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<div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical syndrome</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">Further information: <a href="/wiki/Neonatal_withdrawal" title="Neonatal withdrawal">Neonatal withdrawal</a></div> <p><b>Prenatal cocaine exposure</b> (<b>PCE</b>), theorized in the 1970s, occurs when a pregnant woman uses <a href="/wiki/Cocaine" title="Cocaine">cocaine</a> including <a href="/wiki/Crack_cocaine" title="Crack cocaine">crack cocaine</a> and thereby exposes her <a href="/wiki/Fetus" title="Fetus">fetus</a> to the <a href="/wiki/Drug" title="Drug">drug</a>. Babies whose mothers used cocaine while pregnant supposedly have increased risk of several different health issues during growth and development and are colloquially known as <i>crack babies</i>.<sup id="cite_ref-Ross15_1-0" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>PCE is very difficult to study, because it rarely occurs in isolation; usually it coexists with a variety of other factors, which may <a href="/wiki/Confound" class="mw-redirect" title="Confound">confound</a> a study's results.<sup id="cite_ref-Ackerman10_2-0" class="reference"><a href="#cite_note-Ackerman10-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Pregnant mothers who use cocaine often use <a href="/wiki/Prenatal_drug_exposure" class="mw-redirect" title="Prenatal drug exposure">other drugs in addition</a>, may be malnourished and lacking in medical care, are at risk of violence, and may <a href="/wiki/Child_neglect" title="Child neglect">neglect</a> their children. Children with PCE in foster care may experience problems due to unstable family situations. Factors such as <a href="/wiki/Poverty" title="Poverty">poverty</a> that are frequently associated with PCE have a much stronger influence on children's intellectual and academic abilities than does exposure to cocaine in isolation.<sup id="cite_ref-Lambert12_3-0" class="reference"><a href="#cite_note-Lambert12-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Thus, researchers have had difficulty in determining which effects result from PCE and which result from other factors in the children's histories. </p><p>PCE is associated with <a href="/wiki/Preterm_birth" title="Preterm birth">premature birth</a>, <a href="/wiki/Birth_defect" title="Birth defect">birth defects</a>, <a href="/wiki/Attention_deficit_hyperactivity_disorder" title="Attention deficit hyperactivity disorder">attention deficit hyperactivity disorder</a>, and other conditions. The effects of cocaine on a fetus are thought to be similar to those of tobacco, and are less severe than those of <a href="/wiki/Fetal_alcohol_spectrum_disorder" title="Fetal alcohol spectrum disorder">alcohol</a>.<sup id="cite_ref-Okie09Encouraging_4-0" class="reference"><a href="#cite_note-Okie09Encouraging-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> No scientific evidence has shown a difference in harm to a fetus between crack and powder cocaine.<sup id="cite_ref-Lavoie07_5-0" class="reference"><a href="#cite_note-Lavoie07-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p><p>No <i>specific</i> disorders or conditions have been found to result for people whose mothers used cocaine while pregnant.<sup id="cite_ref-Lamy10_6-0" class="reference"><a href="#cite_note-Lamy10-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> PCE appears to have little effect on infant growth.<sup id="cite_ref-FOOTNOTEGoldberg2009228_7-0" class="reference"><a href="#cite_note-FOOTNOTEGoldberg2009228-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Studies focusing on children of six years and younger have not shown any direct, long-term effects of PCE on language, growth, or development as measured by test scores.<sup id="cite_ref-Ackerman10_2-1" class="reference"><a href="#cite_note-Ackerman10-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>"Crack baby" (or "cocaine baby" and "crack kid") was a term coined to describe children who were exposed to crack cocaine as fetuses, which emerged in the US during the 1980s and 1990s in the midst of a <a href="/wiki/Crack_epidemic" class="mw-redirect" title="Crack epidemic">crack epidemic</a>.<sup id="cite_ref-NPR_8-0" class="reference"><a href="#cite_note-NPR-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Early studies reported that people who had been exposed to crack <i>in utero</i> would be severely emotionally, mentally, and physically disabled; this belief became common in the scientific and lay communities.<sup id="cite_ref-NPR_8-1" class="reference"><a href="#cite_note-NPR-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Fears were widespread that a generation of cocaine-exposed children was going to put severe strain on society and social services as they grew up. Later studies failed to substantiate the findings of earlier ones that PCE has severe disabling consequences; these earlier studies had been methodologically flawed (e.g. with small <a href="/wiki/Sample_size" class="mw-redirect" title="Sample size">sample sizes</a> and confounding factors). Scientists have come to understand that the findings of the early studies may have been overstated.<sup id="cite_ref-NPR_8-2" class="reference"><a href="#cite_note-NPR-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Historical_context">Historical context</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Prenatal_cocaine_exposure&action=edit&section=1" title="Edit section: Historical context"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Publicizing_Dangers_of_Crack_Cocaine_(078)_(7395870920).jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f4/Publicizing_Dangers_of_Crack_Cocaine_%28078%29_%287395870920%29.jpg/220px-Publicizing_Dangers_of_Crack_Cocaine_%28078%29_%287395870920%29.jpg" decoding="async" width="220" height="341" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/f4/Publicizing_Dangers_of_Crack_Cocaine_%28078%29_%287395870920%29.jpg/330px-Publicizing_Dangers_of_Crack_Cocaine_%28078%29_%287395870920%29.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/f4/Publicizing_Dangers_of_Crack_Cocaine_%28078%29_%287395870920%29.jpg/440px-Publicizing_Dangers_of_Crack_Cocaine_%28078%29_%287395870920%29.jpg 2x" data-file-width="6507" data-file-height="10072" /></a><figcaption>The US government published posters like this one in the 1980s and 1990s to warn people away from crack.</figcaption></figure> <p>During 1980s and 1990s, a surge occurred in use of crack <a href="/wiki/Cocaine_in_the_United_States" title="Cocaine in the United States">cocaine in US</a> cities:<sup id="cite_ref-reedHoye15_9-0" class="reference"><a href="#cite_note-reedHoye15-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> the <a href="/wiki/Crack_epidemic" class="mw-redirect" title="Crack epidemic">crack epidemic</a>. During this time, fears arose throughout the country that PCE would create a generation of youth with severe behavioral and cognitive problems.<sup id="cite_ref-Okie09_10-0" class="reference"><a href="#cite_note-Okie09-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-McCarthy14_11-0" class="reference"><a href="#cite_note-McCarthy14-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> Early studies in the mid-1980s reported that cocaine use in pregnancy caused children to have severe problems, including cognitive, developmental, and emotional disruption.<sup id="cite_ref-Thompson09_12-0" class="reference"><a href="#cite_note-Thompson09-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> These early studies had methodological problems, including small <a href="/wiki/Sample_size" class="mw-redirect" title="Sample size">sample size</a>, confounding factors such as poor <a href="/wiki/Nutrition" title="Nutrition">nutrition</a>, and use of other drugs by the mothers.<sup id="cite_ref-Thompson09_12-1" class="reference"><a href="#cite_note-Thompson09-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> The results of the studies, though, sparked widespread media discussion in the context of the new <a href="/wiki/War_on_Drugs" class="mw-redirect" title="War on Drugs">War on Drugs</a>.<sup id="cite_ref-FOOTNOTEDoweiko2008239_13-0" class="reference"><a href="#cite_note-FOOTNOTEDoweiko2008239-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Ross15_1-1" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> For example, a 1985 study that showed harmful effects of cocaine use during pregnancy created a huge media buzz.<sup id="cite_ref-Thompson09_12-2" class="reference"><a href="#cite_note-Thompson09-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Ornes_14-0" class="reference"><a href="#cite_note-Ornes-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> The term "crack baby" resulted from the publicity surrounding crack and PCE.<sup id="cite_ref-FOOTNOTEMercer200962–64_15-0" class="reference"><a href="#cite_note-FOOTNOTEMercer200962–64-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p><p>Media reports commonly emphasized that babies who had been exposed to crack <i>in utero</i> would never develop normally.<sup id="cite_ref-McCarthy14_11-1" class="reference"><a href="#cite_note-McCarthy14-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-FOOTNOTEMercer200962–64_15-1" class="reference"><a href="#cite_note-FOOTNOTEMercer200962–64-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> The children were reported to be inevitably destined to be physically and mentally disabled for their whole lives.<sup id="cite_ref-NPR_8-3" class="reference"><a href="#cite_note-NPR-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Babies exposed to crack <i>in utero</i> were written off as doomed to be severely <a href="/wiki/Disability" title="Disability">disabled</a>, and many were abandoned in hospitals.<sup id="cite_ref-Vargas10_16-0" class="reference"><a href="#cite_note-Vargas10-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> They were expected to be unable to form normal social bonds.<sup id="cite_ref-McCarthy14_11-2" class="reference"><a href="#cite_note-McCarthy14-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> Experts foresaw the development of a "biological underclass" of born criminals who would prey on the rest of the population.<sup id="cite_ref-Ornes_14-1" class="reference"><a href="#cite_note-Ornes-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Vargas10_16-1" class="reference"><a href="#cite_note-Vargas10-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Greider95_17-0" class="reference"><a href="#cite_note-Greider95-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> Crime rates were predicted to rise when the generation of crack-exposed infants grew up (instead, they dropped).<sup id="cite_ref-Vargas10_16-2" class="reference"><a href="#cite_note-Vargas10-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> The children were predicted to be difficult to console, irritable, and hyperactive, putting a strain on the school system.<sup id="cite_ref-FOOTNOTEGoldberg2009228_7-1" class="reference"><a href="#cite_note-FOOTNOTEGoldberg2009228-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Charles_Krauthammer" title="Charles Krauthammer">Charles Krauthammer</a>, a columnist for <i><a href="/wiki/The_Washington_Post" title="The Washington Post">The Washington Post</a></i> wrote in 1989, "[t]heirs will be a life of certain suffering, of probable deviance, of permanent inferiority."<sup id="cite_ref-Ornes_14-2" class="reference"><a href="#cite_note-Ornes-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Vargas10_16-3" class="reference"><a href="#cite_note-Vargas10-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> The president of <a href="/wiki/Boston_University" title="Boston University">Boston University</a> at the time, <a href="/wiki/John_Silber" title="John Silber">John Silber</a>, said, "crack babies ... won't ever achieve the intellectual development to have consciousness of God."<sup id="cite_ref-Vargas10_16-4" class="reference"><a href="#cite_note-Vargas10-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Greider95_17-1" class="reference"><a href="#cite_note-Greider95-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> These claims of biological inferiority played easily into existing <a href="/wiki/Social_class" title="Social class">class</a> and <a href="/wiki/Racism" title="Racism">racial biases</a>. Reporting was often <a href="/wiki/Sensationalism" title="Sensationalism">sensational</a>, favoring the direst predictions and shutting out skeptics.<sup id="cite_ref-Greider95_17-2" class="reference"><a href="#cite_note-Greider95-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> </p> <style data-mw-deduplicate="TemplateStyles:r1237032888/mw-parser-output/.tmulti">.mw-parser-output .tmulti .multiimageinner{display:flex;flex-direction:column}.mw-parser-output .tmulti .trow{display:flex;flex-direction:row;clear:left;flex-wrap:wrap;width:100%;box-sizing:border-box}.mw-parser-output .tmulti .tsingle{margin:1px;float:left}.mw-parser-output .tmulti .theader{clear:both;font-weight:bold;text-align:center;align-self:center;background-color:transparent;width:100%}.mw-parser-output .tmulti .thumbcaption{background-color:transparent}.mw-parser-output .tmulti .text-align-left{text-align:left}.mw-parser-output .tmulti .text-align-right{text-align:right}.mw-parser-output .tmulti .text-align-center{text-align:center}@media all and (max-width:720px){.mw-parser-output .tmulti .thumbinner{width:100%!important;box-sizing:border-box;max-width:none!important;align-items:center}.mw-parser-output .tmulti .trow{justify-content:center}.mw-parser-output .tmulti .tsingle{float:none!important;max-width:100%!important;box-sizing:border-box;text-align:center}.mw-parser-output .tmulti .tsingle .thumbcaption{text-align:left}.mw-parser-output .tmulti .trow>.thumbcaption{text-align:center}}@media screen{html.skin-theme-clientpref-night .mw-parser-output .tmulti .multiimageinner img{background-color:white}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .tmulti .multiimageinner img{background-color:white}}</style><div class="thumb tmulti tleft"><div class="thumbinner multiimageinner" style="width:408px;max-width:408px"><div class="trow"><div class="tsingle" style="width:202px;max-width:202px"><div class="thumbimage"><span typeof="mw:File"><a href="/wiki/File:CocaineHydrochloridePowder_cropped.jpg" class="mw-file-description"><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/5/5e/CocaineHydrochloridePowder_cropped.jpg/200px-CocaineHydrochloridePowder_cropped.jpg" decoding="async" width="200" height="200" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/5e/CocaineHydrochloridePowder_cropped.jpg/300px-CocaineHydrochloridePowder_cropped.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/5e/CocaineHydrochloridePowder_cropped.jpg/400px-CocaineHydrochloridePowder_cropped.jpg 2x" data-file-width="754" data-file-height="754" /></a></span></div></div><div class="tsingle" style="width:202px;max-width:202px"><div class="thumbimage"><span typeof="mw:File"><a href="/wiki/File:Crack_street_dosage_cropped.jpg" class="mw-file-description"><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/4/47/Crack_street_dosage_cropped.jpg/200px-Crack_street_dosage_cropped.jpg" decoding="async" width="200" height="200" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/47/Crack_street_dosage_cropped.jpg/300px-Crack_street_dosage_cropped.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/47/Crack_street_dosage_cropped.jpg/400px-Crack_street_dosage_cropped.jpg 2x" data-file-width="1764" data-file-height="1765" /></a></span></div></div></div><div class="trow" style="display:flex"><div class="thumbcaption">Powder (left) and crack cocaine (right)</div></div></div></div> <p>Reporting on the effects of PCE may have been affected by <a href="/wiki/Publication_bias" title="Publication bias">publication bias</a>, a disproportionate publication of studies indicating more severe outcomes as the crack epidemic emerged.<sup id="cite_ref-Bauer05_18-0" class="reference"><a href="#cite_note-Bauer05-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> Scientific studies that reported PCE to have significant effects were more likely to be published than those that did not.<sup id="cite_ref-Buckingham13_19-0" class="reference"><a href="#cite_note-Buckingham13-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Between 1980 and 1989, 57% of studies showing cocaine has effects on a fetus were accepted by the Society for Pediatric Research, compared with only 11% of studies showing no effects.<sup id="cite_ref-Volpe1025_20-0" class="reference"><a href="#cite_note-Volpe1025-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Findings that other factors such as prematurity were behind symptoms that cocaine-exposed babies showed did not "fit within the narrative of what had become a national scare" and were given less attention.<sup id="cite_ref-retroreport13_21-0" class="reference"><a href="#cite_note-retroreport13-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> Ideas about severe effects of PCE may have been more readily embraced because they "fit in with cultural stereotypes".<sup id="cite_ref-retroreport13_21-1" class="reference"><a href="#cite_note-retroreport13-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> </p><p>At the time, the proposed mechanism by which cocaine harmed fetuses was as a stimulant— cocaine was predicted to disrupt normal development of parts of the brain that dealt with stimulation, resulting in problems such as <a href="/wiki/Bipolar_disorder" title="Bipolar disorder">bipolar disorder</a> and <a href="/wiki/Attention_deficit_disorder" class="mw-redirect" title="Attention deficit disorder">attention deficit disorder</a>.<sup id="cite_ref-NPR_8-4" class="reference"><a href="#cite_note-NPR-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Reports from the mid-1980s to early '90s raised concerns about links between PCE and slowed growth, deformed limbs, defects of the kidneys and <a href="/wiki/Genitourinary_system" title="Genitourinary system">genitourinary</a> and <a href="/wiki/Gastrointestinal_tract" title="Gastrointestinal tract">gastrointestinal systems</a>, <a href="/wiki/Neurological" class="mw-redirect" title="Neurological">neurological</a> damage, <a href="/wiki/Microcephaly" title="Microcephaly">small head size</a>, <a href="/wiki/Atrophy" title="Atrophy">atrophy</a> or <a href="/wiki/Cysts" class="mw-redirect" title="Cysts">cysts</a> in the <a href="/wiki/Cerebral_cortex" title="Cerebral cortex">cerebral cortex</a>, <a href="/wiki/Intraventricular_hemorrhage" title="Intraventricular hemorrhage">bleeding into the brain's ventricles</a>, and obstruction of blood supply in the <a href="/wiki/Central_nervous_system" title="Central nervous system">central nervous system</a>.<sup id="cite_ref-Bauer05_18-1" class="reference"><a href="#cite_note-Bauer05-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p><p>After the early studies that reported that PCE children would be severely disabled came studies that purported to show that cocaine exposure <i>in utero</i> has no important effects.<sup id="cite_ref-Vargas10_16-5" class="reference"><a href="#cite_note-Vargas10-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> Almost every prenatal complication originally thought to be due directly to PCE was found to result from confounding factors such as poor maternal nutrition, use of other drugs, <a href="/wiki/Major_depressive_disorder" title="Major depressive disorder">depression</a>, and lack of <a href="/wiki/Prenatal_care" title="Prenatal care">prenatal care</a>.<sup id="cite_ref-FOOTNOTEDoweiko2008240_22-0" class="reference"><a href="#cite_note-FOOTNOTEDoweiko2008240-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> More recently, the scientific community has begun to reach an understanding that PCE does have some important effects, but that they are not severe as was predicted in the early studies.<sup id="cite_ref-Vargas10_16-6" class="reference"><a href="#cite_note-Vargas10-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> The effects of PCE are subtle but they exist.<sup id="cite_ref-Bauer05_18-2" class="reference"><a href="#cite_note-Bauer05-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Messinger04_23-0" class="reference"><a href="#cite_note-Messinger04-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Eiden09_24-0" class="reference"><a href="#cite_note-Eiden09-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> Most people who were exposed to cocaine <i>in utero</i> are normal or close to it.<sup id="cite_ref-McCarthy14_11-3" class="reference"><a href="#cite_note-McCarthy14-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Pathophysiology">Pathophysiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Prenatal_cocaine_exposure&action=edit&section=2" title="Edit section: Pathophysiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Cocaine3DanBS.gif" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/e/e8/Cocaine3DanBS.gif/220px-Cocaine3DanBS.gif" decoding="async" width="220" height="220" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/e/e8/Cocaine3DanBS.gif 1.5x" data-file-width="256" data-file-height="256" /></a><figcaption>Cocaine is a small enough molecule to pass across the placental barrier into the bloodstream of the fetus.<sup id="cite_ref-FOOTNOTEChandlerLane201423_25-0" class="reference"><a href="#cite_note-FOOTNOTEChandlerLane201423-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup></figcaption></figure> <p>Cocaine, a small molecule, is able to cross the <a href="/wiki/Placenta" title="Placenta">placenta</a> into the bloodstream of the fetus.<sup id="cite_ref-FOOTNOTEChandlerLane201423_25-1" class="reference"><a href="#cite_note-FOOTNOTEChandlerLane201423-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-FOOTNOTEMiller_''et_al''.2013197_26-0" class="reference"><a href="#cite_note-FOOTNOTEMiller_''et_al''.2013197-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> In fact, it may be present in a higher concentration in the <a href="/wiki/Amniotic_fluid" title="Amniotic fluid">amniotic fluid</a> than it is in the mother's bloodstream.<sup id="cite_ref-FOOTNOTEDoweiko2008241_27-0" class="reference"><a href="#cite_note-FOOTNOTEDoweiko2008241-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> The skin of the fetus is able to absorb the chemical directly from the amniotic fluid until the 24th week of pregnancy.<sup id="cite_ref-FOOTNOTEDoweiko2008241_27-1" class="reference"><a href="#cite_note-FOOTNOTEDoweiko2008241-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> Cocaine can also show up in <a href="/wiki/Breast_milk" title="Breast milk">breast milk</a> and affect the nursing baby.<sup id="cite_ref-FOOTNOTEDoweiko2008241_27-2" class="reference"><a href="#cite_note-FOOTNOTEDoweiko2008241-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-FOOTNOTEYaffeBriggsFreeman2008417_28-0" class="reference"><a href="#cite_note-FOOTNOTEYaffeBriggsFreeman2008417-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> The severity of effects depends on how much of the drug is used, how often, and the stage in the development of the fetus.<sup id="cite_ref-FOOTNOTEChandlerLane201424_29-0" class="reference"><a href="#cite_note-FOOTNOTEChandlerLane201424-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> </p><p>Cocaine prevents the <a href="/wiki/Reuptake" title="Reuptake">reuptake</a> of the <a href="/wiki/Neurotransmitters" class="mw-redirect" title="Neurotransmitters">neurotransmitters</a> <a href="/wiki/Dopamine" title="Dopamine">dopamine</a>, <a href="/wiki/Serotonin" title="Serotonin">serotonin</a>, and <a href="/wiki/Norepinephrine" title="Norepinephrine">norepinephrine</a>.<sup id="cite_ref-Buckingham13_19-1" class="reference"><a href="#cite_note-Buckingham13-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Thus, they stay in the <a href="/wiki/Synapse" title="Synapse">synapse</a> longer, causing excitement of the <a href="/wiki/Sympathetic_nervous_system" title="Sympathetic nervous system">sympathetic nervous system</a> and evoking a stress response.<sup id="cite_ref-Volpe1025_20-1" class="reference"><a href="#cite_note-Volpe1025-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> The <a href="/wiki/Euphoria" title="Euphoria">euphoria</a> experienced by cocaine users is thought to be largely due to the way it prevents the serotonin from being reabsorbed by the <a href="/wiki/Presynaptic_neuron" class="mw-redirect" title="Presynaptic neuron">presynaptic neuron</a> that released it.<sup id="cite_ref-Feng05_30-0" class="reference"><a href="#cite_note-Feng05-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Ross15_1-2" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Buckingham13_19-2" class="reference"><a href="#cite_note-Buckingham13-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p><p>Use of cocaine during pregnancy can negatively affect both the mother and the fetus,<sup id="cite_ref-Volpe1025_20-2" class="reference"><a href="#cite_note-Volpe1025-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> but the ways in which it affects the fetus are poorly understood.<sup id="cite_ref-FOOTNOTEDoweiko2008240_22-1" class="reference"><a href="#cite_note-FOOTNOTEDoweiko2008240-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> Three main mechanisms of cocaine exposure can harm a fetus, by altering <a href="/wiki/Neurochemistry" title="Neurochemistry">brain chemistry</a>, altering the expression of certain <a href="/wiki/Gene" title="Gene">genes</a>, and the constriction of blood vessels.<sup id="cite_ref-Ross15_1-3" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> The neurotransmitters affected by cocaine are involved in the development of the fetus's brain,<sup id="cite_ref-FOOTNOTEChandlerLane201424_29-1" class="reference"><a href="#cite_note-FOOTNOTEChandlerLane201424-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> so the drug may affect fetal development directly by altering the development of the brain's <a href="/wiki/Monoaminergic" title="Monoaminergic">monoaminergic</a> system.<sup id="cite_ref-Singer02_31-0" class="reference"><a href="#cite_note-Singer02-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> The most important way cocaine affects fetal development is by binding to dopamine receptors.<sup id="cite_ref-McCarthy14_11-4" class="reference"><a href="#cite_note-McCarthy14-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p><p>Another possible mechanism by which cocaine harms the fetus may be in part by interfering with blood supply to the uterus.<sup id="cite_ref-FOOTNOTEDoweiko2008241_27-3" class="reference"><a href="#cite_note-FOOTNOTEDoweiko2008241-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Aronson08_32-0" class="reference"><a href="#cite_note-Aronson08-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> Cocaine causes <a href="/wiki/Vasoconstriction" title="Vasoconstriction">vasoconstriction</a> (narrowing of blood vessels) in both mother and fetus, which can cause <a href="/wiki/Hypoxia_(medical)" class="mw-redirect" title="Hypoxia (medical)">hypoxia</a> in the fetus.<sup id="cite_ref-FOOTNOTEChandlerLane201424–25_33-0" class="reference"><a href="#cite_note-FOOTNOTEChandlerLane201424–25-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> Constricting blood vessels causes tissues to receive insufficient blood flow, killing cells, but this effect is less pronounced with cocaine than with <a href="/wiki/Nicotine" title="Nicotine">nicotine</a>.<sup id="cite_ref-Konijnenberg15_34-0" class="reference"><a href="#cite_note-Konijnenberg15-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> The reduction in blood flow to the uterus limits the delivery of oxygen and nutrients to the fetus.<sup id="cite_ref-FOOTNOTEMercer200962–64_15-2" class="reference"><a href="#cite_note-FOOTNOTEMercer200962–64-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Cocaine also constricts the blood vessels in the fetus, which is potentially linked to slowed fetal growth and abnormal development of the <a href="/wiki/Genitourinary_system" title="Genitourinary system">genitourinary</a>, <a href="/wiki/Cardiovascular_system" class="mw-redirect" title="Cardiovascular system">cardiovascular</a>, <a href="/wiki/Digestive_system" class="mw-redirect" title="Digestive system">digestive</a>, and <a href="/wiki/Musculoskeletal_system" class="mw-redirect" title="Musculoskeletal system">musculoskeletal systems</a>.<sup id="cite_ref-FOOTNOTEChandlerLane201424_29-2" class="reference"><a href="#cite_note-FOOTNOTEChandlerLane201424-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> Cocaine causes changes in the mother's <a href="/wiki/Blood_pressure" title="Blood pressure">blood pressure</a> that are thought to be the cause of <a href="/wiki/Stroke" title="Stroke">strokes</a> in the fetus; one study found that 6% of cocaine-exposed infants had had one or more strokes.<sup id="cite_ref-FOOTNOTEDoweiko2008241_27-4" class="reference"><a href="#cite_note-FOOTNOTEDoweiko2008241-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> Such prenatal strokes may be the cause of neurological problems found in some cocaine-exposed infants after birth.<sup id="cite_ref-FOOTNOTEGoldberg2009228_7-2" class="reference"><a href="#cite_note-FOOTNOTEGoldberg2009228-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Blood vessel contraction can also cause <a href="/wiki/Premature_labor" class="mw-redirect" title="Premature labor">premature labor</a> and premature birth.<sup id="cite_ref-FOOTNOTEMercer200962–64_15-3" class="reference"><a href="#cite_note-FOOTNOTEMercer200962–64-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Cocaine has also been found to enhance the contractility of the tissue in the uterus, another factor that has been suggested as a possible mechanism for its contribution to increased prematurity rates.<sup id="cite_ref-Aronson08_32-1" class="reference"><a href="#cite_note-Aronson08-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> Increased contractility of the uterus may also be behind the increased likelihood of <a href="/wiki/Placental_abruption" title="Placental abruption">placental abruption</a> (the placenta tearing away from the uterine wall), which some findings have linked with PCE.<sup id="cite_ref-Volpe1025_20-3" class="reference"><a href="#cite_note-Volpe1025-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Prenatal_cocaine_exposure&action=edit&section=3" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Cocaine use during pregnancy can be discovered by asking the mother, but sometimes women will not admit to having used drugs.<sup id="cite_ref-FOOTNOTEZuckermanFrank2012127_35-0" class="reference"><a href="#cite_note-FOOTNOTEZuckermanFrank2012127-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> Mothers may lie for fear of prosecution<sup id="cite_ref-FOOTNOTEZuckermanFrank2012127_35-1" class="reference"><a href="#cite_note-FOOTNOTEZuckermanFrank2012127-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> or having their children taken away, but even when they are willing to tell the truth, their memories may not be very accurate.<sup id="cite_ref-Konijnenberg15_34-1" class="reference"><a href="#cite_note-Konijnenberg15-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> Determining the purity of the drug they have taken also may not be possible.<sup id="cite_ref-FOOTNOTEChandlerLane201420_36-0" class="reference"><a href="#cite_note-FOOTNOTEChandlerLane201420-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> More reliable methods for detecting cocaine exposure involve testing the newborn's hair or <a href="/wiki/Meconium" title="Meconium">meconium</a> (the infant's earliest stool).<sup id="cite_ref-Ostrea01_37-0" class="reference"><a href="#cite_note-Ostrea01-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> Hair analysis, however, can give <a href="/wiki/False_positive" class="mw-redirect" title="False positive">false positives</a> for cocaine exposure,<sup id="cite_ref-Ostrea01_37-1" class="reference"><a href="#cite_note-Ostrea01-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> and a newborn may not have enough hair to test.<sup id="cite_ref-Konijnenberg15_34-2" class="reference"><a href="#cite_note-Konijnenberg15-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> The newborn's urine can be tested for cocaine and <a href="/wiki/Metabolite" title="Metabolite">metabolites</a>, but it must be collected as soon as possible after birth.<sup id="cite_ref-FOOTNOTEChandlerLane201420_36-1" class="reference"><a href="#cite_note-FOOTNOTEChandlerLane201420-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> It is not known how long after exposure the markers will still show up in a newborn's urine.<sup id="cite_ref-FOOTNOTEZuckermanFrank2012127_35-2" class="reference"><a href="#cite_note-FOOTNOTEZuckermanFrank2012127-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> The mother's urine can also be tested for drugs, but it cannot detect drugs used too far in the past or determine how much or how often the drugs were used.<sup id="cite_ref-Konijnenberg15_34-3" class="reference"><a href="#cite_note-Konijnenberg15-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> Tests cannot generally detect cocaine use over a week prior to sample collection.<sup id="cite_ref-FOOTNOTEZuckermanFrank2012127_35-3" class="reference"><a href="#cite_note-FOOTNOTEZuckermanFrank2012127-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> Mothers are more honest about cocaine use when their urine is also tested, but many users still deny it.<sup id="cite_ref-FOOTNOTEZuckermanFrank2012127_35-4" class="reference"><a href="#cite_note-FOOTNOTEZuckermanFrank2012127-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> Both maternal and neonatal urine tests can give <a href="/wiki/False_negative" class="mw-redirect" title="False negative">false negatives</a>.<sup id="cite_ref-FOOTNOTEZuckermanFrank2012127_35-5" class="reference"><a href="#cite_note-FOOTNOTEZuckermanFrank2012127-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Effects_and_prognosis">Effects and prognosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Prenatal_cocaine_exposure&action=edit&section=4" title="Edit section: Effects and prognosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>As of 2014, studies had returned widely varying reports of the effects of PCE; some claimed the physical disabilities are severe and generalized, others find specific effects, others none all.<sup id="cite_ref-Ross15_1-4" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>The timing of the dose of the drug is an important determinant of outcome, in addition to how much is used, for how long, and what kind of care is rendered after birth.<sup id="cite_ref-Ross15_1-5" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Drug use in the <a href="/wiki/First_trimester" class="mw-redirect" title="First trimester">first trimester</a> is the most harmful to the fetus in terms of neurological and developmental outcome.<sup id="cite_ref-Marrus02_38-0" class="reference"><a href="#cite_note-Marrus02-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> The effects of PCE later in a child's life are poorly understood; as of 2010 , little information was available about the effects of <i>in utero</i> cocaine exposure on children over the age of five.<sup id="cite_ref-Ackerman10_2-2" class="reference"><a href="#cite_note-Ackerman10-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Some studies have found PCE-related differences in height and weight, while others have not; these differences are generally either small or are gone by the time children are of school age.<sup id="cite_ref-Ackerman10_2-3" class="reference"><a href="#cite_note-Ackerman10-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Much is unknown about what factors may exist to aid children who were exposed to cocaine <i>in utero</i>.<sup id="cite_ref-FOOTNOTEDoweiko2008240_22-2" class="reference"><a href="#cite_note-FOOTNOTEDoweiko2008240-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> Whether the effects of PCE are increased once children reach adolescence was unknown in 2013, as was whether the neural rewiring that occurs during this developmental period attenuates the effects.<sup id="cite_ref-Buckingham13_19-3" class="reference"><a href="#cite_note-Buckingham13-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> A review of 27 studies performed between 2006 and 2012 found that <a href="/wiki/Cognitive_development" title="Cognitive development">cognitive development</a> was mildly to moderately affected in PCE adolescents, but how important these effects were in practical terms was unclear.<sup id="cite_ref-Buckingham13_19-4" class="reference"><a href="#cite_note-Buckingham13-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p><p>Unlike <a href="/wiki/Fetal_alcohol_syndrome" class="mw-redirect" title="Fetal alcohol syndrome">fetal alcohol syndrome</a>, no set of characteristics has been discovered that results uniquely from cocaine exposure <i>in utero</i>.<sup id="cite_ref-FOOTNOTEDoweiko2008240_22-3" class="reference"><a href="#cite_note-FOOTNOTEDoweiko2008240-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> Cocaine exposure <i>in utero</i> may affect the structure and function of the brain, predisposing children to developmental problems later, or these effects may be explained by children of crack-using mothers being at higher risk for <a href="/wiki/Domestic_violence" title="Domestic violence">domestic violence</a>, <a href="/wiki/Deadbeat_parent" title="Deadbeat parent">deadbeat parenting</a>, and <a href="/wiki/Major_depressive_disorder" title="Major depressive disorder">maternal depression</a>.<sup id="cite_ref-Ackerman10_2-4" class="reference"><a href="#cite_note-Ackerman10-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> As of 2008, when researchers were able to identify effects of PCE, they were typically small.<sup id="cite_ref-FOOTNOTEDoweiko2008240_22-4" class="reference"><a href="#cite_note-FOOTNOTEDoweiko2008240-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Pregnancy_and_birth">Pregnancy and birth</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Prenatal_cocaine_exposure&action=edit&section=5" title="Edit section: Pregnancy and birth"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Premature_infant_with_ventilator.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/3/3e/Premature_infant_with_ventilator.jpg/170px-Premature_infant_with_ventilator.jpg" decoding="async" width="170" height="227" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/3e/Premature_infant_with_ventilator.jpg/255px-Premature_infant_with_ventilator.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/3e/Premature_infant_with_ventilator.jpg/340px-Premature_infant_with_ventilator.jpg 2x" data-file-width="768" data-file-height="1024" /></a><figcaption>Premature baby</figcaption></figure> <p>As of 2013, studies had found after controlling for other factors that some effects are present in pregnancies involving cocaine: <a href="/wiki/Placental_abruption" title="Placental abruption">abruptio placenta</a>, <a href="/wiki/Preterm_birth" title="Preterm birth">prematurity</a>, low <a href="/wiki/Birth_weight" title="Birth weight">birth weight</a>, and small size compared to babies of the same gestational time.<sup id="cite_ref-FOOTNOTEMiller_''et_al''.2013197_26-1" class="reference"><a href="#cite_note-FOOTNOTEMiller_''et_al''.2013197-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> PCE newborns have <a href="/wiki/Microcephaly" title="Microcephaly">smaller heads</a> and shorter bodies.<sup id="cite_ref-Lambert12_3-1" class="reference"><a href="#cite_note-Lambert12-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Ross15_1-6" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> PCE effects are more severe when the amounts of cocaine are greater.<sup id="cite_ref-FOOTNOTEMiller_''et_al''.2013197_26-2" class="reference"><a href="#cite_note-FOOTNOTEMiller_''et_al''.2013197-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> As many as 17–27% of cocaine-using pregnant women deliver prematurely.<sup id="cite_ref-Aronson08_32-2" class="reference"><a href="#cite_note-Aronson08-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> In association with prematurity, growth in the womb is reduced, and low birth weight is connected to PCE.<sup id="cite_ref-Buckingham13_19-5" class="reference"><a href="#cite_note-Buckingham13-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Also, some data associate <a href="/wiki/Spontaneous_abortion" class="mw-redirect" title="Spontaneous abortion">spontaneous abortion</a> with cocaine use.<sup id="cite_ref-Ornes_14-3" class="reference"><a href="#cite_note-Ornes-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> Cocaine reduces the appetite and has been linked with reduced maternal weight gain during pregnancy; in addition, constriction of the blood vessels may further limit supply of nutrients to the fetus.<sup id="cite_ref-FOOTNOTEChandlerLane201425_39-0" class="reference"><a href="#cite_note-FOOTNOTEChandlerLane201425-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> Using cocaine while pregnant also heightens the chances of maternal and fetal vitamin deficiencies, <a href="/wiki/Infant_respiratory_distress_syndrome" title="Infant respiratory distress syndrome">respiratory distress syndrome</a> for the baby, and <a href="/wiki/Infarction" title="Infarction">infarction</a> of the bowels.<sup id="cite_ref-FOOTNOTEDoweiko2008241_27-5" class="reference"><a href="#cite_note-FOOTNOTEDoweiko2008241-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> Early reports found that cocaine-exposed babies were at high risk for <a href="/wiki/Sudden_infant_death_syndrome" class="mw-redirect" title="Sudden infant death syndrome">sudden infant death syndrome</a>;<sup id="cite_ref-Bauer05_18-3" class="reference"><a href="#cite_note-Bauer05-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> however, by itself, cocaine exposure during fetal development has not subsequently been identified as a risk factor for the syndrome.<sup id="cite_ref-Frank01_40-0" class="reference"><a href="#cite_note-Frank01-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> Some PCE children experience <a href="/wiki/Hypertonia" title="Hypertonia">hypertonia</a> (excessive <a href="/wiki/Muscle_tone" title="Muscle tone">muscle tone</a>),<sup id="cite_ref-Ren04_41-0" class="reference"><a href="#cite_note-Ren04-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> and reduced reflexes and motor function have been found in babies four to six weeks old.<sup id="cite_ref-Buckingham13_19-6" class="reference"><a href="#cite_note-Buckingham13-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p><p>While newborns who were exposed prenatally to drugs such as <a href="/wiki/Barbiturates" class="mw-redirect" title="Barbiturates">barbiturates</a> or <a href="/wiki/Heroin" title="Heroin">heroin</a> frequently have symptoms of drug <a href="/wiki/Drug_withdrawal" title="Drug withdrawal">withdrawal</a> (<a href="/wiki/Neonatal_withdrawal" title="Neonatal withdrawal">neonatal abstinence syndrome</a>), this does not happen with babies exposed to crack <i>in utero</i>; at least, such symptoms are difficult to separate in the context of other factors such as <a href="/wiki/Preterm_birth" title="Preterm birth">prematurity</a> or prenatal exposure to other drugs.<sup id="cite_ref-FOOTNOTEMercer200962–64_15-4" class="reference"><a href="#cite_note-FOOTNOTEMercer200962–64-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Mental,_emotional,_and_behavioral_outcomes"><span id="Mental.2C_emotional.2C_and_behavioral_outcomes"></span>Mental, emotional, and behavioral outcomes</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Prenatal_cocaine_exposure&action=edit&section=6" title="Edit section: Mental, emotional, and behavioral outcomes"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1251242444">.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox 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src="//upload.wikimedia.org/wikipedia/en/thumb/f/f2/Edit-clear.svg/40px-Edit-clear.svg.png" decoding="async" width="40" height="40" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/f/f2/Edit-clear.svg/60px-Edit-clear.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/f/f2/Edit-clear.svg/80px-Edit-clear.svg.png 2x" data-file-width="48" data-file-height="48" /></span></span></div></td><td class="mbox-text"><div class="mbox-text-span">This section <b>may be <a href="/wiki/Wikipedia:Article_size" title="Wikipedia:Article size">too long</a> to read and navigate comfortably</b>.<span class="hide-when-compact"> Consider <a href="/wiki/Wikipedia:Splitting" title="Wikipedia:Splitting">splitting</a> content into sub-articles, <a href="/wiki/Wikipedia:Summary_style" title="Wikipedia:Summary style">condensing</a> it, or adding <a href="/wiki/Help:Section#Subsections" title="Help:Section">subheadings</a>. Please discuss this issue on the article's <a href="/wiki/Talk:Prenatal_cocaine_exposure" title="Talk:Prenatal cocaine exposure">talk page</a>.</span> <span class="date-container"><i>(<span class="date">May 2024</span>)</i></span></div></td></tr></tbody></table> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1251242444"><table class="box-Update plainlinks metadata ambox ambox-content ambox-Update" role="presentation"><tbody><tr><td class="mbox-image"><div class="mbox-image-div"><span typeof="mw:File"><span><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/5/53/Ambox_current_red_Americas.svg/42px-Ambox_current_red_Americas.svg.png" decoding="async" width="42" height="34" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/53/Ambox_current_red_Americas.svg/63px-Ambox_current_red_Americas.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/53/Ambox_current_red_Americas.svg/84px-Ambox_current_red_Americas.svg.png 2x" data-file-width="360" data-file-height="290" /></span></span></div></td><td class="mbox-text"><div class="mbox-text-span">This section needs to be <b>updated</b>.<span class="hide-when-compact"> Please help update this article to reflect recent events or newly available information.</span> <span class="date-container"><i>(<span class="date">May 2024</span>)</i></span></div></td></tr></tbody></table> </div> </div><span class="hide-when-compact"><i> (<small><a href="/wiki/Help:Maintenance_template_removal" title="Help:Maintenance template removal">Learn how and when to remove this message</a></small>)</i></span></div></td></tr></tbody></table> <p>As of 2013, studies had shown small deficits in behavioral, cognitive, attention, emotional, and language function in PCE infants, children, and adolescents,<sup id="cite_ref-Buckingham13_19-7" class="reference"><a href="#cite_note-Buckingham13-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> but in 2015, other studies attributed findings of negative effects on cognitive development to confounding factors.<sup id="cite_ref-Konijnenberg15_34-4" class="reference"><a href="#cite_note-Konijnenberg15-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> Studies suggest that the environment in which a child grows up makes a more important contribution to outcome in cognitive, behavioral, and other outcomes than does the cocaine exposure itself.<sup id="cite_ref-Lambert12_3-2" class="reference"><a href="#cite_note-Lambert12-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> <a href="/w/index.php?title=School_performance&action=edit&redlink=1" class="new" title="School performance (page does not exist)">School performance</a> is mildly affected in older children.<sup id="cite_ref-FOOTNOTEMiller_''et_al''.2013197_26-3" class="reference"><a href="#cite_note-FOOTNOTEMiller_''et_al''.2013197-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> In a 2015 <a href="/wiki/Intelligence_quotient" title="Intelligence quotient">IQ</a> study, cocaine-exposed children did not appear to score lower than others.<sup id="cite_ref-Ross15_1-7" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Although PCE is correlated with low IQ scores, scientists generally believe that PCE alone does not cause this effect; rather, it is more likely due to associated factors.<sup id="cite_ref-Lambert12_3-3" class="reference"><a href="#cite_note-Lambert12-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> In school-aged and younger children, PCE does not appear in studies to predispose children to poorer intellectual performance.<sup id="cite_ref-Ackerman10_2-5" class="reference"><a href="#cite_note-Ackerman10-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Poor performance on IQ tests could actually be due to trouble with sustaining <a href="/wiki/Attention" title="Attention">attention</a> if the tests fail to account for this factor separately.<sup id="cite_ref-Konijnenberg15_34-5" class="reference"><a href="#cite_note-Konijnenberg15-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> </p><p>Cocaine causes impaired growth of the fetus's brain, an effect that is most pronounced with high levels of cocaine and prolonged duration of exposure throughout all three trimesters of pregnancy.<sup id="cite_ref-Ren04_41-1" class="reference"><a href="#cite_note-Ren04-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> Prenatal cocaine exposure has been found to affect the cognitive performance of individuals and affect speech and language development, behavior, physical and cognitive growth, and function. The more of the substance the fetus is exposed to, the more of an effect it can have on the overall development, as well as running the risk of being fatal to the fetus during the prenatal stage(s) of pregnancy. The effects of cocaine uses can cause for there to be an increased chance of the baby being born premature, affecting the body weight, height and the growth of the organs and brain due to the premature state of the baby, as well as the impact of the harmful substances the baby was exposed to. This can have effects on other areas such as brain development, being exposed to a stimulant such as cocaine can cause damage and issues in development over time. In behavior, cognition, memory, grasping of information, and attention are areas that are common struggles for children that were exposed to cocaine in the womb. These effects are seen in individuals reaching the age of 10 and older. Long-term studies have shown that there are alterations made in the structure and function of the brain occur when exposed to these drugs with cause change in the behaviors of the individual over time and they develop and grow. All of the effects physically and cognitively all vary for each individual based on their level of exposure to the drug, the gestational timing of the infant as it develops, determine some physical effect that might have occurred and the care they receive after being born.<sup id="cite_ref-Ross15_1-8" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Studies that use <a href="/wiki/Neuroimaging" title="Neuroimaging">neuroimaging</a> such as <a href="/wiki/Magnetic_resonance_imaging" title="Magnetic resonance imaging">magnetic resonance imaging</a> (MRI) and <a href="/wiki/Functional_magnetic_resonance_imaging" title="Functional magnetic resonance imaging">FMRI</a> have shown differences in brain structure of PCE children, for example in the <a href="/wiki/Cerebral_cortex" title="Cerebral cortex">cerebral cortex</a> and <a href="/wiki/Limbic_system" title="Limbic system">limbic system</a>.<sup id="cite_ref-Ross15_1-9" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Those PCE children who had slowed brain growth as fetuses are at higher risk for impaired brain growth and motor, language and attention problems after they are born.<sup id="cite_ref-Ren04_41-2" class="reference"><a href="#cite_note-Ren04-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> Studies have found that children exposed to cocaine during fetal development experience problems with language, behavior, development, and attention.<sup id="cite_ref-Buckingham13_19-8" class="reference"><a href="#cite_note-Buckingham13-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Lester10_42-0" class="reference"><a href="#cite_note-Lester10-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> However these effects are small, especially when studies control for other factors like exposure to other drugs.<sup id="cite_ref-Buckingham13_19-9" class="reference"><a href="#cite_note-Buckingham13-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Cognitive and attention skills can be impacted by PCE, possibly due to effects on brain areas such as the <a href="/wiki/Prefrontal_cortex" title="Prefrontal cortex">prefrontal cortex</a>.<sup id="cite_ref-Thompson09_12-3" class="reference"><a href="#cite_note-Thompson09-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Brain areas in the frontal lobe involved in dealing with stress, attention, and impulsiveness seem to be particularly impacted by PCE, as evidenced by neuroimaging studies that show abnormalities in these areas of the brain.<sup id="cite_ref-Lambert12_3-4" class="reference"><a href="#cite_note-Lambert12-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> PCE infants have been shown to be more jittery and excitable and have lower <a href="/wiki/Arousal" title="Arousal">arousal</a> and self-regulation; such behavioral effects may persist or worsen after 12 months of age.<sup id="cite_ref-Ross15_1-10" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Children whose mothers used cocaine during pregnancy may develop symptoms akin to those of <a href="/wiki/Attention_deficit_disorder" class="mw-redirect" title="Attention deficit disorder">attention deficit disorder</a>,<sup id="cite_ref-Thompson09_12-4" class="reference"><a href="#cite_note-Thompson09-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> and a link has been found between the disorder itself and PCE.<sup id="cite_ref-FOOTNOTEBeauchaineHinshaw2015427_43-0" class="reference"><a href="#cite_note-FOOTNOTEBeauchaineHinshaw2015427-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> Mild deficits in language have been found in older PCE children.<sup id="cite_ref-FOOTNOTEMiller_''et_al''.2013197_26-4" class="reference"><a href="#cite_note-FOOTNOTEMiller_''et_al''.2013197-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> Language development is impaired, possibly into late adolescence, but adolescents up to age 17 may improve their receptive language skills.<sup id="cite_ref-Ross15_1-11" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>Evidence suggests that <i>in utero</i> cocaine exposure leads to problems with behavior and sustained <a href="/wiki/Attention" title="Attention">attention</a>, possibly by affecting parts of the brain that are vulnerable to <a href="/wiki/Toxin" title="Toxin">toxins</a> during fetal development.<sup id="cite_ref-Ackerman10_2-6" class="reference"><a href="#cite_note-Ackerman10-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> School-age PCE children have been found to have trouble regulating their behavior and sustaining their attention.<sup id="cite_ref-Konijnenberg15_34-6" class="reference"><a href="#cite_note-Konijnenberg15-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> Children who had been exposed to high levels of cocaine <i>in utero</i> show poorer behavioral inhibition than those with lower levels of exposure or unexposed children.<sup id="cite_ref-Lambert12_3-5" class="reference"><a href="#cite_note-Lambert12-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> The changes in behavior and attention caused by PCE are measurable by standardized scales;<sup id="cite_ref-Ren04_41-3" class="reference"><a href="#cite_note-Ren04-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> however these behavioral effects seem to be mild.<sup id="cite_ref-Thompson09_12-5" class="reference"><a href="#cite_note-Thompson09-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Children exposed to cocaine in the first trimester are less sociable, more withdrawn, and show more anxious and depressed behaviors.<sup id="cite_ref-Ross15_1-12" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Those exposed to higher doses of cocaine have been reported to show aggressive and <a href="/w/index.php?title=Disruptive_behavior&action=edit&redlink=1" class="new" title="Disruptive behavior (page does not exist)">disruptive behaviors</a>.<sup id="cite_ref-Ross15_1-13" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> PCE girls are seven times more likely to have delinquent behavioral problems, but PCE boys are no more likely than other boys.<sup id="cite_ref-FOOTNOTEBeauchaineHinshaw2015427_43-1" class="reference"><a href="#cite_note-FOOTNOTEBeauchaineHinshaw2015427-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> Studies from the 2000s and 2010s are conflicted on whether PCE adolescents are at greater risk for use of drugs such as cocaine, alcohol, and marijuana.<sup id="cite_ref-Buckingham13_19-10" class="reference"><a href="#cite_note-Buckingham13-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> A 2010 study found that PCE adolescent girls were have anxiety than their non-exposed peers.<sup id="cite_ref-Buckingham13_19-11" class="reference"><a href="#cite_note-Buckingham13-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Physical_outcomes">Physical outcomes</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Prenatal_cocaine_exposure&action=edit&section=7" title="Edit section: Physical outcomes"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Slowed growth is well documented in fetuses, but it is not as clear whether older children remain smaller or catch up to their peers.<sup id="cite_ref-Ross15_1-14" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Some studies show that growth remains slowed for as many as ten years.<sup id="cite_ref-Lambert12_3-6" class="reference"><a href="#cite_note-Lambert12-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Ross15_1-15" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> PCE may also interfere with the way the motor system matures.<sup id="cite_ref-Ren04_41-4" class="reference"><a href="#cite_note-Ren04-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> Motor effects that have been documented include poorer reflexes and quality of movement in infants.<sup id="cite_ref-Ross15_1-16" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> PCE may have an effect on the <a href="/wiki/Neuroendocrine_system" class="mw-redirect" title="Neuroendocrine system">neuroendocrine system</a>, but more study is needed to determine whether it does and what the effects are.<sup id="cite_ref-Buckingham13_19-12" class="reference"><a href="#cite_note-Buckingham13-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p><p>A review of the literature reported that cocaine use causes <a href="/wiki/Congenital_defect" class="mw-redirect" title="Congenital defect">congenital defects</a> between 15 and 20% of the time; however another large-scale study found no difference in rates of birth anomalies in PCE and non-PCE infants.<sup id="cite_ref-Aronson517_44-0" class="reference"><a href="#cite_note-Aronson517-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> It has been suggested that some birth defects could be due to cocaine's disruption of blood vessel growth.<sup id="cite_ref-Aronson517_44-1" class="reference"><a href="#cite_note-Aronson517-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> Most PCE-related congenital defects are found in the brain, heart, <a href="/wiki/Genitourinary_tract" class="mw-redirect" title="Genitourinary tract">genitourinary tract</a>, arms and legs.<sup id="cite_ref-Aronson517_44-2" class="reference"><a href="#cite_note-Aronson517-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> Cocaine use by pregnant mothers may directly or indirectly contribute to defects in the formation of the <a href="/wiki/Circulatory_system" title="Circulatory system">circulatory system</a> and is associated with abnormalities in development of the <a href="/wiki/Aorta" title="Aorta">aorta</a>.<sup id="cite_ref-Aronson08_32-3" class="reference"><a href="#cite_note-Aronson08-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> Heart malformations can include a missing <a href="/wiki/Ventricle_(heart)" title="Ventricle (heart)">ventricle</a> and defects with the <a href="/wiki/Septum" title="Septum">septum</a> of the heart, and can result in potentially deadly <a href="/wiki/Congestive_heart_failure" class="mw-redirect" title="Congestive heart failure">congestive heart failure</a>.<sup id="cite_ref-Feng05_30-1" class="reference"><a href="#cite_note-Feng05-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> Genital malformations occur at a higher-than-normal rate with PCE.<sup id="cite_ref-Aronson517_44-3" class="reference"><a href="#cite_note-Aronson517-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> The liver and lungs are also at higher risk for abnormalities.<sup id="cite_ref-Feng05_30-2" class="reference"><a href="#cite_note-Feng05-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Cloverleaf_skull" class="mw-redirect" title="Cloverleaf skull">Cloverleaf skull</a>, a congenital malformation in which the <a href="/wiki/Human_skull" class="mw-redirect" title="Human skull">skull</a> has three lobes, the brain is deformed, and <a href="/wiki/Hydrocephalus" title="Hydrocephalus">hydrocephalus</a> occurs, is also associated with PCE.<sup id="cite_ref-Aronson520_45-0" class="reference"><a href="#cite_note-Aronson520-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> Like birth defects, small head size, and <a href="/wiki/Intracerebral_hemorrhage" title="Intracerebral hemorrhage">stroke</a> are risks in PCE.<sup id="cite_ref-FOOTNOTEMacDonaldSeshia2015_46-0" class="reference"><a href="#cite_note-FOOTNOTEMacDonaldSeshia2015-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Prenatal_cocaine_exposure&action=edit&section=8" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Of all cocaine users, women of childbearing age comprise 15–17%.<sup id="cite_ref-FOOTNOTEMiller_''et_al''.2013197_26-5" class="reference"><a href="#cite_note-FOOTNOTEMiller_''et_al''.2013197-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> An estimated 0.6 to 3% of pregnant women in the developed world use cocaine.<sup id="cite_ref-Lamy10_6-1" class="reference"><a href="#cite_note-Lamy10-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-McCarthy14_11-5" class="reference"><a href="#cite_note-McCarthy14-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> A 1995 survey in the US found that between 30,000 and 160,000 cases of prenatal exposure to cocaine occur each year.<sup id="cite_ref-Harvey04_47-0" class="reference"><a href="#cite_note-Harvey04-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> By one estimate, in the US 100,000 babies are born each year after having been exposed to crack cocaine <i>in utero</i>.<sup id="cite_ref-Aronson08_32-4" class="reference"><a href="#cite_note-Aronson08-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> An estimated 7.5 million PCE children are living in the US.<sup id="cite_ref-McCarthy14_11-6" class="reference"><a href="#cite_note-McCarthy14-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> Pregnant women in urban parts of the US and who are of a low <a href="/wiki/Socioeconomic_status" title="Socioeconomic status">socioeconomic status</a> use cocaine more often.<sup id="cite_ref-Singer02_31-1" class="reference"><a href="#cite_note-Singer02-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> However, the real <a href="/wiki/Prevalence" title="Prevalence">prevalence</a> of cocaine use by pregnant women is unknown.<sup id="cite_ref-FOOTNOTEDoweiko2008240_22-5" class="reference"><a href="#cite_note-FOOTNOTEDoweiko2008240-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Lambert12_3-7" class="reference"><a href="#cite_note-Lambert12-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Legal_and_ethical_issues">Legal and ethical issues</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Prenatal_cocaine_exposure&action=edit&section=9" title="Edit section: Legal and ethical issues"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Smoking_Crack.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/d/da/Smoking_Crack.jpg/220px-Smoking_Crack.jpg" decoding="async" width="220" height="165" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/da/Smoking_Crack.jpg/330px-Smoking_Crack.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/da/Smoking_Crack.jpg/440px-Smoking_Crack.jpg 2x" data-file-width="1024" data-file-height="768" /></a><figcaption>Women have been prosecuted for using crack while pregnant.</figcaption></figure> <p>The harm to a child from PCE has implications for public policy and law. Some US states have pressed charges against pregnant women who use drugs, including <a href="/wiki/Assault_with_a_deadly_weapon" class="mw-redirect" title="Assault with a deadly weapon">assault with a deadly weapon</a>, corruption of a minor, <a href="/wiki/Manslaughter" title="Manslaughter">manslaughter</a>, <a href="/wiki/Child_abuse" title="Child abuse">child abuse</a>, and distribution of drugs to a minor.<sup id="cite_ref-FOOTNOTEGainesKremling2013453_48-0" class="reference"><a href="#cite_note-FOOTNOTEGainesKremling2013453-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> However these approaches have generally been rejected in the courts on the basis that a fetus is not legally a child.<sup id="cite_ref-Marrus02_38-1" class="reference"><a href="#cite_note-Marrus02-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> Between 1985 and 2001, more than 200 women in over 30 US states faced prosecution for drug use during pregnancy.<sup id="cite_ref-Frank01_40-1" class="reference"><a href="#cite_note-Frank01-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> In South Carolina, a woman who used crack in her third <a href="/wiki/Trimester_of_pregnancy" class="mw-redirect" title="Trimester of pregnancy">trimester of pregnancy</a> was sentenced to prison for eight years when her child was born with cocaine <a href="/wiki/Metabolite" title="Metabolite">metabolites</a> in its system.<sup id="cite_ref-Marrus02_38-2" class="reference"><a href="#cite_note-Marrus02-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> The Supreme Court of South Carolina upheld this conviction.<sup id="cite_ref-Marrus02_38-3" class="reference"><a href="#cite_note-Marrus02-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> As of 2013, all but one of the women prosecuted in the US for drug use while pregnant have won their cases on appeal.<sup id="cite_ref-FOOTNOTEGainesKremling2013453_48-1" class="reference"><a href="#cite_note-FOOTNOTEGainesKremling2013453-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> </p><p>From 1989 to 1994, in the midst of public outcry about cocaine babies, the <a href="/wiki/Medical_University_of_South_Carolina" title="Medical University of South Carolina">Medical University of South Carolina</a> tested pregnant women for cocaine, reporting those who tested positive to the police.<sup id="cite_ref-Annas01_49-0" class="reference"><a href="#cite_note-Annas01-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> The US Supreme Court <a href="/wiki/Ferguson_v._City_of_Charleston" title="Ferguson v. City of Charleston">found the policy to be unacceptable</a> on constitutional grounds in 2001.<sup id="cite_ref-Annas01_49-1" class="reference"><a href="#cite_note-Annas01-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> Some advocates argue that punishment for crack-using pregnant women as a means to treat their addiction is a violation of their right to privacy.<sup id="cite_ref-Marrus02_38-4" class="reference"><a href="#cite_note-Marrus02-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> According to studies, fear of prosecution and having children taken away is associated with a refusal to seek prenatal care or medical treatment.<sup id="cite_ref-Thompson09_12-6" class="reference"><a href="#cite_note-Thompson09-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p><p>Some nonprofit organizations aim to prevent PCE with <a href="/wiki/Birth_control" title="Birth control">birth control</a>. One such initiative, <a href="/wiki/Project_Prevention" title="Project Prevention">Project Prevention</a>, offers women addicted to cocaine money as an incentive to undergo long-term birth control or, frequently, <a href="/wiki/Human_sterilization_(surgical_procedure)" class="mw-redirect" title="Human sterilization (surgical procedure)">sterilization</a>—an approach which has led to public outcry from those who consider this practice to be <a href="/wiki/Eugenics" title="Eugenics">eugenics</a>.<sup id="cite_ref-Hardtalk_50-0" class="reference"><a href="#cite_note-Hardtalk-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Social_stigma">Social stigma</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Prenatal_cocaine_exposure&action=edit&section=10" title="Edit section: Social stigma"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Children who were exposed to crack prenatally faced <a href="/wiki/Social_stigma" title="Social stigma">social stigma</a> as babies and school-aged children; some experts say that the "crack baby" stigma was more harmful than the PCE.<sup id="cite_ref-Ornes_14-4" class="reference"><a href="#cite_note-Ornes-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> Teachers were affected by these cultural stereotypes; such biases may have negatively affected the educational experiences of children thus stigmatized.<sup id="cite_ref-FOOTNOTEGainesKremling2013452_51-0" class="reference"><a href="#cite_note-FOOTNOTEGainesKremling2013452-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> Teachers who knew that specific children had been exposed to crack <i>in utero</i> may have expected these children to be disruptive and <a href="/wiki/Developmental_disability" title="Developmental disability">developmentally delayed</a>.<sup id="cite_ref-Frank01_40-2" class="reference"><a href="#cite_note-Frank01-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> Children who were exposed to cocaine might be teased by others who knew of the exposure, and problems these children had might be misdiagnosed by doctors or others as resulting from PCE when they may really have been due to factors like illness or abuse.<sup id="cite_ref-Okie09_10-1" class="reference"><a href="#cite_note-Okie09-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Commentators have characterized the phenomenon as a <a href="/wiki/Moral_panic" title="Moral panic">moral panic</a>.<sup id="cite_ref-52" class="reference"><a href="#cite_note-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-53" class="reference"><a href="#cite_note-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup> The social stigma of the drug also complicated studies of PCE; researchers labored under the awareness that their findings would have political implications.<sup id="cite_ref-Okie09_10-2" class="reference"><a href="#cite_note-Okie09-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> In addition, the perceived hopelessness of 'crack babies' may have caused researchers to ignore possibilities for early intervention that could have helped them.<sup id="cite_ref-FOOTNOTEGoldberg2009228_7-3" class="reference"><a href="#cite_note-FOOTNOTEGoldberg2009228-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> The social stigma may turn out to be a <a href="/wiki/Self-fulfilling_prophecy" title="Self-fulfilling prophecy">self-fulfilling prophecy</a>.<sup id="cite_ref-FOOTNOTEConnors2007_54-0" class="reference"><a href="#cite_note-FOOTNOTEConnors2007-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Research">Research</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Prenatal_cocaine_exposure&action=edit&section=11" title="Edit section: Research"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Confounding_factors">Confounding factors</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Prenatal_cocaine_exposure&action=edit&section=12" title="Edit section: Confounding factors"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A number of the effects that had been thought after early studies to be attributable to prenatal exposure to cocaine are actually due partially or wholly to other factors, such as exposure to other substances (including <a href="/wiki/Tobacco" title="Tobacco">tobacco</a>, <a href="/wiki/Alcoholic_beverage" title="Alcoholic beverage">alcohol</a>, or <a href="/wiki/Marijuana" class="mw-redirect" title="Marijuana">marijuana</a>) or to the environment in which the child is raised.<sup id="cite_ref-Aronson517_44-4" class="reference"><a href="#cite_note-Aronson517-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> </p><p>PCE is very difficult to study because of a variety of factors that may confound the results: pre- and postnatal care may be poor; the pregnant mother and child may be <a href="/wiki/Malnutrition" title="Malnutrition">malnourished</a>; the amount of cocaine a mother takes can vary; she may take a variety of drugs during pregnancy in addition to cocaine; measurements for detecting deficits may not be sensitive enough; and results that are found may only last a short time.<sup id="cite_ref-Harvey04_47-1" class="reference"><a href="#cite_note-Harvey04-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> Studies differ in how they define heavy or light cocaine use during pregnancy, and the time period of exposure during pregnancy on which they focus (e.g. first, second, or <a href="/wiki/Third_trimester" class="mw-redirect" title="Third trimester">third trimester</a>.<sup id="cite_ref-Buckingham13_19-13" class="reference"><a href="#cite_note-Buckingham13-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Drug use by mothers puts children at high risk for exposure to toxic or otherwise dangerous environments, and PCE does not present much risk beyond these risk factors.<sup id="cite_ref-Ackerman10_2-7" class="reference"><a href="#cite_note-Ackerman10-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> PCE is clustered with other risk factors to the child, such as physical abuse and neglect, <a href="/wiki/Domestic_violence" title="Domestic violence">domestic violence</a>, and prenatal exposure to other substances.<sup id="cite_ref-Aronson517_44-5" class="reference"><a href="#cite_note-Aronson517-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> Such environmental factors are known to adversely affect children in the same areas being studied with respect to PCE.<sup id="cite_ref-Singer02_31-2" class="reference"><a href="#cite_note-Singer02-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> Most women who use cocaine while pregnant use other drugs too; one study found that 93% of those who use cocaine or opiates also use tobacco, marijuana, or alcohol.<sup id="cite_ref-Konijnenberg15_34-7" class="reference"><a href="#cite_note-Konijnenberg15-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> When researchers control for use of other drugs, many of the seeming effects of cocaine on head size, birth weight, <a href="/wiki/Apgar_score" title="Apgar score">Apgar scores</a>, and prematurity disappear.<sup id="cite_ref-Konijnenberg15_34-8" class="reference"><a href="#cite_note-Konijnenberg15-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> </p><p>Addiction to any substance, including crack, may be a risk factor for child abuse or <a href="/wiki/Child_neglect" title="Child neglect">neglect</a>.<sup id="cite_ref-Frank01_40-3" class="reference"><a href="#cite_note-Frank01-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> Crack addiction, like other addictions, distracts parents from the child and leads to inattentive parenting.<sup id="cite_ref-FOOTNOTEMercer200962–64_15-5" class="reference"><a href="#cite_note-FOOTNOTEMercer200962–64-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Mothers who continue to use drugs once their babies are born have trouble forming the normal parental bonds, more often interacting with their babies with a detached, unenthusiastic, flat demeanor.<sup id="cite_ref-FOOTNOTEChandlerLane201428_55-0" class="reference"><a href="#cite_note-FOOTNOTEChandlerLane201428-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup> Conversely, low-stress environments and responsive caregiving may provide a protective effect on the child's brain, potentially compensating for negative effects of PCE.<sup id="cite_ref-Buckingham13_19-14" class="reference"><a href="#cite_note-Buckingham13-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Many drug users do not get <a href="/wiki/Prenatal_care" title="Prenatal care">prenatal care</a>, for a variety of reasons including that they may not know they are pregnant.<sup id="cite_ref-Marrus02_38-5" class="reference"><a href="#cite_note-Marrus02-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> Many crack addicts get no medical care at all and have extremely poor diets, and children who live around crack smoking are at risk of inhaling <a href="/wiki/Passive_smoking" title="Passive smoking">secondary smoke</a>.<sup id="cite_ref-FOOTNOTEMercer200962–64_15-6" class="reference"><a href="#cite_note-FOOTNOTEMercer200962–64-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Cocaine using mothers also have a higher rate of <a href="/wiki/Sexually_transmitted_infection" title="Sexually transmitted infection">sexually transmitted infections</a> such as <a href="/wiki/HIV" title="HIV">HIV</a> and <a href="/wiki/Hepatitis" title="Hepatitis">hepatitis</a>.<sup id="cite_ref-Bauer05_18-4" class="reference"><a href="#cite_note-Bauer05-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p><p>In some cases, it is not clear whether direct results of PCE lead to behavioral problems, or whether environmental factors are at fault.<sup id="cite_ref-Ackerman10_2-8" class="reference"><a href="#cite_note-Ackerman10-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> For example, children who have caregiver instability may have more behavioral problems as a result, or it may be that behavioral problems manifested by PCE children lead to greater turnover in caregivers.<sup id="cite_ref-Ackerman10_2-9" class="reference"><a href="#cite_note-Ackerman10-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Other factors that make studying PCE difficult include unwillingness of mothers to tell the truth about drug history, uncertainty of dosages of street drugs<sup id="cite_ref-FOOTNOTEZuckermanFrank2012127_35-6" class="reference"><a href="#cite_note-FOOTNOTEZuckermanFrank2012127-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> and high rates of attrition (loss of participants) from studies.<sup id="cite_ref-Singer02_31-3" class="reference"><a href="#cite_note-Singer02-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Animal_models">Animal models</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Prenatal_cocaine_exposure&action=edit&section=13" title="Edit section: Animal models"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>One way to address problems with uncertainty about cocaine's effects due to confounding factors is to use animal models; these allow experimenters to study the effects at specific doses and times.<sup id="cite_ref-FOOTNOTEChandlerLane201422_56-0" class="reference"><a href="#cite_note-FOOTNOTEChandlerLane201422-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> Studies have used mice, other rodents, rabbits, and primates.<sup id="cite_ref-McCarthy14_11-7" class="reference"><a href="#cite_note-McCarthy14-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> However, differences between species' physiology and <a href="/wiki/Gestation" title="Gestation">gestation</a> times mean findings in animals may not apply to humans.<sup id="cite_ref-FOOTNOTEChandlerLane201422_56-1" class="reference"><a href="#cite_note-FOOTNOTEChandlerLane201422-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> Mice, rats, and rabbits have shorter gestational times, so experimenters must continue giving drugs after they are born to more closely model human gestation; however this introduces more differences.<sup id="cite_ref-Ross15_1-17" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Animals and humans metabolize drugs at different rates, and drugs that are highly <a href="/wiki/Teratogenicity" class="mw-redirect" title="Teratogenicity">teratogenic</a> in animals may not be in humans and vice versa.<sup id="cite_ref-FOOTNOTEZuckermanFrank2012125_57-0" class="reference"><a href="#cite_note-FOOTNOTEZuckermanFrank2012125-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> Animals cannot be used to measure differences in abilities such as reasoning that are only found in humans.<sup id="cite_ref-FOOTNOTEZuckermanFrank2012125_57-1" class="reference"><a href="#cite_note-FOOTNOTEZuckermanFrank2012125-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> Animal studies in various species have found that cocaine impacts brain structure, function, and chemistry, and causes long-term changes at the molecular, cellular, and behavioral levels.<sup id="cite_ref-Ross15_1-18" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Animal Model Studies have shown that cocaine has the ability to cross the placenta and the blood brain barrier in the body. This is yet another example of the damage that can be done that can impact and effect the brain and body function and health overall. While the animal model is not as reliable for certain tests because we function differently, this test in particular gives us the idea of the level of damage that can be cause to the fetus of a pregnant women using cocaine during her pregnancy.<sup id="cite_ref-Ross15_1-19" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> In research studies on pregnant rats, injected cocaine did less damage to cells than injected nicotine, and more recovery occurred between doses.<sup id="cite_ref-Konijnenberg15_34-9" class="reference"><a href="#cite_note-Konijnenberg15-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> Adult rats that were exposed to cocaine prenatally have deficits in learning, memory, and motor skills, and may have abnormalities in dopamine processing.<sup id="cite_ref-FOOTNOTEChandlerLane201428_55-1" class="reference"><a href="#cite_note-FOOTNOTEChandlerLane201428-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup> Animal research has also shown that offspring of males that used cocaine while their sperm were forming may go on to have abnormalities later in life.<sup id="cite_ref-Ross15_1-20" class="reference"><a href="#cite_note-Ross15-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Prenatal_cocaine_exposure&action=edit&section=14" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-Ross15-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-Ross15_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Ross15_1-1"><sup><i><b>b</b></i></sup></a> <a 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Retrieved <span class="nowrap">2022-04-23</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+York+Times&rft.atitle=Opinion+%7C+Slandering+the+Unborn&rft.date=2018-12-28&rft.issn=0362-4331&rft_id=https%3A%2F%2Fwww.nytimes.com%2Finteractive%2F2018%2F12%2F28%2Fopinion%2Fcrack-babies-racism.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APrenatal+cocaine+exposure" class="Z3988"></span></span> </li> <li id="cite_note-FOOTNOTEConnors2007-54"><span class="mw-cite-backlink"><b><a href="#cite_ref-FOOTNOTEConnors2007_54-0">^</a></b></span> <span class="reference-text"><a href="#CITEREFConnors2007">Connors 2007</a>.<span class="error harv-error" style="display: none; font-size:100%"> sfn error: no target: CITEREFConnors2007 (<a href="/wiki/Category:Harv_and_Sfn_template_errors" title="Category:Harv and Sfn template errors">help</a>)</span></span> </li> <li id="cite_note-FOOTNOTEChandlerLane201428-55"><span class="mw-cite-backlink">^ <a href="#cite_ref-FOOTNOTEChandlerLane201428_55-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-FOOTNOTEChandlerLane201428_55-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><a href="#CITEREFChandlerLane2014">Chandler & Lane 2014</a>, p. 28.</span> </li> <li id="cite_note-FOOTNOTEChandlerLane201422-56"><span class="mw-cite-backlink">^ <a href="#cite_ref-FOOTNOTEChandlerLane201422_56-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-FOOTNOTEChandlerLane201422_56-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><a href="#CITEREFChandlerLane2014">Chandler & Lane 2014</a>, p. 22.</span> </li> <li id="cite_note-FOOTNOTEZuckermanFrank2012125-57"><span class="mw-cite-backlink">^ <a href="#cite_ref-FOOTNOTEZuckermanFrank2012125_57-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-FOOTNOTEZuckermanFrank2012125_57-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><a href="#CITEREFZuckermanFrank2012">Zuckerman & Frank 2012</a>, p. 125.</span> </li> </ol></div></div> <div class="mw-heading mw-heading3"><h3 id="Bibliography">Bibliography</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Prenatal_cocaine_exposure&action=edit&section=15" title="Edit section: Bibliography"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239549316">.mw-parser-output .refbegin{margin-bottom:0.5em}.mw-parser-output .refbegin-hanging-indents>ul{margin-left:0}.mw-parser-output .refbegin-hanging-indents>ul>li{margin-left:0;padding-left:3.2em;text-indent:-3.2em}.mw-parser-output .refbegin-hanging-indents ul,.mw-parser-output .refbegin-hanging-indents ul li{list-style:none}@media(max-width:720px){.mw-parser-output .refbegin-hanging-indents>ul>li{padding-left:1.6em;text-indent:-1.6em}}.mw-parser-output .refbegin-columns{margin-top:0.3em}.mw-parser-output .refbegin-columns ul{margin-top:0}.mw-parser-output .refbegin-columns li{page-break-inside:avoid;break-inside:avoid-column}@media screen{.mw-parser-output .refbegin{font-size:90%}}</style><div class="refbegin refbegin-columns references-column-width" style="column-width: 30em"> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFAronson" class="citation book cs1">Aronson, JK (2008). "Cocaine". <i>Meyler's Side Effects of Psychiatric Drugs</i>. Amsterdam: Elsevier Science. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-444-53266-4" title="Special:BookSources/978-0-444-53266-4"><bdi>978-0-444-53266-4</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Cocaine&rft.btitle=Meyler%27s+Side+Effects+of+Psychiatric+Drugs&rft.place=Amsterdam&rft.pub=Elsevier+Science&rft.date=2008&rft.isbn=978-0-444-53266-4&rft.au=Aronson%2C+JK&rfr_id=info%3Asid%2Fen.wikipedia.org%3APrenatal+cocaine+exposure" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBeauchaineHinshaw2015" class="citation book cs1">Beauchaine, TP; Hinshaw, SP (29 October 2015). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=EJyOCgAAQBAJ&pg=PA427"><i>The Oxford Handbook of Externalizing Spectrum Disorders</i></a>. Oxford University Press, Incorporated. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-19-932467-5" title="Special:BookSources/978-0-19-932467-5"><bdi>978-0-19-932467-5</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Oxford+Handbook+of+Externalizing+Spectrum+Disorders&rft.pub=Oxford+University+Press%2C+Incorporated&rft.date=2015-10-29&rft.isbn=978-0-19-932467-5&rft.aulast=Beauchaine&rft.aufirst=TP&rft.au=Hinshaw%2C+SP&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DEJyOCgAAQBAJ%26pg%3DPA427&rfr_id=info%3Asid%2Fen.wikipedia.org%3APrenatal+cocaine+exposure" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFChandlerLane2014" class="citation book cs1">Chandler, LS; Lane, SJ (3 June 2014). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=Za23AwAAQBAJ&pg=PA141"><i>Children With Prenatal Drug Exposure</i></a>. Routledge. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-317-82688-0" title="Special:BookSources/978-1-317-82688-0"><bdi>978-1-317-82688-0</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Children+With+Prenatal+Drug+Exposure&rft.pub=Routledge&rft.date=2014-06-03&rft.isbn=978-1-317-82688-0&rft.aulast=Chandler&rft.aufirst=LS&rft.au=Lane%2C+SJ&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DZa23AwAAQBAJ%26pg%3DPA141&rfr_id=info%3Asid%2Fen.wikipedia.org%3APrenatal+cocaine+exposure" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFConnors,_GJMaisto,_SAGalizio,_M2007" class="citation book cs1">Connors, GJ; Maisto, SA; Galizio, M (2007). <i>Drug Use and Abuse</i>. Belmont, CA: Wadsworth Publishing. p. 136. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-495-09207-0" title="Special:BookSources/978-0-495-09207-0"><bdi>978-0-495-09207-0</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Drug+Use+and+Abuse&rft.place=Belmont%2C+CA&rft.pages=136&rft.pub=Wadsworth+Publishing&rft.date=2007&rft.isbn=978-0-495-09207-0&rft.au=Connors%2C+GJ&rft.au=Maisto%2C+SA&rft.au=Galizio%2C+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3APrenatal+cocaine+exposure" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFDoweiko2008" class="citation book cs1">Doweiko, HE (2008). <i>Concepts of Chemical Dependency</i>. Wadsworth Publishing. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-495-50580-8" title="Special:BookSources/978-0-495-50580-8"><bdi>978-0-495-50580-8</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Concepts+of+Chemical+Dependency&rft.pub=Wadsworth+Publishing&rft.date=2008&rft.isbn=978-0-495-50580-8&rft.aulast=Doweiko&rft.aufirst=HE&rfr_id=info%3Asid%2Fen.wikipedia.org%3APrenatal+cocaine+exposure" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFGainesKremling2013" class="citation book cs1">Gaines, LK; Kremling, J (11 December 2013). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=V4BIAgAAQBAJ&pg=PA452"><i>Drugs, Crime, and Justice: Contemporary Perspectives, Third Edition</i></a>. Waveland Press. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-4786-1318-3" title="Special:BookSources/978-1-4786-1318-3"><bdi>978-1-4786-1318-3</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Drugs%2C+Crime%2C+and+Justice%3A+Contemporary+Perspectives%2C+Third+Edition&rft.pub=Waveland+Press&rft.date=2013-12-11&rft.isbn=978-1-4786-1318-3&rft.aulast=Gaines&rft.aufirst=LK&rft.au=Kremling%2C+J&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DV4BIAgAAQBAJ%26pg%3DPA452&rfr_id=info%3Asid%2Fen.wikipedia.org%3APrenatal+cocaine+exposure" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFGoldberg,_R2009" class="citation book cs1">Goldberg, R (2009). "Cocaine amphetamines". <i>Drugs Across the Spectrum</i>. Brooks Cole. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-495-55793-7" title="Special:BookSources/978-0-495-55793-7"><bdi>978-0-495-55793-7</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Cocaine+amphetamines&rft.btitle=Drugs+Across+the+Spectrum&rft.pub=Brooks+Cole&rft.date=2009&rft.isbn=978-0-495-55793-7&rft.au=Goldberg%2C+R&rfr_id=info%3Asid%2Fen.wikipedia.org%3APrenatal+cocaine+exposure" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFLewis,_MKestler,_L2011" class="citation book cs1">Lewis, M; Kestler, L (2011). <i>Gender Differences in Prenatal Substance Exposure</i>. American Psychological Society. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-4338-1033-6" title="Special:BookSources/978-1-4338-1033-6"><bdi>978-1-4338-1033-6</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Gender+Differences+in+Prenatal+Substance+Exposure&rft.pub=American+Psychological+Society&rft.date=2011&rft.isbn=978-1-4338-1033-6&rft.au=Lewis%2C+M&rft.au=Kestler%2C+L&rfr_id=info%3Asid%2Fen.wikipedia.org%3APrenatal+cocaine+exposure" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMacDonaldSeshia2015" class="citation book cs1">MacDonald, MG; Seshia, MM (29 July 2015). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=K1tECgAAQBAJ&pg=PT4051">"Maternal Drugs and the Developing Fetus"</a>. <i>Avery's Neonatology: Pathophysiology and Management of the Newborn</i>. Wolters Kluwer Health. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-4963-1868-8" title="Special:BookSources/978-1-4963-1868-8"><bdi>978-1-4963-1868-8</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Maternal+Drugs+and+the+Developing+Fetus&rft.btitle=Avery%27s+Neonatology%3A+Pathophysiology+and+Management+of+the+Newborn&rft.pub=Wolters+Kluwer+Health&rft.date=2015-07-29&rft.isbn=978-1-4963-1868-8&rft.aulast=MacDonald&rft.aufirst=MG&rft.au=Seshia%2C+MM&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DK1tECgAAQBAJ%26pg%3DPT4051&rfr_id=info%3Asid%2Fen.wikipedia.org%3APrenatal+cocaine+exposure" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMercer2009" class="citation book cs1">Mercer, J (2009). <span class="id-lock-registration" title="Free registration required"><a rel="nofollow" class="external text" href="https://archive.org/details/childdevelopment0000merc">"Claim 9: "Crack babies" can't be cured and will always have serious problems"</a></span>. <span class="id-lock-registration" title="Free registration required"><a rel="nofollow" class="external text" href="https://archive.org/details/childdevelopment0000merc"><i>Child Development: Myths and Misunderstandings</i></a></span>. Sage Publications, Inc. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-4129-5646-8" title="Special:BookSources/978-1-4129-5646-8"><bdi>978-1-4129-5646-8</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Claim+9%3A+%22Crack+babies%22+can%27t+be+cured+and+will+always+have+serious+problems&rft.btitle=Child+Development%3A+Myths+and+Misunderstandings&rft.pub=Sage+Publications%2C+Inc&rft.date=2009&rft.isbn=978-1-4129-5646-8&rft.aulast=Mercer&rft.aufirst=J&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fchilddevelopment0000merc&rfr_id=info%3Asid%2Fen.wikipedia.org%3APrenatal+cocaine+exposure" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMiller_et_al.2013" class="citation book cs1">Miller, PM; Blume, AW; Kavanaugh, DJ; Kampman, KM; Bates, ME; Larimer, ME; Petry, NM; Dewitte, P; Ball, SA (17 May 2013). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=5gRNl3oIwWEC&pg=PA197"><i>Principles of Addiction: Comprehensive Addictive Behaviors and Disorders</i></a>. Academic Press. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-12-398361-9" title="Special:BookSources/978-0-12-398361-9"><bdi>978-0-12-398361-9</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Principles+of+Addiction%3A+Comprehensive+Addictive+Behaviors+and+Disorders&rft.pub=Academic+Press&rft.date=2013-05-17&rft.isbn=978-0-12-398361-9&rft.aulast=Miller&rft.aufirst=PM&rft.au=Blume%2C+AW&rft.au=Kavanaugh%2C+DJ&rft.au=Kampman%2C+KM&rft.au=Bates%2C+ME&rft.au=Larimer%2C+ME&rft.au=Petry%2C+NM&rft.au=Dewitte%2C+P&rft.au=Ball%2C+SA&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D5gRNl3oIwWEC%26pg%3DPA197&rfr_id=info%3Asid%2Fen.wikipedia.org%3APrenatal+cocaine+exposure" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFSoby2006" class="citation book cs1">Soby, JM (2006). <i>Prenatal Exposure to Drugs/Alcohol: Characteristics And Educational Implications of Fetal Alcohol Syndrome And Cocaine/polydrug Effects</i>. Charles C. Thomas Ltd. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-398-07635-1" title="Special:BookSources/978-0-398-07635-1"><bdi>978-0-398-07635-1</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Prenatal+Exposure+to+Drugs%2FAlcohol%3A+Characteristics+And+Educational+Implications+of+Fetal+Alcohol+Syndrome+And+Cocaine%2Fpolydrug+Effects&rft.pub=Charles+C.+Thomas+Ltd.&rft.date=2006&rft.isbn=978-0-398-07635-1&rft.aulast=Soby&rft.aufirst=JM&rfr_id=info%3Asid%2Fen.wikipedia.org%3APrenatal+cocaine+exposure" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFWenzel,_SLKosofsky,_BEHarvey,_JAIguchi,_MY2001" class="citation book cs1">Wenzel, SL; Kosofsky, BE; Harvey, JA; Iguchi, MY; Steinberg, PS; Watkins, KE; Shaikh R (2001). <a rel="nofollow" class="external text" href="https://www.rand.org/pubs/monograph_reports/MR1347.html"><i>Prenatal Cocaine Exposure: Scientific Considerations and Policy Implications</i></a>. RAND Drug Policy Research Center and NY Academy of Sciences. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-8330-3001-6" title="Special:BookSources/978-0-8330-3001-6"><bdi>978-0-8330-3001-6</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Prenatal+Cocaine+Exposure%3A+Scientific+Considerations+and+Policy+Implications&rft.pub=RAND+Drug+Policy+Research+Center+and+NY+Academy+of+Sciences&rft.date=2001&rft.isbn=978-0-8330-3001-6&rft.au=Wenzel%2C+SL&rft.au=Kosofsky%2C+BE&rft.au=Harvey%2C+JA&rft.au=Iguchi%2C+MY&rft.au=Steinberg%2C+PS&rft.au=Watkins%2C+KE&rft.au=Shaikh+R&rft_id=https%3A%2F%2Fwww.rand.org%2Fpubs%2Fmonograph_reports%2FMR1347.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APrenatal+cocaine+exposure" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFVolpe" class="citation book cs1">Volpe, JJ (2008). "Teratogenic effects of drugs and passive addiction". <i>Neurology of the Newborn</i>. Vol. 22. Philadelphia: Saunders. pp. 1–648. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-4160-3995-2" title="Special:BookSources/978-1-4160-3995-2"><bdi>978-1-4160-3995-2</bdi></a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/7022034">7022034</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Teratogenic+effects+of+drugs+and+passive+addiction&rft.btitle=Neurology+of+the+Newborn&rft.place=Philadelphia&rft.pages=1-648&rft.pub=Saunders&rft.date=2008&rft_id=info%3Apmid%2F7022034&rft.isbn=978-1-4160-3995-2&rft.au=Volpe%2C+JJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3APrenatal+cocaine+exposure" class="Z3988"></span> <span class="cs1-visible-error citation-comment"><code class="cs1-code">{{<a href="/wiki/Template:Cite_book" title="Template:Cite book">cite book</a>}}</code>: </span><span class="cs1-visible-error citation-comment"><code class="cs1-code">|journal=</code> ignored (<a href="/wiki/Help:CS1_errors#periodical_ignored" title="Help:CS1 errors">help</a>)</span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFYaffeBriggsFreeman2008" class="citation book cs1">Yaffe, SJ; Briggs, GG; Freeman, RA (2008). <span class="id-lock-registration" title="Free registration required"><a rel="nofollow" class="external text" href="https://archive.org/details/drugsinpregnancy0008brig">"Cocaine"</a></span>. <span class="id-lock-registration" title="Free registration required"><a rel="nofollow" class="external text" href="https://archive.org/details/drugsinpregnancy0008brig"><i>Drugs in pregnancy and lactation: A reference guide to fetal and neonatal risk</i></a></span>. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-7817-7876-3" title="Special:BookSources/978-0-7817-7876-3"><bdi>978-0-7817-7876-3</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Cocaine&rft.btitle=Drugs+in+pregnancy+and+lactation%3A+A+reference+guide+to+fetal+and+neonatal+risk&rft.place=Philadelphia&rft.pub=Wolters+Kluwer+Health%2FLippincott+Williams+%26+Wilkins&rft.date=2008&rft.isbn=978-0-7817-7876-3&rft.au=Yaffe%2C+SJ&rft.au=Briggs%2C+GG&rft.au=Freeman%2C+RA&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fdrugsinpregnancy0008brig&rfr_id=info%3Asid%2Fen.wikipedia.org%3APrenatal+cocaine+exposure" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFZuckermanFrank2012" class="citation book cs1">Zuckerman, B; Frank, DA (2 December 2012). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=wNHAIVuyb3gC&pg=PA173">"Prenatal Cocaine and Marijuana Exposure: Research and Clinical Implications"</a>. In Zagon, IS; Slotkin TA (eds.). <i>Maternal Substance Abuse and the Developing Nervous System</i>. Elsevier. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-08-092667-4" title="Special:BookSources/978-0-08-092667-4"><bdi>978-0-08-092667-4</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Prenatal+Cocaine+and+Marijuana+Exposure%3A+Research+and+Clinical+Implications&rft.btitle=Maternal+Substance+Abuse+and+the+Developing+Nervous+System&rft.pub=Elsevier&rft.date=2012-12-02&rft.isbn=978-0-08-092667-4&rft.aulast=Zuckerman&rft.aufirst=B&rft.au=Frank%2C+DA&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DwNHAIVuyb3gC%26pg%3DPA173&rfr_id=info%3Asid%2Fen.wikipedia.org%3APrenatal+cocaine+exposure" class="Z3988"></span></li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Prenatal_cocaine_exposure&action=edit&section=16" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a rel="nofollow" class="external text" href="https://web.archive.org/web/20130904231440/http://retroreport.org/crack-babies-a-tale-from-the-drug-wars/">Crack Babies: A Tale from the Drug Wars</a>, a documentary from <i>The New York Times</i></li></ul> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1129693374">.mw-parser-output .hlist dl,.mw-parser-output .hlist ol,.mw-parser-output .hlist ul{margin:0;padding:0}.mw-parser-output .hlist dd,.mw-parser-output .hlist dt,.mw-parser-output .hlist li{margin:0;display:inline}.mw-parser-output .hlist.inline,.mw-parser-output .hlist.inline dl,.mw-parser-output .hlist.inline ol,.mw-parser-output .hlist.inline ul,.mw-parser-output .hlist dl dl,.mw-parser-output .hlist dl ol,.mw-parser-output .hlist dl ul,.mw-parser-output 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li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Infants_and_their_care" title="Template:Infants and their care"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Infants_and_their_care" title="Template talk:Infants and their care"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Infants_and_their_care" title="Special:EditPage/Template:Infants and their care"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Infants_and_their_care" style="font-size:114%;margin:0 4em"><a href="/wiki/Infant" title="Infant">Infants</a> and their care</div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Health (<a href="/wiki/Pediatrics" title="Pediatrics">Pediatrics</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Baby_food" title="Baby food">Baby food</a></li> <li><a href="/wiki/Birth_weight" title="Birth weight">Birth weight</a></li> <li><a href="/wiki/Breast_pump" title="Breast pump">Breast pump</a></li> <li><a href="/wiki/Breastfeeding" title="Breastfeeding">Breastfeeding</a></li> <li><a href="/wiki/Breastfeeding_and_medications" title="Breastfeeding and medications">Breastfeeding and medications</a></li> <li><a href="/wiki/Breastfeeding_and_mental_health" title="Breastfeeding and mental health">Breastfeeding and mental health</a></li> <li><a href="/wiki/Bottle_feeding" class="mw-redirect" title="Bottle feeding">Bottle feeding</a></li> <li><a href="/wiki/Baby_colic" title="Baby colic">Colic</a></li> <li><a href="/wiki/Cradle_cap" title="Cradle cap">Cradle cap</a></li> <li><a href="/wiki/Esotropia" title="Esotropia">Esotropia</a></li> <li><a href="/wiki/Failure_to_thrive" title="Failure to thrive">Failure to thrive</a></li> <li><a href="/wiki/Immunization" title="Immunization">Immunization</a></li> <li><a href="/wiki/Infant_and_toddler_safety" title="Infant and toddler safety">Infant and toddler safety</a></li> <li><a href="/wiki/Infant_bathing" class="mw-redirect" title="Infant bathing">Infant bathing</a></li> <li><a href="/wiki/Infant_feeding" title="Infant feeding">Infant feeding</a></li> <li><a href="/wiki/Infant_food_safety" title="Infant food safety">Infant food safety</a></li> <li><a href="/wiki/Infant_formula" title="Infant formula">Infant formula</a></li> <li><a href="/wiki/Infant_massage" title="Infant massage">Infant massage</a></li> <li><a href="/wiki/Infant_respiratory_distress_syndrome" title="Infant respiratory distress syndrome">Infant respiratory distress syndrome</a></li> <li><a href="/wiki/Infant_sleep_training" title="Infant sleep training">Infant sleep training</a></li> <li><a href="/wiki/Neonatal_intensive_care_unit" title="Neonatal intensive care unit">Neonatal intensive care unit</a></li> <li><a href="/wiki/Newborn_care_and_safety" title="Newborn care and safety">Newborn care and safety</a></li> <li><a href="/wiki/Oral_rehydration_therapy" title="Oral rehydration therapy">Oral rehydration therapy</a> <ul><li><a href="/wiki/Pedialyte" title="Pedialyte">Pedialyte</a></li></ul></li> <li><a href="/wiki/Preterm_birth" title="Preterm birth">Preterm birth</a></li> <li><a href="/wiki/Shaken_baby_syndrome" title="Shaken baby syndrome">Shaken baby syndrome</a></li> <li><a href="/wiki/Soy_formula" title="Soy formula">Soy formula</a></li> <li><a href="/wiki/SIDS" title="SIDS">SIDS</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Development</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Attachment_parenting" title="Attachment parenting">Attachment parenting</a></li> <li><a href="/wiki/Baby-led_weaning" title="Baby-led weaning">Baby-led weaning</a></li> <li><a href="/wiki/Baby_talk" title="Baby talk">Baby talk</a></li> <li><a href="/wiki/Babbling" title="Babbling">Babbling</a></li> <li><a href="/wiki/Birth_defect" title="Birth defect">Birth defect</a></li> <li><a href="/wiki/Childbirth" title="Childbirth">Childbirth</a></li> <li><a href="/wiki/Crawling_(human)" title="Crawling (human)">Crawling</a></li> <li><a href="/wiki/Gestational_age" title="Gestational age">Gestational age</a></li> <li><a href="/wiki/Infant_visual_development" title="Infant visual development">Infant visual development</a></li> <li><a href="/wiki/Irritant_diaper_dermatitis" title="Irritant diaper dermatitis">Irritant diaper dermatitis</a></li> <li><a href="/wiki/Infant_cognitive_development" title="Infant cognitive development">Infant cognitive development</a></li> <li><a href="/wiki/Infant_crying" title="Infant crying">Infant crying</a></li> <li><a href="/wiki/Kangaroo_care" title="Kangaroo care">Kangaroo care</a></li> <li><a href="/wiki/Mother" title="Mother">Mother</a></li> <li><a href="/wiki/Nursery_rhyme" title="Nursery rhyme">Nursery rhyme</a></li> <li><a href="/wiki/Object_permanence" title="Object permanence">Object permanence</a></li> <li><a href="/wiki/Parent" title="Parent">Parent</a></li> <li><a href="/wiki/Parenting" title="Parenting">Parenting</a></li> <li><a href="/wiki/Peekaboo" title="Peekaboo">Peekaboo</a></li> <li><a href="/wiki/Play_(activity)" title="Play (activity)">Play</a></li> <li><a href="/wiki/Prenatal_development" title="Prenatal development">Prenatal development</a></li> <li><a href="/wiki/File:Prenatal_development_table.svg" title="File:Prenatal development table.svg">Prenatal development table</a></li> <li><a href="/wiki/Teething" title="Teething">Teething</a></li> <li><a href="/wiki/Gross_motor_skill#Learning_to_walk" title="Gross motor skill">Walking</a></li> <li><a href="/wiki/Weaning" title="Weaning">Weaning</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Socialization and Culture</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Attachment_theory" title="Attachment theory">Attachment</a></li> <li><a href="/wiki/Babysitting" title="Babysitting">Babysitting</a></li> <li><a href="/wiki/Child_abuse" title="Child abuse">Child abuse</a></li> <li><a href="/wiki/Child_care" title="Child care">Child care</a></li> <li><a href="/wiki/Child_custody" title="Child custody">Child custody</a></li> <li><a href="/wiki/Children%27s_rights" title="Children's rights">Children's rights</a> <ul><li><a href="/wiki/Convention_on_the_Rights_of_the_Child" title="Convention on the Rights of the Child">UN Child rights</a></li></ul></li> <li><a href="/wiki/Circumcision" title="Circumcision">Circumcision</a></li> <li><a href="/wiki/Foster_care" title="Foster care">Foster care</a></li> <li><a href="/wiki/Grandparent_visitation" title="Grandparent visitation">Grandparent visitation</a></li> <li><a href="/wiki/Infant_swimming" title="Infant swimming">Infant swimming</a></li> <li><a href="/wiki/Human_milk_banking_in_North_America" title="Human milk banking in North America">Milk bank</a></li> <li><a href="/wiki/Nanny" title="Nanny">Nanny</a></li> <li><a href="/wiki/Wet_nurse" title="Wet nurse">Wet nurse</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Infant care and equipment</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Baby_jumper" title="Baby jumper">Baby bouncer</a></li> <li><a href="/wiki/Baby_gate" title="Baby gate">Baby gate</a></li> <li><a href="/wiki/Baby_monitor" title="Baby monitor">Baby monitor</a>/<a href="/wiki/Hidden_camera" title="Hidden camera">Hidden camera</a></li> <li><a href="/wiki/Baby_powder" title="Baby powder">Baby powder</a></li> <li><a href="/wiki/Baby_shampoo" title="Baby shampoo">Baby shampoo</a></li> <li><a href="/w/index.php?title=Baby_toy&action=edit&redlink=1" class="new" title="Baby toy (page does not exist)">Baby toy</a></li> <li><a href="/wiki/Baby_walker" title="Baby walker">Baby walker</a></li> <li><a href="/wiki/Bib_(garment)" title="Bib (garment)">Bib</a></li> <li><a href="/wiki/Swing_(seat)" title="Swing (seat)">Baby swing</a></li> <li><a href="/wiki/Baby_transport" title="Baby transport">Baby transport</a></li> <li><a href="/wiki/Bassinet" title="Bassinet">Bassinet</a></li> <li><a href="/wiki/Car_seat_safety" class="mw-redirect" title="Car seat safety">Car seat safety</a></li> <li><a href="/wiki/Cloth_diaper" title="Cloth diaper">Cloth diaper</a></li> <li><a href="/wiki/Cradle_board" class="mw-redirect" title="Cradle board">Cradle board</a></li> <li><a href="/wiki/Diaper" title="Diaper">Diaper</a></li> <li><a href="/wiki/Diaper_bag" title="Diaper bag">Diaper bag</a></li> <li><a href="/wiki/Baby_wipes" class="mw-redirect" title="Baby wipes">Baby wipes</a></li> <li><a href="/wiki/Haberman_Feeder" title="Haberman Feeder">Haberman Feeder</a></li> <li><a href="/wiki/High_chair" title="High chair">High chair</a></li> <li><a href="/wiki/Infant_bed" title="Infant bed">Infant bed</a> <small><i>(American 'crib' and 'cradle', British 'cot')</i></small></li> <li><a href="/wiki/Infant_carrier" class="mw-redirect" title="Infant carrier">Infant carrier</a></li> <li><a href="/wiki/Infant_clothing" title="Infant clothing">Infant clothing</a></li> <li><a href="/wiki/Pacifier" title="Pacifier">Pacifier</a></li> <li><a href="/wiki/Playpen" title="Playpen">Playpen</a></li> <li><a href="/wiki/Stroller" class="mw-redirect" title="Stroller">Stroller</a></li> <li><a href="/wiki/Supplemental_nursing_system" title="Supplemental nursing system">Supplemental nursing system</a></li> <li><a href="/wiki/Swaddling" title="Swaddling">Swaddling</a></li> <li><a href="/wiki/Swim_diaper" title="Swim diaper">Swim diaper</a></li> <li><a href="/wiki/Teether" title="Teether">Teether</a></li> <li><a href="/wiki/Travel_cot" title="Travel cot">Travel cot</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other topics</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Baby_shower" title="Baby shower">Baby shower</a></li> <li><a href="/wiki/Babywearing" title="Babywearing">Babywearing</a></li> <li><a href="/wiki/Child_neglect" title="Child neglect">Child neglect</a></li> <li><a href="/wiki/Closed_adoption" title="Closed adoption">Closed adoption</a></li> <li><a href="/wiki/Cry_room" title="Cry room">Cry room</a></li> <li><a href="/wiki/Infant_ear_piercing" title="Infant ear piercing">Infant ear piercing</a></li> <li><a href="/wiki/Open_adoption" title="Open adoption">Open adoption</a></li> <li><a class="mw-selflink selflink">Prenatal cocaine exposure</a></li> <li><a href="/wiki/Neonatal_withdrawal" title="Neonatal withdrawal">Neonatal withdrawal syndrome</a></li> <li><a href="/wiki/Parental_child_abduction" title="Parental child abduction">Parental child abduction</a></li> <li><a href="/wiki/Parental_responsibility_(access_and_custody)" title="Parental responsibility (access and custody)">Parental responsibility</a></li> <li><a href="/wiki/Parenting_plan" title="Parenting plan">Parenting plan</a></li> <li><a href="/wiki/Paternity_law" title="Paternity law">Paternity</a> <ul><li><a href="/wiki/Paternity_fraud" title="Paternity fraud">Paternity fraud</a></li></ul></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Recreational_drug_use" style="padding:3px"><table class="nowraplinks hlist mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2" style="text-align:center;"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Drug_use" title="Template:Drug use"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Drug_use" title="Template talk:Drug use"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Drug_use" title="Special:EditPage/Template:Drug use"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Recreational_drug_use" style="font-size:114%;margin:0 4em"><a href="/wiki/Recreational_drug_use" title="Recreational drug use">Recreational drug use</a></div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2" style="text-align:center;"><div id="Major_recreational_drugs" style="font-size:114%;margin:0 4em">Major recreational drugs</div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Depressant" title="Depressant">Depressants</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Barbiturate" title="Barbiturate">Barbiturates</a></li> <li><a href="/wiki/Benzodiazepine" title="Benzodiazepine">Benzodiazepines</a></li> <li><a href="/wiki/Carbamate" title="Carbamate">Carbamates</a></li> <li><a href="/wiki/Alcohol_(drug)" title="Alcohol (drug)">Ethanol (alcohol)</a> <ul><li><a href="/wiki/Alcoholic_beverage" title="Alcoholic beverage">Alcoholic beverage</a></li> <li><a href="/wiki/Beer" title="Beer">Beer</a></li> <li><a href="/wiki/Wine" title="Wine">Wine</a></li></ul></li> <li><a href="/wiki/Gabapentinoid" title="Gabapentinoid">Gabapentinoids</a></li> <li><a href="/wiki/Gamma-Hydroxybutyric_acid" class="mw-redirect" title="Gamma-Hydroxybutyric acid">GHB</a></li> <li><a href="/wiki/Inhalant" title="Inhalant">Inhalants</a> <ul><li>Medical <ul><li><a href="/wiki/Nitrous_oxide" title="Nitrous oxide">Nitrous oxide</a> (<a href="/wiki/Recreational_use_of_nitrous_oxide" title="Recreational use of nitrous oxide">recreational use</a>)</li></ul></li> <li>Hazardous <a href="/wiki/Solvent" title="Solvent">solvents</a> <ul><li><a href="/wiki/Adhesive#Contact" title="Adhesive">contact adhesives</a></li> <li><a href="/wiki/Gasoline" title="Gasoline">Gasoline</a></li> <li><a href="/wiki/Nail_polish#Nail_polish_remover" title="Nail polish">nail polish remover</a></li> <li><a href="/wiki/Paint_thinner" title="Paint thinner">Paint thinner</a></li></ul></li> <li>Other <ul><li><a href="/wiki/Freon" title="Freon">Freon</a></li></ul></li></ul></li> <li><a href="/wiki/Kava" title="Kava">Kava</a></li> <li><a href="/wiki/Nonbenzodiazepine" title="Nonbenzodiazepine">Nonbenzodiazepines</a></li> <li><a href="/wiki/Quinazolinone" title="Quinazolinone">Quinazolinones</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Opioid" title="Opioid">Opioids</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Buprenorphine" title="Buprenorphine">Buprenorphine</a> <ul><li>Suboxone</li> <li>Subutex</li></ul></li> <li><a href="/wiki/Codeine" title="Codeine">Codeine</a> <ul><li><a href="/wiki/Lean_(drug)" title="Lean (drug)">Lean</a></li></ul></li> <li><a href="/wiki/Desomorphine" title="Desomorphine">Desomorphine</a> <ul><li>Krokodil</li></ul></li> <li><a href="/wiki/Dextropropoxyphene" title="Dextropropoxyphene">Dextropropoxyphene</a> <ul><li>Darvocet</li> <li>Darvon</li></ul></li> <li><a href="/wiki/Fentanyl" title="Fentanyl">Fentanyl</a></li> <li><a href="/wiki/Heroin" title="Heroin">Diamorphine</a> <ul><li>Heroin</li></ul></li> <li><a href="/wiki/Hydrocodone" title="Hydrocodone">Hydrocodone</a></li> <li><a href="/wiki/Hydromorphone" title="Hydromorphone">Hydromorphone</a> <ul><li>Dilaudid</li></ul></li> <li><a href="/wiki/Methadone" title="Methadone">Methadone</a></li> <li><a href="/wiki/Mitragyna_speciosa" title="Mitragyna speciosa">Mitragyna speciosa</a> <ul><li><a href="/wiki/Kratom" class="mw-redirect" title="Kratom">Kratom</a></li></ul></li> <li><a href="/wiki/Morphine" title="Morphine">Morphine</a> <ul><li><a href="/wiki/Opium" title="Opium">Opium</a></li></ul></li> <li><a href="/wiki/Oxycodone" title="Oxycodone">Oxycodone</a> <ul><li><a href="/wiki/Oxycodone/paracetamol" title="Oxycodone/paracetamol">/paracetamol</a></li></ul></li> <li><a href="/wiki/Tramadol" title="Tramadol">Tramadol</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Stimulant" title="Stimulant">Stimulants</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Amphetamine" title="Amphetamine">Amphetamine</a></li> <li><a href="/wiki/Arecoline" title="Arecoline">Arecoline</a> <ul><li><a href="/wiki/Areca" title="Areca">Areca</a></li></ul></li> <li><a href="/wiki/Paan" class="mw-redirect" title="Paan">Betel</a></li> <li><a href="/wiki/Caffeine" title="Caffeine">Caffeine</a> <ul><li><a href="/wiki/Coffee" title="Coffee">Coffee</a></li> <li><a href="/wiki/Energy_drink" title="Energy drink">Energy drinks</a></li> <li><a href="/wiki/Tea" title="Tea">Tea</a></li></ul></li> <li><a href="/wiki/Cathinone" title="Cathinone">Cathinone</a> <ul><li><a href="/wiki/Khat" title="Khat">Khat</a></li></ul></li> <li><a href="/wiki/Cocaine" title="Cocaine">Cocaine</a> <ul><li><a href="/wiki/Coca" title="Coca">Coca</a></li> <li><a href="/wiki/Crack_cocaine" title="Crack cocaine">Crack</a></li></ul></li> <li><a href="/wiki/Ephedrine" title="Ephedrine">Ephedrine</a> <ul><li><a href="/wiki/Ephedra_(medicine)" title="Ephedra (medicine)">Ephedra</a></li></ul></li> <li><a href="/wiki/Methylenedioxypyrovalerone" title="Methylenedioxypyrovalerone">MDPV</a></li> <li><a href="/wiki/Mephedrone" title="Mephedrone">Mephedrone</a></li> <li><a href="/wiki/Methamphetamine" title="Methamphetamine">Methamphetamine</a></li> <li><a href="/wiki/Methylone" title="Methylone">Methylone</a></li> <li><a href="/wiki/Methylphenidate" title="Methylphenidate">Methylphenidate</a></li> <li><a href="/wiki/Modafinil" title="Modafinil">Modafinil</a></li> <li><a href="/wiki/Nicotine" title="Nicotine">Nicotine</a> <ul><li><a href="/wiki/Nicotine_polacrilex" title="Nicotine polacrilex">Polacrilex</a></li> <li><a href="/wiki/Nicotine_salt" title="Nicotine salt">Salt</a></li> <li><a href="/wiki/Tobacco" title="Tobacco">Tobacco</a></li></ul></li> <li><a href="/wiki/Theobromine" title="Theobromine">Theobromine</a> <ul><li><a href="/wiki/Cocoa_bean" title="Cocoa bean">Cocoa</a></li> <li><a href="/wiki/Chocolate" title="Chocolate">Chocolate</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Empathogen%E2%80%93entactogen" class="mw-redirect" title="Empathogen–entactogen">Entactogens</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/2C_(psychedelics)" title="2C (psychedelics)">2C series</a></li> <li><a href="/wiki/6-APB" title="6-APB">6-APB</a> <ul><li>Benzofury</li></ul></li> <li><a href="/wiki/Alpha-Methyltryptamine" class="mw-redirect" title="Alpha-Methyltryptamine">AMT</a></li> <li><a href="/wiki/3,4-Methylenedioxyamphetamine" title="3,4-Methylenedioxyamphetamine">MDA</a></li> <li><a href="/wiki/MDMA" title="MDMA">MDMA</a> <ul><li><a href="/wiki/MDMA#Forms" title="MDMA">Ecstasy</a></li> <li><a href="/wiki/MDMA#Forms" title="MDMA">Molly</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hallucinogen" title="Hallucinogen">Hallucinogens</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><a href="/wiki/Psychedelic_drug" title="Psychedelic drug">Psychedelics</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bufotenin" title="Bufotenin">Bufotenin</a> <ul><li><a href="/wiki/Colorado_River_toad" title="Colorado River toad">Psychoactive toads</a></li> <li><a href="/wiki/Anadenanthera_colubrina" title="Anadenanthera colubrina">Vilca</a></li> <li><a href="/wiki/Anadenanthera_peregrina" title="Anadenanthera peregrina">Yopo</a></li></ul></li> <li><a href="/wiki/N,N-Dimethyltryptamine" title="N,N-Dimethyltryptamine">DMT</a> <ul><li><a href="/wiki/Ayahuasca" title="Ayahuasca">Ayahuasca</a></li></ul></li> <li><a href="/wiki/Ergine" title="Ergine">LSA</a></li> <li><a href="/wiki/LSD" title="LSD">LSD-25</a></li> <li><a href="/wiki/Mescaline" title="Mescaline">Mescaline</a> <ul><li><a href="/wiki/Echinopsis_peruviana" class="mw-redirect" title="Echinopsis peruviana">Peruvian torch</a></li> <li><a href="/wiki/Peyote" title="Peyote">Peyote</a></li> <li><a href="/wiki/Echinopsis_pachanoi" class="mw-redirect" title="Echinopsis pachanoi">San Pedro</a></li></ul></li> <li><a href="/wiki/Psilocybin" title="Psilocybin">Psilocybin</a> / <a href="/wiki/Psilocin" title="Psilocin">Psilocin</a> <ul><li><a href="/wiki/Psilocybin_mushroom" title="Psilocybin mushroom">Psilocybin mushrooms</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><a href="/wiki/Dissociative" title="Dissociative">Dissociatives</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Dextromethorphan" title="Dextromethorphan">DXM</a> (<a href="/wiki/Recreational_use_of_dextromethorphan" title="Recreational use of dextromethorphan">recreational use</a>)</li> <li><a href="/wiki/Glaucine" title="Glaucine">Glaucine</a></li> <li><a href="/wiki/Inhalant" title="Inhalant">Inhalants</a> <ul><li><a href="/wiki/Nitrous_oxide" title="Nitrous oxide">Nitrous oxide</a> (<a href="/wiki/Recreational_use_of_nitrous_oxide" title="Recreational use of nitrous oxide">recreational use</a>)</li> <li><a href="/wiki/Alkyl_nitrites" class="mw-redirect" title="Alkyl nitrites">alkyl nitrites</a></li> <li><a href="/wiki/Poppers" title="Poppers">poppers</a></li> <li><a href="/wiki/Amyl_nitrite" title="Amyl nitrite">amyl nitrite</a></li></ul></li> <li><a href="/wiki/Ketamine" title="Ketamine">Ketamine</a></li> <li><a href="/wiki/Methoxetamine" title="Methoxetamine">MXE</a></li> <li><a href="/wiki/Muscimol" title="Muscimol">Muscimol</a> <ul><li><a href="/wiki/Amanita_muscaria" title="Amanita muscaria">Amanita muscaria</a></li></ul></li> <li><a href="/wiki/Phencyclidine" title="Phencyclidine">PCP</a></li> <li><a href="/wiki/Salvinorin_A" title="Salvinorin A">Salvinorin A</a> <ul><li><a href="/wiki/Salvia_divinorum" title="Salvia divinorum">Salvia divinorum</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><a href="/wiki/Deliriant" title="Deliriant">Deliriants</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Atropine" title="Atropine">Atropine</a> and <a href="/wiki/Scopolamine" title="Scopolamine">Scopolamine</a> <ul><li><a href="/wiki/Atropa_belladonna" title="Atropa belladonna">Atropa belladonna</a></li> <li><a href="/wiki/Datura" title="Datura">Datura</a></li> <li><a href="/wiki/Hyoscyamus_niger" title="Hyoscyamus niger">Hyoscyamus niger</a></li> <li><a href="/wiki/Mandragora_officinarum" title="Mandragora officinarum">Mandragora officinarum</a></li></ul></li> <li><a href="/wiki/Dimenhydrinate" title="Dimenhydrinate">Dimenhydrinate</a></li> <li><a href="/wiki/Diphenhydramine" title="Diphenhydramine">Diphenhydramine</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><a href="/wiki/Cannabinoid" title="Cannabinoid">Cannabinoids</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Tetrahydrocannabinol" title="Tetrahydrocannabinol">THC</a> <ul><li><a href="/wiki/Cannabis_(drug)" title="Cannabis (drug)">Cannabis (Marijuana)</a></li> <li><a href="/wiki/Hashish" title="Hashish">Hashish</a></li> <li><a href="/wiki/Hash_oil" title="Hash oil">Hash oil</a></li></ul></li> <li><a href="/wiki/Neocannabinoid" class="mw-redirect" title="Neocannabinoid">Neocannabinoid / synthetic cannabinoids</a> <ul><li><a href="/wiki/JWH-018" title="JWH-018">JWH-018</a></li> <li><a href="/wiki/APICA_(synthetic_cannabinoid_drug)" title="APICA (synthetic cannabinoid drug)">APICA</a></li> <li><a href="/wiki/APINACA" title="APINACA">APINACA</a></li> <li><a href="/wiki/Spice_(drug)" class="mw-redirect" title="Spice (drug)">Spice</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><a href="/wiki/Oneirogen" title="Oneirogen">Oneirogens</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Calea_ternifolia" title="Calea ternifolia">Calea zacatechichi</a></li> <li><a href="/wiki/Silene_undulata" title="Silene undulata">Silene capensis</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Club_drug" title="Club drug">Club drugs</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cocaine" title="Cocaine">Cocaine</a></li> <li><a href="/wiki/Methaqualone" title="Methaqualone">Quaaludes</a></li> <li><a href="/wiki/MDMA" title="MDMA">MDMA</a> <ul><li><a href="/wiki/MDMA#Forms" title="MDMA">Ecstasy</a></li> <li><a href="/wiki/MDMA#Forms" title="MDMA">Molly</a></li></ul></li> <li><a href="/wiki/Nitrous_oxide" title="Nitrous oxide">Nitrous oxide</a> (<a href="/wiki/Recreational_use_of_nitrous_oxide" title="Recreational use of nitrous oxide">recreational use</a>)</li> <li><a href="/wiki/Poppers" title="Poppers">Poppers</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2" style="text-align:center;"><div id="Drug_culture" style="font-size:114%;margin:0 4em"><a href="/wiki/Drug_culture" title="Drug culture">Drug culture</a></div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Cannabis_culture" title="Cannabis culture">Cannabis culture</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/420_(cannabis_culture)" title="420 (cannabis culture)">420</a></li> <li><a href="/wiki/Cannabis_consumption" title="Cannabis consumption">Cannabis consumption</a></li> <li><a href="/wiki/Cannabis_cultivation" title="Cannabis cultivation">Cannabis cultivation</a></li> <li><a href="/wiki/Cannabis_edible" title="Cannabis edible">Cannabis edible</a></li> <li><a href="/wiki/Cannabis_rights" title="Cannabis rights">Cannabis rights</a></li> <li><a href="/wiki/List_of_cannabis_rights_leaders" title="List of cannabis rights leaders">Cannabis rights leaders</a></li> <li><a href="/wiki/List_of_cannabis_rights_organizations" title="List of cannabis rights organizations">List of cannabis rights organizations</a></li> <li><a href="/wiki/Cannabis_smoking" title="Cannabis smoking">Cannabis smoking</a></li> <li><a href="/wiki/Cannabis_Social_Club" title="Cannabis Social Club">Cannabis Social Club</a></li> <li><a href="/wiki/Cannabis_tea" title="Cannabis tea">Cannabis tea</a></li> <li><a href="/wiki/Vaporizer_(inhalation_device)#Cannabis_vaporizers" title="Vaporizer (inhalation device)">Cannabis vaping</a></li> <li><a href="/wiki/Head_shop" title="Head shop">Head shop</a></li> <li><a href="/wiki/Legal_history_of_cannabis_in_the_United_States" title="Legal history of cannabis in the United States">Legal history of cannabis in the United States</a></li> <li><a href="/wiki/Legality_of_cannabis" title="Legality of cannabis">Legality of cannabis</a></li> <li><a href="/wiki/Marijuana_Policy_Project" title="Marijuana Policy Project">Marijuana Policy Project</a></li> <li><a href="/wiki/Medical_cannabis" title="Medical cannabis">Medical cannabis</a></li> <li><a href="/wiki/National_Organization_for_the_Reform_of_Marijuana_Laws" title="National Organization for the Reform of Marijuana Laws">NORML</a></li> <li><a href="/wiki/Cannabis_and_religion" title="Cannabis and religion">Cannabis and religion</a></li> <li><a href="/wiki/Stoner_film" title="Stoner film">Stoner film</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Coffee_culture" title="Coffee culture">Coffee culture</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Break_(work)#Coffee_break" title="Break (work)">Coffee break</a></li> <li><a href="/wiki/Coffeehouse" title="Coffeehouse">Coffeehouse</a></li> <li><a href="/wiki/Latte_art" title="Latte art">Latte art</a></li> <li><a href="/wiki/Teahouse" title="Teahouse">Teahouse</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Drinking_culture" title="Drinking culture">Drinking culture</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bartender" title="Bartender">Bartending</a></li> <li><a href="/wiki/Beer#Beer_and_society" title="Beer">Beer culture</a></li> <li><a href="/wiki/Beer_festival" title="Beer festival">Beer festival</a></li> <li><a href="/wiki/Binge_drinking" title="Binge drinking">Binge drinking</a></li> <li><a href="/wiki/Diethyl_ether#Recreational_use" title="Diethyl ether">Diethyl ether</a></li> <li><a href="/wiki/Drinking_game" title="Drinking game">Drinking games</a></li> <li><a href="/wiki/Drinking_song" title="Drinking song">Drinking song</a></li> <li><a href="/wiki/Happy_hour" title="Happy hour">Happy hour</a></li> <li><a href="/wiki/Hip_flask" title="Hip flask">Hip flask</a></li> <li><a href="/wiki/Nightclub" title="Nightclub">Nightclub</a></li> <li><a href="/wiki/Oktoberfest" title="Oktoberfest">Oktoberfest</a></li> <li><a href="/wiki/Pub" title="Pub">Pub</a></li> <li><a href="/wiki/Pub_crawl" title="Pub crawl">Pub crawl</a></li> <li><a href="/wiki/Sommelier" title="Sommelier">Sommelier</a></li> <li><a href="/wiki/Bar_(establishment)" title="Bar (establishment)">Sports bar</a></li> <li><a href="/wiki/Tailgate_party" title="Tailgate party">Tailgate party</a></li> <li><a href="/wiki/Wine_bar" title="Wine bar">Wine bar</a></li> <li><a href="/wiki/Wine_tasting" title="Wine tasting">Wine tasting</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Psychedelia" title="Psychedelia">Psychedelia</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Psychonautics" title="Psychonautics">Psychonautics</a></li> <li><a href="/wiki/Psychedelic_art" title="Psychedelic art">Art</a></li> <li><a href="/wiki/Psychedelic_drug" title="Psychedelic drug">Drug</a></li> <li><a href="/wiki/Psychedelic_era" title="Psychedelic era">Era</a></li> <li><a href="/wiki/Psychedelic_experience" title="Psychedelic experience">Experience</a></li> <li><a href="/wiki/Psychedelic_literature" class="mw-redirect" title="Psychedelic literature">Literature</a></li> <li><a href="/wiki/Psychedelic_music" title="Psychedelic music">Music</a></li> <li><a href="/wiki/Psychedelic_microdosing" title="Psychedelic microdosing">Microdosing</a></li> <li><a href="/wiki/Smart_shop" title="Smart shop">Smart shop</a></li> <li><a href="/wiki/Psychedelic_therapy" title="Psychedelic therapy">Therapy</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Smoking#Society_and_culture" title="Smoking">Smoking culture</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cigarette_card" title="Cigarette card">Cigarette card</a></li> <li><a href="/wiki/Fashion_cigarettes" title="Fashion cigarettes">Fashion cigarettes</a></li> <li><a href="/wiki/Cloud-chasing" title="Cloud-chasing">Cloud-chasing</a></li> <li><a href="/wiki/Loosie" title="Loosie">Loosie</a></li> <li><a href="/wiki/Smokeasy" title="Smokeasy">Smokeasy</a></li> <li><a href="/wiki/Smoking_fetishism" title="Smoking fetishism">Smoking fetishism</a></li> <li><a href="/wiki/Tobacco_smoking" title="Tobacco smoking">Tobacco smoking</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Chasing_the_dragon" title="Chasing the dragon">Chasing the dragon</a></li> <li><a href="/wiki/Club_drug" title="Club drug">Club drug</a></li> <li><a href="/wiki/Counterculture_of_the_1960s" title="Counterculture of the 1960s">Counterculture of the 1960s</a></li> <li><a href="/wiki/Dance_party" title="Dance party">Dance party</a></li> <li><a href="/wiki/Drug_paraphernalia" title="Drug paraphernalia">Drug paraphernalia</a></li> <li><a href="/wiki/Recreational_drug_tourism" title="Recreational drug tourism">Drug tourism</a></li> <li><a href="/wiki/Entheogen" title="Entheogen">Entheogen</a></li> <li><a href="/wiki/Hippie" title="Hippie">Hippie</a></li> <li><a href="/wiki/Needle_sharing" title="Needle sharing">Needle sharing</a></li> <li><a href="/wiki/Nootropic" title="Nootropic">Nootropic</a></li> <li><a href="/wiki/Party_and_play" title="Party and play">Party and play</a></li> <li><a href="/wiki/Poly_drug_use" class="mw-redirect" title="Poly drug use">Poly drug use</a></li> <li><a href="/wiki/Rave" title="Rave">Rave</a></li> <li><a href="/wiki/Religion_and_drugs" title="Religion and drugs">Religion and drugs</a></li> <li><a href="/wiki/Self-medication" title="Self-medication">Self-medication</a></li> <li><a href="/wiki/Sex_and_drugs" title="Sex and drugs">Sex and drugs</a></li> <li><a href="/wiki/Urban_legends_about_drugs" title="Urban legends about drugs">Urban legends about drugs</a></li> <li><a href="/wiki/Whoonga" title="Whoonga">Whoonga</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2" style="text-align:center;"><div id="Legality_of_drug_use" style="font-size:114%;margin:0 4em">Legality of drug use</div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">International</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/United_Nations_drug_control_conventions" class="mw-redirect" title="United Nations drug control conventions">International drug control conventions</a> <ul><li><a href="/wiki/Single_Convention_on_Narcotic_Drugs" title="Single Convention on Narcotic Drugs">1961 Narcotic Drugs</a></li> <li><a href="/wiki/Convention_on_Psychotropic_Substances" title="Convention on Psychotropic Substances">1971 Psychotropic Substances</a></li> <li><a href="/wiki/United_Nations_Convention_Against_Illicit_Traffic_in_Narcotic_Drugs_and_Psychotropic_Substances" title="United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances">1988 Drug Trafficking</a></li></ul></li> <li>Other treaties addressing drugs <ul><li><a href="/wiki/United_Nations_Convention_on_the_Law_of_the_Sea" title="United Nations Convention on the Law of the Sea">Law of the Sea Convention</a></li> <li><a href="/wiki/International_Convention_Against_Doping_in_Sport" title="International Convention Against Doping in Sport">Convention Against Doping</a></li> <li><a href="/wiki/Council_of_the_European_Union_decisions_on_designer_drugs" title="Council of the European Union decisions on designer drugs">Council of the European Union decisions on designer drugs</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">State level</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Drug_policy" title="Drug policy">Drug policy</a> <ul><li><a href="/wiki/Decriminalization" title="Decriminalization">Decriminalization</a></li> <li><a href="/wiki/Legalization" title="Legalization">Legalization</a></li> <li><a href="/wiki/Prohibition_of_drugs" class="mw-redirect" title="Prohibition of drugs">Prohibition</a></li> <li><a href="/wiki/Regulation" title="Regulation">Regulation</a></li> <li><a href="/wiki/Supply_reduction" title="Supply reduction">Supply reduction</a></li></ul></li> <li><a href="/wiki/Drug_policy_reform" class="mw-redirect" title="Drug policy reform">Policy reform</a> <ul><li><a href="/wiki/Demand_reduction" title="Demand reduction">Demand reduction</a></li> <li><a href="/wiki/Drug_Policy_Alliance" title="Drug Policy Alliance">Drug Policy Alliance</a></li> <li><a href="/wiki/Harm_reduction" title="Harm reduction">Harm reduction</a></li> <li><a href="/wiki/Law_Enforcement_Action_Partnership" title="Law Enforcement Action Partnership">Law Enforcement Action Partnership</a></li> <li><a href="/wiki/Drug_liberalization" title="Drug liberalization">Liberalization</a> <ul><li><a href="/wiki/Latin_American_drug_legalization" title="Latin American drug legalization">Latin America</a></li></ul></li> <li><a href="/wiki/Students_for_Sensible_Drug_Policy" title="Students for Sensible Drug Policy">Students for Sensible Drug Policy</a></li> <li><a href="/wiki/Transform_Drug_Policy_Foundation" title="Transform Drug Policy Foundation">Transform Drug Policy Foundation</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Drug policy<br /> by country</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Drug_policy#Australia" title="Drug policy">Australia</a></li> <li><a href="/wiki/Drug_policy_of_Canada" title="Drug policy of Canada">Canada</a></li> <li><a href="/wiki/Drug_policy_of_the_Czech_Republic" class="mw-redirect" title="Drug policy of the Czech Republic">Czech Republic</a></li> <li><a href="/wiki/Drug_policy#Germany" title="Drug policy">Germany</a></li> <li><a href="/wiki/Drug_policy_of_India" title="Drug policy of India">India</a></li> <li><a href="/wiki/Drug_policy_of_the_Netherlands" title="Drug policy of the Netherlands">Netherlands</a></li> <li><a href="/wiki/Drug_policy_of_Portugal" title="Drug policy of Portugal">Portugal</a></li> <li><a href="/wiki/Drug_policy_of_Slovakia" title="Drug policy of Slovakia">Slovakia</a></li> <li><a href="/wiki/Drug_policy_of_the_Soviet_Union" title="Drug policy of the Soviet Union">Soviet Union</a></li> <li><a href="/wiki/Drug_policy_of_Sweden" title="Drug policy of Sweden">Sweden</a></li> <li><a href="/wiki/Drug_policy#Switzerland" title="Drug policy">Switzerland</a></li> <li><a href="/wiki/Federal_drug_policy_of_the_United_States" title="Federal drug policy of the United States">United States</a> <ul><li><a href="/wiki/Just_Say_No" title="Just Say No">Just Say No</a></li> <li><a href="/wiki/Office_of_National_Drug_Control_Policy" title="Office of National Drug Control Policy">Office of National Drug Control Policy</a></li> <li><a href="/wiki/School_district_drug_policies" title="School district drug policies">School district drug policies</a></li> <li><a href="/wiki/Drug_policy_of_California" title="Drug policy of California">California</a></li> <li><a href="/wiki/Cannabis_in_Colorado" title="Cannabis in Colorado">Colorado</a></li> <li><a href="/wiki/Drug_policy_of_Maryland" title="Drug policy of Maryland">Maryland</a></li> <li><a href="/wiki/Drug_policy_of_Oregon" title="Drug policy of Oregon">Oregon</a></li> <li><a href="/wiki/Drug_policy_of_Virginia" title="Drug policy of Virginia">Virginia</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Drug legality</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcohol_law" title="Alcohol law">Alcohol legality</a></li> <li><a href="/wiki/Anabolic_steroid#Legal_status" title="Anabolic steroid">Anabolic steroid legality</a></li> <li><a href="/wiki/Legality_of_cannabis" title="Legality of cannabis">Cannabis legality</a></li> <li><a href="/wiki/Legal_status_of_cocaine" title="Legal status of cocaine">Cocaine legality</a></li> <li><a href="/wiki/Legal_status_of_methamphetamine" title="Legal status of methamphetamine">Methamphetamine legality</a></li> <li><a href="/wiki/Psilocybin_decriminalization_in_the_United_States" title="Psilocybin decriminalization in the United States">Psilocybin decriminalization in the U.S.</a></li> <li><a href="/wiki/Legal_status_of_psilocybin_mushrooms" title="Legal status of psilocybin mushrooms">Psilocybin mushrooms legality</a></li> <li><a href="/wiki/Legal_status_of_Salvia_divinorum" title="Legal status of Salvia divinorum">Salvia legality</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Arguments_for_and_against_drug_prohibition" title="Arguments for and against drug prohibition">Arguments for and against drug prohibition</a></li> <li><a href="/wiki/Cannabis_rights" title="Cannabis rights">Cannabis rights</a></li> <li><a href="/wiki/Capital_punishment_for_drug_trafficking" title="Capital punishment for drug trafficking">Capital punishment for drug trafficking</a></li> <li><a href="/wiki/Cognitive_liberty" title="Cognitive liberty">Cognitive liberty</a></li> <li><a href="/wiki/Designer_drug" title="Designer drug">Designer drug</a></li> <li><a href="/wiki/Drug_court" title="Drug court">Drug court</a></li> <li><a href="/wiki/Drug_possession" class="mw-redirect" title="Drug possession">Drug possession</a></li> <li><a href="/wiki/Drug_test" title="Drug test">Drug test</a></li> <li><a href="/wiki/Informant" title="Informant">Narc</a></li> <li><a href="/wiki/Politics_of_drug_abuse" title="Politics of drug abuse">Politics of drug abuse</a></li> <li><a href="/wiki/War_on_drugs" title="War on drugs">War on drugs</a> <ul><li><a href="/wiki/Mexican_drug_war" title="Mexican drug war">Mexican drug war</a></li> <li><a href="/wiki/Plan_Colombia" title="Plan Colombia">Plan Colombia</a></li> <li><a href="/wiki/Philippine_drug_war" title="Philippine drug war">Philippine drug war</a></li></ul></li> <li><a href="/wiki/Zero_tolerance" title="Zero tolerance">Zero tolerance</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2" style="text-align:center;"><div id="Other" style="font-size:114%;margin:0 4em">Other</div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Drug<br /> production<br /> and trade</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;">Drug<br /> production</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Coca_production_in_Colombia" title="Coca production in Colombia">Coca production in Colombia</a></li> <li><a href="/wiki/Precursor_chemicals" title="Precursor chemicals">Drug precursors</a></li> <li><a href="/wiki/Opium_production_in_Afghanistan" title="Opium production in Afghanistan">Opium production in Afghanistan</a></li> <li><a href="/wiki/Rolling_meth_lab" title="Rolling meth lab">Rolling meth lab</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;">Drug trade</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Illegal_drug_trade" title="Illegal drug trade">Illegal drug trade</a> <ul><li><a href="/wiki/Illegal_drug_trade_in_Afghanistan" class="mw-redirect" title="Illegal drug trade in Afghanistan">Afghanistan</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Aruba" title="Illegal drug trade in Aruba">Aruba</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Australia" class="mw-redirect" title="Illegal drug trade in Australia">Australia</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Bangladesh" class="mw-redirect" title="Illegal drug trade in Bangladesh">Bangladesh</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Belize" class="mw-redirect" title="Illegal drug trade in Belize">Belize</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Benin" class="mw-redirect" title="Illegal drug trade in Benin">Benin</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Bhutan" class="mw-redirect" title="Illegal drug trade in Bhutan">Bhutan</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Bolivia" class="mw-redirect" title="Illegal drug trade in Bolivia">Bolivia</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Brazil" class="mw-redirect" title="Illegal drug trade in Brazil">Brazil</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Burma" class="mw-redirect" title="Illegal drug trade in Burma">Burma</a></li> <li><a href="/wiki/Drugs_in_Cambodia" title="Drugs in Cambodia">Cambodia</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Chile" class="mw-redirect" title="Illegal drug trade in Chile">Chile</a></li> <li><a href="/wiki/Illegal_drug_trade_in_China" title="Illegal drug trade in China">China</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Colombia" title="Illegal drug trade in Colombia">Colombia</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Costa_Rica" class="mw-redirect" title="Illegal drug trade in Costa Rica">Costa Rica</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Cuba" class="mw-redirect" title="Illegal drug trade in Cuba">Cuba</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Cyprus" class="mw-redirect" title="Illegal drug trade in Cyprus">Cyprus</a></li> <li><a href="/wiki/Illegal_drug_trade_in_the_Dominican_Republic" class="mw-redirect" title="Illegal drug trade in the Dominican Republic">Dominican Republic</a></li> <li><a href="/wiki/Illegal_drug_trade_in_El_Salvador" title="Illegal drug trade in El Salvador">El Salvador</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Estonia" class="mw-redirect" title="Illegal drug trade in Estonia">Estonia</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Finland" class="mw-redirect" title="Illegal drug trade in Finland">Finland</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Germany" class="mw-redirect" title="Illegal drug trade in Germany">Germany</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Haiti" title="Illegal drug trade in Haiti">Haiti</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Honduras" class="mw-redirect" title="Illegal drug trade in Honduras">Honduras</a></li> <li><a href="/wiki/Illegal_drug_trade_in_India" class="mw-redirect" title="Illegal drug trade in India">India</a></li> <li><a href="/wiki/Illegal_drug_trade_in_the_Indian_Ocean_region" title="Illegal drug trade in the Indian Ocean region">Indian Ocean region</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Iran" class="mw-redirect" title="Illegal drug trade in Iran">Iran</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Italy" class="mw-redirect" title="Illegal drug trade in Italy">Italy</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Japan" title="Illegal drug trade in Japan">Japan</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Kenya" class="mw-redirect" title="Illegal drug trade in Kenya">Kenya</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Kosovo" class="mw-redirect" title="Illegal drug trade in Kosovo">Kosovo</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Kyrgyzstan" class="mw-redirect" title="Illegal drug trade in Kyrgyzstan">Kyrgyzstan</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Laos" class="mw-redirect" title="Illegal drug trade in Laos">Laos</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Latin_America" title="Illegal drug trade in Latin America">Latin America</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Latvia" class="mw-redirect" title="Illegal drug trade in Latvia">Latvia</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Malaysia" class="mw-redirect" title="Illegal drug trade in Malaysia">Malaysia</a></li> <li><a href="/wiki/Drug_trafficking_in_Mauritius" title="Drug trafficking in Mauritius">Mauritius</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Moldova" class="mw-redirect" title="Illegal drug trade in Moldova">Moldova</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Nigeria" class="mw-redirect" title="Illegal drug trade in Nigeria">Nigeria</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Norway" class="mw-redirect" title="Illegal drug trade in Norway">Norway</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Oman" class="mw-redirect" title="Illegal drug trade in Oman">Oman</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Panama" title="Illegal drug trade in Panama">Panama</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Papua_New_Guinea" class="mw-redirect" title="Illegal drug trade in Papua New Guinea">Papua New Guinea</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Paraguay" title="Illegal drug trade in Paraguay">Paraguay</a></li> <li><a href="/wiki/Illegal_drug_trade_in_the_Philippines" title="Illegal drug trade in the Philippines">Philippines</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Poland" class="mw-redirect" title="Illegal drug trade in Poland">Poland</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Portugal" class="mw-redirect" title="Illegal drug trade in Portugal">Portugal</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Puerto_Rico" title="Illegal drug trade in Puerto Rico">Puerto Rico</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Russia" class="mw-redirect" title="Illegal drug trade in Russia">Russia</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Saint_Kitts_and_Nevis" class="mw-redirect" title="Illegal drug trade in Saint Kitts and Nevis">Saint Kitts and Nevis</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Seychelles" title="Illegal drug trade in Seychelles">Seychelles</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Slovakia" class="mw-redirect" title="Illegal drug trade in Slovakia">Slovakia</a></li> <li><a href="/wiki/Illegal_drug_trade_in_South_Africa" class="mw-redirect" title="Illegal drug trade in South Africa">South Africa</a></li> <li><a href="/wiki/Illegal_drug_trade_in_South_Korea" class="mw-redirect" title="Illegal drug trade in South Korea">South Korea</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Spain" class="mw-redirect" title="Illegal drug trade in Spain">Spain</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Suriname" class="mw-redirect" title="Illegal drug trade in Suriname">Suriname</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Switzerland" class="mw-redirect" title="Illegal drug trade in Switzerland">Switzerland</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Taiwan" class="mw-redirect" title="Illegal drug trade in Taiwan">Taiwan</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Thailand" class="mw-redirect" title="Illegal drug trade in Thailand">Thailand</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Turkey" title="Illegal drug trade in Turkey">Turkey</a></li> <li><a href="/wiki/Illegal_drug_trade_in_the_Turks_and_Caicos_Islands" title="Illegal drug trade in the Turks and Caicos Islands">Turks and Caicos Islands</a></li> <li><a href="/wiki/Illegal_drug_trade_in_the_United_Arab_Emirates" class="mw-redirect" title="Illegal drug trade in the United Arab Emirates">United Arab Emirates</a></li> <li><a href="/wiki/Illegal_drug_trade_in_the_United_States" title="Illegal drug trade in the United States">United States</a></li> <li><a href="/wiki/Illegal_drug_trade_in_Venezuela" title="Illegal drug trade in Venezuela">Venezuela</a></li></ul></li> <li><a href="/wiki/Darknet_market" title="Darknet market">Darknet market</a></li> <li><a href="/wiki/Pharmaceutical_distribution" title="Pharmaceutical distribution">Pharmaceutical distribution</a> <ul><li><a href="/wiki/Beer_shop" class="mw-redirect" title="Beer shop">Beer shop</a></li> <li><a href="/wiki/Cannabis_shop" class="mw-redirect" title="Cannabis shop">Cannabis shop</a></li> <li><a href="/wiki/Liquor_store" title="Liquor store">Liquor store</a></li> <li><a href="/wiki/Liquor_license" title="Liquor license">Liquor license</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Issues with<br />drug use</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Substance_abuse" title="Substance abuse">Abuse</a></li> <li><a href="/wiki/Addiction" title="Addiction">Addiction</a></li> <li><a href="/wiki/Date_rape_drug" title="Date rape drug">Date rape drug</a></li> <li><a href="/wiki/Substance_dependence" title="Substance dependence">Dependence</a></li> <li><a href="/wiki/Driving_under_the_influence" title="Driving under the influence">Driving impaired</a></li> <li><a href="/wiki/Drug_harmfulness" class="mw-redirect" title="Drug harmfulness">Drug harmfulness</a> <ul><li><a href="/wiki/Effects_of_cannabis" title="Effects of cannabis">Effects of cannabis</a></li></ul></li> <li><a href="/wiki/Drug-related_crime" title="Drug-related crime">Drug-related crime</a></li> <li><a href="/wiki/Fetal_alcohol_spectrum_disorder" title="Fetal alcohol spectrum disorder">Fetal alcohol spectrum disorder</a></li> <li><a href="/wiki/Long-term_effects_of_cannabis" title="Long-term effects of cannabis">Long-term effects of cannabis</a></li> <li><a href="/wiki/Neurotoxicity" title="Neurotoxicity">Neurotoxicity</a></li> <li><a href="/wiki/Drug_overdose" title="Drug overdose">Overdose</a></li> <li><a href="/wiki/Passive_smoking" title="Passive smoking">Passive smoking</a> <ul><li>of tobacco or other substances</li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Harm reduction</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Drug_checking" title="Drug checking">Drug checking</a></li> <li><a href="/wiki/Drug_legalization" class="mw-redirect" title="Drug legalization">Drug legalization</a></li> <li><a href="/wiki/Drug_rehabilitation" title="Drug rehabilitation">Drug rehabilitation</a></li> <li><a href="/wiki/Needle_and_syringe_programmes" title="Needle and syringe programmes">Needle and syringe programmes</a></li> <li><a href="/wiki/Opioid_replacement_therapy" class="mw-redirect" title="Opioid replacement therapy">Opioid replacement therapy</a></li> <li><a href="/wiki/Pharmacovigilance" title="Pharmacovigilance">Pharmacovigilance</a></li> <li><a href="/wiki/Reagent_testing" title="Reagent testing">Reagent testing</a></li> <li><a href="/wiki/Regulation_of_therapeutic_goods" title="Regulation of therapeutic goods">Regulation of therapeutic goods</a></li> <li><a href="/wiki/Responsible_drug_use" title="Responsible drug use">Responsible drug use</a></li> <li><a href="/wiki/Substance_abuse_prevention" title="Substance abuse prevention">Substance abuse prevention</a></li> <li><a href="/wiki/Supervised_injection_site" title="Supervised injection site">Supervised injection site</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Countries by <br /> drug use</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/List_of_countries_by_alcohol_consumption_per_capita" title="List of countries by alcohol consumption per capita">Alcohol consumption</a></li> <li><a href="/wiki/List_of_countries_by_prevalence_of_cocaine_use" title="List of countries by prevalence of cocaine use">Cocaine use</a></li> <li>Cannabis <ul><li><a href="/wiki/Annual_cannabis_use_by_country" class="mw-redirect" title="Annual cannabis use by country">Annual use</a></li> <li><a href="/wiki/Adult_lifetime_cannabis_use_by_country" title="Adult lifetime cannabis use by country">Lifetime use</a></li></ul></li> <li><a href="/wiki/List_of_countries_by_prevalence_of_opiates_use" title="List of countries by prevalence of opiates use">Opiates use</a></li> <li><a href="/wiki/List_of_countries_by_tobacco_consumption" class="mw-redirect" title="List of countries by tobacco consumption">Tobacco consumption</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" 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syndrome</a></li> <li><a class="mw-selflink selflink">Prenatal cocaine exposure</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Psychoactive_substance-related_disorders" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Psychoactive_substance_use" title="Template:Psychoactive substance use"><abbr title="View this 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title="Substance-related disorder">SID</a> <ul><li><a href="/wiki/Substance_intoxication" title="Substance intoxication">Substance intoxication</a> / <a href="/wiki/Drug_overdose" title="Drug overdose">Drug overdose</a></li> <li><a href="/wiki/Substance-induced_psychosis" title="Substance-induced psychosis">Substance-induced psychosis</a></li> <li><a href="/wiki/Drug_withdrawal" title="Drug withdrawal">Withdrawal</a>: <ul><li><a href="/wiki/Neonatal_withdrawal" title="Neonatal withdrawal">Neonatal withdrawal</a></li> <li><a href="/wiki/Post-acute-withdrawal_syndrome" title="Post-acute-withdrawal syndrome">Post-acute-withdrawal syndrome</a> (PAWS)</li></ul></li></ul></li> <li><a href="/wiki/Substance_use_disorder" title="Substance use disorder">SUD</a> <ul><li><a href="/wiki/Substance_abuse" title="Substance abuse">Substance abuse</a> / <a href="/wiki/Substance-related_disorder" title="Substance-related disorder">Substance-related disorders</a></li> <li><a href="/wiki/Physical_dependence" title="Physical dependence">Physical dependence</a> / <a href="/wiki/Psychological_dependence" title="Psychological dependence">Psychological dependence</a> / <a href="/wiki/Substance_dependence" title="Substance dependence">Substance dependence</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Combined<br />substance use</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SUD <ul><li><a href="/wiki/Polysubstance_dependence" title="Polysubstance dependence">Polysubstance dependence</a></li></ul></li> <li>SID <ul><li><a href="/wiki/Combined_drug_intoxication" title="Combined drug intoxication">Combined drug intoxication</a> (CDI)</li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Alcohol_(drug)" title="Alcohol (drug)">Alcohol</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">SID</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Alcohol_and_cardiovascular_disease" title="Alcohol and cardiovascular disease">Cardiovascular diseases</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcoholic_cardiomyopathy" title="Alcoholic cardiomyopathy">Alcoholic cardiomyopathy</a> (ACM)</li> <li><a href="/wiki/Alcohol_flush_reaction" title="Alcohol flush reaction">Alcohol flush reaction</a> (AFR)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Gastrointestinal_disease" title="Gastrointestinal disease">Gastrointestinal diseases</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcoholic_liver_disease" title="Alcoholic liver disease">Alcoholic liver disease</a> (ALD): <ul><li><a href="/wiki/Alcoholic_hepatitis" title="Alcoholic hepatitis">Alcoholic hepatitis</a></li> <li><a href="/wiki/Zieve%27s_syndrome" title="Zieve's syndrome">Zieve's syndrome</a></li></ul></li> <li><a href="/wiki/Auto-brewery_syndrome" title="Auto-brewery syndrome">Auto-brewery syndrome</a> (ABS)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Endocrine_disease" title="Endocrine disease">Endocrine diseases</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcoholic_ketoacidosis" title="Alcoholic ketoacidosis">Alcoholic ketoacidosis</a> (AKA)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Nervous_system_disease" title="Nervous system disease">Nervous<br /> system diseases</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcohol-related_dementia" title="Alcohol-related dementia">Alcohol-related dementia</a> (ARD)</li> <li><a href="/wiki/Alcohol_intoxication" title="Alcohol intoxication">Alcohol intoxication</a></li> <li><a href="/wiki/Hangover" title="Hangover">Hangover</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Neurological_disorder" title="Neurological disorder">Neurological<br /> disorders</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcoholic_hallucinosis" title="Alcoholic hallucinosis">Alcoholic hallucinosis</a></li> <li><a href="/wiki/Alcoholic_polyneuropathy" title="Alcoholic polyneuropathy">Alcoholic polyneuropathy</a></li></ul> <ul><li><a href="/wiki/Alcohol-related_brain_damage" title="Alcohol-related brain damage">Alcohol-related brain damage</a> (ARDB)</li> <li><a href="/wiki/Alcohol_withdrawal_syndrome" title="Alcohol withdrawal syndrome">Alcohol withdrawal syndrome</a> (AWS): <ul><li><a href="/wiki/Alcoholic_hallucinosis" title="Alcoholic hallucinosis">Alcoholic hallucinosis</a></li> <li><a href="/wiki/Delirium_tremens" title="Delirium tremens">Delirium tremens</a> (DTs)</li></ul></li> <li><a href="/wiki/Fetal_alcohol_spectrum_disorder" title="Fetal alcohol spectrum disorder">Fetal alcohol spectrum disorder</a> (FASD)</li> <li><a href="/wiki/Korsakoff_syndrome" title="Korsakoff syndrome">Korsakoff syndrome</a> (KS)</li> <li><a href="/wiki/Marchiafava%E2%80%93Bignami_disease" title="Marchiafava–Bignami disease">Marchiafava–Bignami disease</a> (MBD)</li> <li><a href="/wiki/Positional_alcohol_nystagmus" title="Positional alcohol nystagmus">Positional alcohol nystagmus</a> (PAN)</li> <li><a href="/wiki/Wernicke%E2%80%93Korsakoff_syndrome" title="Wernicke–Korsakoff syndrome">Wernicke–Korsakoff syndrome</a> (WKS)</li> <li><a href="/wiki/Wernicke_encephalopathy" title="Wernicke encephalopathy">Wernicke encephalopathy</a> (WE)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Respiratory_disease" title="Respiratory disease">Respiratory tract diseases</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcohol-induced_respiratory_reactions" title="Alcohol-induced respiratory reactions">Alcohol-induced respiratory reactions</a></li> <li><a href="/wiki/Alcoholic_lung_disease" title="Alcoholic lung disease">Alcoholic lung disease</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">SUD</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcoholism" title="Alcoholism">Alcoholism</a> (alcohol use disorder (AUD))</li> <li><a href="/wiki/Binge_drinking" title="Binge drinking">Binge drinking</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Caffeine" title="Caffeine">Caffeine</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SID <ul><li><a href="/wiki/Caffeine-induced_anxiety_disorder" title="Caffeine-induced anxiety disorder">Caffeine-induced anxiety disorder</a></li> <li><a href="/wiki/Caffeine-induced_psychosis" title="Caffeine-induced psychosis">Caffeine-induced psychosis</a></li> <li><a href="/wiki/Caffeine-induced_sleep_disorder" title="Caffeine-induced sleep disorder">Caffeine-induced sleep disorder</a></li> <li><a href="/wiki/Caffeinism" title="Caffeinism">Caffeinism</a></li></ul></li> <li>SUD <ul><li><a href="/wiki/Caffeine_dependence" title="Caffeine dependence">Caffeine dependence</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Cannabis_(drug)" title="Cannabis (drug)">Cannabis</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SID <ul><li><a href="/w/index.php?title=Cannabis_arteritis&action=edit&redlink=1" class="new" title="Cannabis arteritis (page does not exist)">Cannabis arteritis</a></li> <li><a href="/wiki/Cannabinoid_hyperemesis_syndrome" title="Cannabinoid hyperemesis syndrome">Cannabinoid hyperemesis syndrome</a> (CHS)</li> <li><a href="/wiki/Intravenous_marijuana_syndrome" title="Intravenous marijuana syndrome">Intravenous marijuana syndrome</a></li></ul></li> <li>SUD <ul><li><a href="/wiki/Amotivational_syndrome" title="Amotivational syndrome">Amotivational syndrome</a></li> <li><a href="/wiki/Cannabis_use_disorder" title="Cannabis use disorder">Cannabis use disorder</a> (CUD)</li> <li><a href="/w/index.php?title=Synthetic_cannabinoid_use_disorder&action=edit&redlink=1" class="new" title="Synthetic cannabinoid use disorder (page does not exist)">Synthetic cannabinoid use disorder</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Cocaine" title="Cocaine">Cocaine</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SID <ul><li><a href="/wiki/Cocaine_intoxication" title="Cocaine intoxication">Cocaine intoxication</a></li> <li><a class="mw-selflink selflink">Prenatal cocaine exposure</a> (PCE)</li></ul></li> <li>SUD <ul><li><a href="/wiki/Cocaine_dependence" title="Cocaine dependence">Cocaine dependence</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hallucinogen" title="Hallucinogen">Hallucinogen</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SID <ul><li><a href="/wiki/Bad_trip" title="Bad trip">Acute intoxication from hallucinogens (bad trip)</a></li> <li><a href="/wiki/Hallucinogen_persisting_perception_disorder" title="Hallucinogen persisting perception disorder">Hallucinogen persisting perception disorder</a> (HPPD)</li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Nicotine" title="Nicotine">Nicotine</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SID <ul><li><a href="/wiki/Green_Tobacco_Sickness" title="Green Tobacco Sickness">Green Tobacco Sickness</a> (GTS)</li> <li><a href="/wiki/Nicotine_poisoning" title="Nicotine poisoning">Nicotine poisoning</a></li> <li><a href="/wiki/Nicotine_withdrawal" title="Nicotine withdrawal">Nicotine withdrawal</a></li></ul></li> <li>SUD <ul><li><a href="/wiki/Nicotine_dependence" title="Nicotine dependence">Nicotine dependence</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Opioid" title="Opioid">Opioids</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SID <ul><li><a href="/wiki/Opioid_overdose" title="Opioid overdose">Opioid overdose</a></li> <li><a href="/wiki/Opioid_withdrawal" title="Opioid withdrawal">Opioid withdrawal</a></li> <li><a href="/wiki/Opioid-induced_hyperalgesia" title="Opioid-induced hyperalgesia">Opioid-induced hyperalgesia</a> (OIH)</li> <li><a href="/wiki/Opioid-induced_endocrinopathy" title="Opioid-induced endocrinopathy">Opioid-induced endocrinopathy</a> (OIE)</li> <li><a href="/wiki/Opioid-induced_constipation" class="mw-redirect" title="Opioid-induced constipation">Opioid-induced constipation</a> (OIC)</li></ul></li> <li>SUD <ul><li><a href="/wiki/Opioid_use_disorder" title="Opioid use disorder">Opioid use disorder</a> (OUD)</li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Sedative" title="Sedative">Sedative</a> /<br /><a href="/wiki/Hypnotic" title="Hypnotic">hypnotic</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SID <ul><li><a href="/wiki/Kindling_(sedative%E2%80%93hypnotic_withdrawal)" title="Kindling (sedative–hypnotic withdrawal)">Kindling (sedative–hypnotic withdrawal)</a></li></ul></li> <li><i><a href="/wiki/Benzodiazepine" title="Benzodiazepine">benzodiazepine</a>:</i> SID <ul><li><a href="/wiki/Benzodiazepine_overdose" title="Benzodiazepine overdose">Benzodiazepine overdose</a></li> <li><a href="/wiki/Benzodiazepine_withdrawal_syndrome" title="Benzodiazepine withdrawal syndrome">Benzodiazepine withdrawal</a></li></ul></li> <li>SUD <ul><li><a href="/wiki/Benzodiazepine_use_disorder" title="Benzodiazepine use disorder">Benzodiazepine use disorder</a> (BUD)</li> <li><a href="/wiki/Benzodiazepine_dependence" title="Benzodiazepine dependence">Benzodiazepine dependence</a></li></ul></li> <li><i><a href="/wiki/Barbiturate" title="Barbiturate">barbiturate</a>:</i> SID <ul><li><a href="/wiki/Barbiturate_overdose" title="Barbiturate overdose">Barbiturate overdose</a></li></ul></li> <li>SUD <ul><li><a href="/wiki/Barbiturate_dependence" title="Barbiturate dependence">Barbiturate dependence</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Stimulant" title="Stimulant">Stimulants</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SID <ul><li><a href="/wiki/Stimulant_psychosis" title="Stimulant psychosis">Stimulant psychosis</a></li></ul></li> <li><i><a href="/wiki/Amphetamine" title="Amphetamine">amphetamine</a>:</i> SUD <ul><li><a href="/wiki/Amphetamine_dependence" title="Amphetamine dependence">Amphetamine dependence</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Solvent" title="Solvent">Volatile<br /> solvent</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SID <ul><li><a href="/wiki/Sudden_sniffing_death_syndrome" class="mw-redirect" title="Sudden sniffing death syndrome">Sudden sniffing death syndrome</a> (SSDS)</li> <li><a href="/wiki/Toluene_toxicity" title="Toluene toxicity">Toluene toxicity</a></li></ul></li> <li>SUD <ul><li><a href="/wiki/Chronic_solvent-induced_encephalopathy" title="Chronic solvent-induced encephalopathy">Chronic solvent-induced encephalopathy</a></li> <li><a href="/wiki/Inhalant" title="Inhalant">Inhalant abuse</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Related</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Anabolic-androgenic_steroid" class="mw-redirect" title="Anabolic-androgenic steroid">Anabolic-androgenic steroids</a></i>: SUD <ul><li><a href="/wiki/Anabolic-androgenic_steroids_abuse" class="mw-redirect" title="Anabolic-androgenic steroids abuse">Anabolic-androgenic steroids abuse</a></li></ul></li> <li><a href="/wiki/Chocoholic" class="mw-redirect" title="Chocoholic">Chocolate</a></li></ul> </div></td></tr></tbody></table></div>    </div><noscript><img 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