January: The criminalization of substance use during pregnancy

Written by Sharanya Subramaniam

POint of View:
Draconian Laws Deter Pregnant Women from Treating Drug Abuse

Experts in maternal health discuss the challenges faced by pregnant and postpartum persons during the opioid crisis. Neonatologist and Executive Director of Firefly, an opiate use disorder (OUD) treatment program at Vanderbilt University, Stephen Patrick, points out frequent occurrences of people with OUD being labeled unfit parents and being separated from their infants. State laws require healthcare professionals to report suspected prenatal substance use to Child Protective Services, which can have unexpected outcomes. Some parents are scared of asking for help because they are afraid of legal trouble. Mishka Terplan, an Ob-Gyn, points out that these laws contribute to many infants entering foster care, which harms both parents and children. The authors highlight the need for supporting pregnant people with substance-use disorders and making treatment more accessible. Miriam Komaromy, medical director of the Grayken Center for Addiction, advocates for creating an environment where pregnant people feel comfortable seeking help without the threat of legal consequences. By shifting the focus towards supportive treatment, the aim is to empower parents to address their OUD, supporting the well-being of families.

Resource:
Center for Addiction Recovery in Pregnancy and Parenting

The Center for Addiction Recovery in Pregnancy and Parenting (CARPP) at Dartmouth Health helps pregnant and parenting women recovering from addiction. It is a network of experienced healthcare providers and researchers focused on helping women and their children who are affected by substance-use disorder in the Upper Valley region and beyond. One of CARPP’s programs is Moms in Recovery. This program offers care for pregnant and parenting women with substance-use disorders, including group and individual treatment, care before and after birth, mental health support, and newborn care, all in one location. CARPP also offers other programs to support families affected by substance use disorder.

News Story:
Pregnant and addicted to opioids: A mother speaks

In this short clip from AthenaHealth, a young mother recounted her struggle with substance use disorder. She became addicted after using painkillers as prescribed by her doctor, but upon finding out she was pregnant, this mom was told that withdrawal would be too difficult on the baby. Although she was sad that her substance use put her baby at risk, she expressed how the doctors and nurses in her clinic have treated her with such kindness and compassion, without judgment, that she was able to get the care she needed to take care of herself and her baby. This mom’s testimony highlights the need for supporting moms in care rather than punishing them. Because the clinic made her feel safe and supported, this brave mother took control of her health to create a better future for her family.

Scientific Publication:
Association of Punitive and Reporting State Policies Related to Substance Use in Pregnancy With Rates of Neonatal Abstinence Syndrome

This study aimed to understand how state policies on substance use during pregnancy affect rates of neonatal abstinence syndrome (NAS), which includes conditions caused when a newborn withdraws from exposure to maternal substance use before birth. Using data from 4.6 million births across 8 U.S. states during 2003-2014, the authors studied two types of state policies: 1) those that punished substance use, and 2) those that mandated reporting of suspected prenatal substance use. The study found that the rate of NAS per 10,000 births was significantly higher in states with punitive policies compared with states without these policies. The NAS rate was 46 per 10,000 live births (95% CI, 43-48) in states without punitive policies; 57 per 10,000 live births (95% CI, 48-65) during the first full year after policy enactment in states with punitive policies, and 60 per 10,000 live births (95% CI, 56-65) in states with punitive policies in effect for more than 1 full year. The study points out the importance of focusing on prevention of NAS through treatment rather than criminalization of substance use during pregnancy.