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 To try to protect the youngest victims of the nation’s opioid
epidemic, Tennessee enacted a law that sent new mothers to jail for
substance abuse, while other states employ existing child-abuse laws
to punish prenatal drug users and remove their children.
But sanctions have backfired, serving only to drive pregnant women
away from necessary prenatal care and substance-use treatment,
pediatricians say in three new papers.
In one, published this week in Pediatrics, the American Academy of
Pediatrics exhorts policymakers to support a public health approach
- rather than a criminal justice response - to opioid use in
pregnancy.
“I don’t think these laws are in the best interests of moms or
babies,” Dr. Stephen Patrick, lead author of the report in
Pediatrics, said in an interview. “Opioid-use disorder is a medical
problem and not a moral failing.”
Patrick is a professor at Vanderbilt University School of Medicine
in Nashville, Tennessee, where he treats infants suffering
withdrawal from opioids.
Instead of jail, he called for improved access to long-term
contraceptives and substance-treatment programs designed to care for
pregnant women.
About 100 substance-using new mothers went to jail in Tennessee
between 2014 and 2016 under a fetal-assault law that’s no longer in
effect, Patrick said.
The law incited so much fear in pregnant addicts that some refused
to go to the hospital and gave birth at home, in cars or on the side
of the road, he said.
Meanwhile, the number of pregnant women who use opioids and the
number of babies born with withdrawal symptoms continues to rise.
Patrick estimated that as many as 440,000 substance-exposed infants
are born in the U.S. every year and asserted: “We’re not going to
arrest 440,000.”
Dr. Mary Beth Sutter, a professor at the University of New Mexico in
Albuquerque, works with expectant drug addicts in her state, where
prosecutors charge pregnant drug users under child-abuse laws, she
said in a phone interview.
“Putting women in jail and taking their babies away to try to
prevent substance abuse really isn’t working,” she said. “It does
nothing to help these women and children, but it tends to turn them
way from care.”
Newborns who stay with their mothers require fewer days in the
hospital, cutting the cost in half, Sutter writes in a new review in
the journal Obstetrics and Gynecology Clinics of North America.
Physicians can better help drug-addicted infants when they know
mothers are using illicit substances. But expectant mothers worry so
much about being stigmatized, jailed and having their babies taken
from them that they frequently fail to disclose drug use, Sutter
writes.
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Carrying a baby motivates substance users to quit. “If there ever
was a time when it’s good to help people with substance abuse,”
Sutter said, “it’s pregnancy.”
But the demand for substance-treatment programs designed to meet the
unique needs of pregnant women and their babies far outstrips their
availability. Only 19 states have such programs.
New Mexico has only one in-patient treatment program with just six
beds for pregnant and parenting women in the entire state, Sutter
said.
Medication-assisted therapy with methadone or buprenorphine has
become standard care for pregnant women with opioid-use disorder,
Patrick writes. But women who fear losing custody of their babies
sometimes avoid treatment so as not to raise suspicion, according to
another new report in the Journal of Substance Abuse Treatment.
Psychologist Dennis Hand, a professor of obstetrics and gynecology
at Thomas Jefferson University in Philadelphia, examined opioid use
in pregnancy throughout the U.S. and found the problem particularly
acute in the South.
Southern states have fewer drug-treatment facilities, and more women
take benzodiazepines, a class of sedatives and anti-anxiety drugs,
along with opioids, Hand found. The combination complicates
treatment for mothers and babies.
Southern women also are less likely to have health insurance, and
the South has even fewer treatment programs for pregnant women than
other areas, Hand said. Tennessee does not cover methadone, and
Mississippi has only one methadone clinic, compared to California,
which has 138, he said.
The number of infants experiencing opioid withdrawal after birth, or
neonatal abstinence syndrome, grew nearly fivefold over the past
decade, Patrick writes.
Many of the mothers of newborns that Patrick and Sutter treated had
no idea that taking doctor-prescribed pain relievers could lead them
and their babies to addiction. Sutter said her patients frequently
were prescribed opioids following car accidents, dental surgeries
and cesarean sections for previous births.
SOURCES: http://bit.ly/2lljoJH Pediatrics, online February 20, 2017;
http://bit.ly/2kQqxTR Obstetrics and Gynecology Clinics of North
America, online February 2, 2017; http://bit.ly/2lOHvl8 Journal of
Substance Abuse Treatment, online February 1, 2017.
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