Doctors call for changes to laws that criminalize drug use during pregnancy


Bandi Williams had been up for two straight days smoking crack cocaine when she realized she was going into labor.It was a cold Tennessee morning in December 2014, and Williams had to pull herself together to get to a hospital. She borrowed. SAcar from a friend whose excessive alcohol use required him to have a breathalyzer attached to the car’s starter.

“Here I am in full-blown labor, driving myself and I can feel the baby’s head, like, right there,” Williams recalls. “And I’m having to blow in this damn machine or the car would shut off.”She made it to the hospital in time. As she walked through the doors to give birth to her daughter, Williams made one last preparation before delivery.

Underneath Williams’ raw honesty lies a layer of sad humility. “I was ashamed that I was still getting high while pregnant. I was ashamed because I couldn’t quit.”

Treatments for drug addiction during pregnancy are safe for both the mother and the baby, doctors say. Methadone and buprenorphine, for example, can reduce craving. And help users carry a pregnancy full term, without long-lasting effects on the baby.

But shame and stigma, the same that Brandi Williams felt, stopped. Many pregnant women from seeking help.

A bigger deterrent, however, is the crippling fear that their babies will be taken away by state welfare authorities. Some states, based on their interpretation of a federal law. View substance use during pregnancy as child abuse so heinous. That it deserves criminal prosecution.

That’s why a growing number of experts — including maternal/fetal specialists. Federal health officials and people who treat addiction — are calling for changes to the laws.

“We should remove criminalization of women who are pregnant and taking drugs,” Dr. Nora Volkow. Head of the National Institute on Drug Abuse (NIDA), said in an interview. “That needs to stop.”

Substance use disorder “does not diagnose anyone’s ability to parent,” said Dr. Hendrée Jones. Executive director of the University of North Carolina’s Horizons Program. A drug treatment program.

“I have a woman getting ready to deliver. And she is terrified that somehow they’re going to find drugs. In her system and Child Protective Services is going to be called and her baby’s going to be snatched away,” Jones said.

A study published Wednesday in the Maternal. And Child Health Journal that included 26 pregnant women in Massachusetts found. . In what happened with respect to mandated reporting to Child Protective Services at the time of delivery. Said Dr. Davida Schiff, the study author. And an addiction medicine specialist at Massachusetts General Hospital in Boston.

Women in the study felt “intense anxiety and stress” under the threat that they would be reported to CPS.

“This has led to many women either deciding no. To start life-saving medication during pregnancy or to wean. Off of that life-saving medication during pregnancy. And really risk poor outcomes for themselves and their babies,” Schiff said.

The effects are not limited to Massachusetts.

“Across the entire country, we’re seeing a general trend toward more punitive policies. And those are kind of the policies that consider substance use during pregnancy to be child abuse or neglect. Said Laura Faherty, a policy researcher at the RAND Corporation. .

Calls for change have an urgent timing.

The rate of women with opioid-related diagnoses at the time of delivery increased by 131% from 2010 to 2017, according to a 2019 study. Research is ongoing, although addiction experts. Expect yet another significant rate increase after 2017.

And the no. 1 cause of preventable death among pregnant and postpartum women in particular is not pregnancy-related at all. It’s drug overdose, NIDA’s Volkow said.

“We know that mortality from overdoses is greater in women who are pregnant than counterparts of the same age who are not pregnant,” Volkow said. “This is extraordinarily important because it’s telling us that there’s something that is making. These pregnant women more vulnerable.”

According to a study published last year, the number of pregnant women and new mothers dying of drug overdoses reached. Arecord high in 2020: 11.85 per 100,000, up from 6.56 per 100,000 in 2017.

In 1974, Congress passed the Child Abuse Prevention and Treatment Act, known as CAPTA. It requires states to have a plan in place to address and respond to child abuse and neglect.

A provision that suggests child abuse can include babies born affected by drug withdrawal.

It is up to each state to determine how to interpret CAPTA.

Twenty-five states and Washington, D.C. Consider substance abuse during pregnancy to be child abuse. According to the Guttmacher Institute, a reproductive health and policy research group. Those states require health care professionals to report any suspected prenatal drug use to au

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