Laws that punish women who abuse drugs during pregnancy are often presented as a way to protect unborn babies from addiction. But new research has found that they have the opposite effect: After states enact laws that treat pregnant drug users as mothers or improper criminals, the number of newborns suffering from drug withdrawal increases significantly.
The new findings suggest that laws that criminalize mother's drug use during pregnancy or threaten to remove newborns from maternal care discourage women from seeking addiction treatment and place their babies at greater risk for health problems from the moment they are born.
The study, led by experts from Rand Corp., based in Santa Monica, was published Wednesday in JAMA Network Open magazine. This is as more states enact laws against illicit drug users in an attempt to reverse a growing epidemic of opioid analgesic addiction.
"These punitive policies are pushing women into the shadows," said study leader Dr. Laura Faherty, pediatrician and health policy researcher. "It's a shame for them to receive antenatal care and substance-disorder treatments that they need to keep themselves and their babies healthy."
Faherty said it would be unthinkable to punish women for having epilepsy or diabetes during pregnancy.
"But we treat substance use disorder as a moral flaw rather than the medical condition it really is," she said.
Between 1999 and 2013, the number of women in the United States with a opioid use disorder at delivery quadrupled. The consequences for babies can range from mild to terrible: If a pregnant woman is taking pain-prescribed opioids, receiving low doses of opioids as a treatment for addiction or heroin abuse, the newborn is likely to suffer from neonatal withdrawal syndrome. – essentially drug withdrawal – in its early days and weeks of life.
While neonatal abstinence syndrome, or NAS, can be managed by pediatric specialists in a hospital, often distressing to a newborn and very expensive. Babies born to mothers who have taken opioids may need weeks or months of hospitalization, during which the newborn may cry inconsolably and experience tremors, convulsions, and problems with breathing and feeding.
In the United States, the rate of babies born with NAS increased fourfold between 2000 and 2014. Annual hospital fees for the treatment of these young patients are about $ 1.5 billion.
It is not clear that a baby born with NAS will suffer long-term health risks. But the American College of Obstetricians and Gynecologists (ACOG) noted that chronic untreated heroin addiction is related to a lack of prenatal care and a higher risk of fetal death, premature birth and low birth weight. Being born too early and / or too small can have life-long consequences for a child's health.
Between 2000 and 2015, the growing opioid epidemic led 13 states to enact laws that would punish a pregnant drug user, bringing the total number of states with these laws to 25.
Rand's researchers focused on eight states with laws related to substance abuse during pregnancy. They searched data from early 2003 to late 2014 on infants born with NAS for several years before and after these laws came into force.
In total, the researchers examined more than 4.5 million live births and identified 23,377 newborns diagnosed with NAS. They compared NAS rates in states with and without punitive laws aimed at pregnant women with substance abuse problems.
In the first year after the adoption of punitive laws, rates of babies born with neonatal withdrawal syndrome increased by 24%. Before states adopted the laws, 46 out of 10,000 newborns suffered from NAS. That rate rose to 57 per 10,000 live births in the first year after these states – separately and at different times – put a law in the books.
In subsequent years, when the existence of these laws was presumably better known to pregnant women, the NAS's birth rate reached 60 per 10,000 live births.
There was no increase in the rate of babies born with dependence in states that passed laws requiring notification of these births without explicit punitive measures, the researchers said.
To lawmakers and public health officials, takeaway's message is clear, he said. Dr. Rahul GuptaMarch of Dimes Chief Physician: "Making punitive policies for a time when women are at their most vulnerable – during pregnancy – is not the best policy."
Much previous research has documented the harm of such policies to women. "But it shows that the results are not good for the baby either," said Gupta.
Professor of Law at Drexel University David S. Cohen They said many of these state laws were backed by enemies of abortion who tried to set legal precedents that confer personality rights on a developing fetus. If behavior that harms a fetus is a crime in the eyes of the law, women's right to abortion would be at risk, Cohen said.
"Nothing has found that a child's or mother's health is improved by punitive policies," said Cohen, who managed defended a Pennsylvania woman accused of child abuse after the birth of a child exposed to illicit drugs she took during her pregnancy. "This brings people to treatment and results in health problems," for both, he added.
It is not clear that placing an opiate-dependent pregnant woman in jail would also protect her unborn child. Two case reports From the 1970s, there was concern that abrupt withdrawal of opioids during pregnancy could lead to fetal stress and death.
More recent studies have found "no clear evidence of an association between clinically supervised withdrawal and fetal death or premature birth," according to ACOG. But the organization said more research is needed.
In 2017 declarationACOG and the American Society for Addiction Medicine opposed laws that would punish a pregnant woman with an addiction. Instead, they argued that all pregnant women should be screened for substance use disorder, and those in need of treatment should receive it.
"In general, a coordinated multidisciplinary approach without criminal sanctions has the best chance of helping babies and families," the two medical groups concluded. "Obstetric care providers have an ethical responsibility towards pregnant patients and parents with substance use disorder to discourage separation from parents and children only on the basis of suspected or confirmed substance use disorder."
Dr. Mishka Terplan, which worked with ACOG to develop drug and pregnancy policies, said states seeking to help babies should give pregnant women preferential access to substance use treatment and protect them from discrimination.
"Few states have written this in the state statute," said Terplan, who has been practicing addiction and obstetrics medicine for nearly two decades. "We all have stories demonstrating the violation of pregnant people who used drugs."
The idea that children are usually better off with their mothers, even those struggling with drug addiction, may seem counterintuitive, Gupta said. But it's true.
"The best way to protect the babies we know is to find a regulatory framework that allows the mother-child dyad to be maintained after birth," he said. "The only way to do that is for Mom not to be criminalized, for her to have a full opportunity to seek and get treatment for her opioid disorder."