), the prevalence of births complicated by
opioids is likely lower.
The statement that the one infant is born every
25 min came from another study [5] suggesting that
neonatal abstinence syndrome rose from 0.34% to 0.58%
between 2009 to 2012. This is similar to the estimate in
the previous paragraph, 0.3312% or 0.506%, but a far cry
from the estimates in the newsletter [1] and its refer-
enced paper’s introduction [2], “14-22% of pregnancies
are complicated due to the use of prescription opioid
medications”. The only way this can be interpreted as a
correct statement is to define any opioid medication
taken at any time during pregnancy as a complication. If
the initially referenced authors and newsletter were
equating any opioid prescription as a complication, then
the equivalence was not transparent.
This is more of a generic situation rather than a specific
instance. While speaking at a local school about opioid
issues in Iowa, a teacher asked me “How many pain pills
* Correspondence: stephan-arndt@uiowa.edu
1Iowa Consortium for Substance Abuse Research and Evaluation, University
of Iowa, 100 MTP4, Iowa City, IA 52245-5000, USA
2Department of Psychiatry, Carver College of Medicine, University of Iowa,
200 Hawkins Drive, Iowa City, IA 52242, USA
Full list of author information is available at the end of the article
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Arndt and Jones Substance Abuse Treatment, Prevention, and Policy (2018) 13:11
https://doi.org/10.1186/s13011-018-0148-3
http://crossmark.crossref.org/dialog/?doi=10.1186/s13011-018-0148-3&domain=pdf
mailto:stephan-arndt@uiowa.edu
http://creativecommons.org/licenses/by/4.0/
http://creativecommons.org/publicdomain/zero/1.0/
did it take to cause irreparable brain damage? Is it one,
two, four?”.
While it is certainly a possibility that an opioid over-
dose might cause oxygen deprivation, which in turn
could cause brain damage, I do not think that was what
the teacher was asking. He was asking about the direct
damage caused by an opioid. Clearly, people take opioids
for pain management from injury and surgery or cancer
pain. Sometimes, the course of opioid treatment is days,
even weeks. There is no evidence for brain damage in
these situations. I did find some threads in discussion
boards that claimed that certain spices (e.g., turmeric)
could reverse the brain damage from opioid use, but
these were unsupported “junk science” comments.
The magazine, Scientific American, had an online art-
icle “Can HGH Reverse Brain Damage in Drug Addicts?”
[6] This article starts out in the first paragraph with the
statement that opiates destroy brain cells, with no sup-
porting peer reviewed references. The article goes on to
describe a study in the Proceedings of the National
Academy of Sciences, which shows that mouse neuronal
cells in a petri dish bathed in morphine tend to die off.
However, when also exposed to synthetic growth hor-
mone, the die off was attenuated [7]. Several studies sug-
gest little or no effects of prescribed opioid use and
cognition [8–10]. While there may be some evidence
that opioids cause apoptosis in neonates [11] and that
extensive use of illicit opioids are associated with cogni-
tive issues, there is scant evidence that they cause cell
death or “brain damage” in adults. These references do
not address whether or not opioids cause anatomical
brain damage. The long term and widespread use of opi-
oids for surgeries might suggest otherwise. Thus, the
wording in the title, although catchy, may be misleading.
There are several things authors, reviewers, and edi-
tors can do to prevent misunderstandings and fake news.
The simplest is to watch for odd and surprising statistics
presented anywhere in an article. Remarkable comments
need scrutiny. Papers need to highlight the importance
of their work, but they also need to remain trustworthy
and should not exaggerate. Hidden presumptions should
not be a part of scientific literature since scientific com-
munication demands transparent and replicable
evidence.
Manuscripts require precise and accurate language de-
void of hidden agendas. Words such as “cognitive im-
pairment”, “deficiency”, and “deficits” appear often in
scientific literature with regard to opiates and medica-
tion assisted treatment (MAT) effects. Of course, these
papers are seldom experimental designs that can assess
causal effects. Furthermore, these terms sound far more
“ominous” than noting that the people in the opioid use
group or MAT group had lower performance than the
comparison group. For example, the differences between
groups on some measure of cognitive functioning should
be called a “difference”. Consider two groups where
Group A has lower scores than Group B. If Group A
were opioid users in treatment and Group B were a
community sample who were age and sex matched, an
author might suggest that Group A had cognitive “defi-
cits”. However, hidden assumptions suddenly show up if
instead of selecting Group A based on their opioid use
we selected these people based their skin color or ethnic
background. The appropriate neutral word would be
“difference”.
Stigma, fear, and exaggeration are poor motivators to
improve science or policy relating to substance use is-
sues. In fact, we as scientists and educators should be
represent reasoned rationality rather than sensational-
ism. Exaggeration, hidden presumptions that misinform,
and unstated agenda are the antithesis of scientific litera-
ture and represents “fake news” and “junk science”. Au-
thors need to present facts clearly and transparently.
Reviewers and editors, as the guardians of rational and
transparent information, need to question authors’ about
wording issues, presumptions, and remarkable
statements.
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
1Iowa Consortium for Substance Abuse Research and Evaluation, University
of Iowa, 100 MTP4, Iowa City, IA 52245-5000, USA. 2Department of Psychiatry,
Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City,
IA 52242, USA. 3Department of Biostatistics, College of Public Health,
University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52245-5000, USA.
Received: 1 March 2018 Accepted: 6 March 2018
1. Addiction Technology Transfer Center (ATTC) Network. Families In Focus
Newsletter, September 2017. Families In Focus. 2017;2: http://attcppwtools.
org/Newsletters/2017-09.aspx.
2. Huybrechts KF, Bateman BT, Desai RJ, Hernandez-Diaz S, Rough K, Mogun H,
Kerzner LS, Davis JM, Stover M, Bartels D. Risk of neonatal drug withdrawal
after intrauterine co-exposure to opioids and psychotropic medications:
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3. Bateman BT, Hernandez-Diaz S, Rathmell JP, Seeger JD, Doherty M, Fischer
MA, Huybrechts KF. Patterns of opioid utilization in pregnancy in a large
cohort of commercial insurance beneficiaries in the United States. J Am Soc
Anesthesiologists. 2014;120:1216–24.
4. Desai RJ, Hernandez-Diaz S, Bateman BT, Huybrechts KF. Increase in
prescription opioid use during pregnancy among Medicaid-enrolled
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5. Patrick SW, Davis MM, Lehmann C, Cooper WO. Increasing incidence and
geographic distribution of neonatal abstinence syndrome: United States
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6. Swaminathan N. Can HGH Reverse Brain Damage in Drug Addicts? In
Scientific American, vol. https://www.scientificamerican.com/article/can-hgh-
reverse-brain-dam/. Online; 2008.
7. Svensson A-L, Bucht N, Hallberg M, Nyberg F. Reversal of opiate-induced
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7304–8.
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http://attcppwtools.org/Newsletters/2017-09.aspx
https://www.scientificamerican.com/article/can-hgh-reverse-brain-dam
https://www.scientificamerican.com/article/can-hgh-reverse-brain-dam
8. Dublin S, Walker RL, Gray SL, Hubbard RA, Anderson ML, Yu O, Crane PK,
Larson EB. Prescription opioids and risk of dementia or cognitive decline: a
prospective cohort study. J Am Geriatr Soc. 2015;63:1519–26.
9. Kamboj S, Conroy L, Tookman A, Carroll E, Jones L, Curran H. Effects of
immediate-release opioid on memory functioning: a randomized-controlled
study in patients receiving sustained-release opioids. Eur J Pain. 2014;18:
1376–84.
10. Tibboel D. Long-term effects of early exposure to stress, pain, opioids and
anaesthetics on pain sensitivity and neurocognition. Curr Pharm Des. 2017;
23:5879–86.
11. Mellon RD, Simone AF, Rappaport BA. Use of anesthetic agents in neonates
and young children. Anesth Analg. 2007;104:509–20.
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