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Addicted and Pregnant: How States Deal With Drug Problems When You're Expecting

Roughly 1 in 20 pregnant women use illicit drugs. States are cracking down on the problem with starkly different approaches.

There has been plenty of discussion of America’s latest heroin epidemic, which started in New England and has spread across the country, particularly ravaging rural areas. But far less public attention has been paid to the children born into that epidemic.

About 1 in 20 women use illicit drugs during pregnancy. An existing federal law requires doctors to administer so-called “safe care” when they identify a pregnant woman as struggling with substance abuse. However, the law leaves it up to the state or hospital to establish what that care will look like. In general, states have struggled to do this. Bills pending at the federal level would change that by requiring the Department of Health and Human Services to provide a clearer action plan for improving treatment programs for pregnant women struggling with addiction.

In the meantime, some states have taken it upon themselves to act, and much of that action has come not in efforts to improve treatment but rather to punish pregnant women who abuse drugs. In Tennessee, where heroin has strongly affected the rural eastern part of the state, a 2014 law allows officials to prosecute women who give birth to infants with neonatal abstinence syndrome (NAS) -- newborns who display symptoms of withdrawal such as excessive crying, vomiting, sweating and fever.

Jessica Young, a Nashville ob-gyn who specializes in addiction, estimates that the state has prosecuted about 100 women since the so-called “fetal assault” law was passed. While some leniency is offered to women in treatment programs, the law mistakenly “presumes there is a plethora of addiction resources for women,” says Young. In fact, there are very few such resources, she says, “and even fewer that are truly comprehensive.”

Alabama and Wisconsin have fetal assault laws that, like Tennessee’s, largely rely on symptoms displayed by a newborn to identify mothers subject to prosecution. The problem with these laws, according to Pam Baston, co-founder of a consulting firm specializing in alcohol and drug abuse treatment, is that only 10 percent of babies born to addicted mothers are actually ever identified because not all infants display signs of NAS. To Baston, these kinds of state laws force a woman to be dishonest with her doctor.

Several states are working to establish clearer “safe care” plans in the absence of federal direction. In 2014, the National Center on Substance Abuse and Child Welfare awarded technical assistance grants to Connecticut, Kentucky, Minnesota, New Jersey, Virginia and West Virginia to research and implement pilot programs aimed at identifying and treating pregnant women dealing with substance abuse. The objective of the grants is to target specific communities. Many of the hardest-hit communities are in rural areas with distinct cultures and ways of life, so it’s seen as imperative to employ local health workers who understand those intricacies. Kentucky, for example, is using its grant money to expand medication-assisted treatment programs in one hard-hit county.

Minnesota’s heroin issue has particularly impacted its tribal communities, which “are typically very isolated with strong cultural values that don’t always align with state health departments’ recommendations,” says Linda Carpenter, a program director with the National Center on Substance Abuse and Child Welfare. “So our question is: Who can we use in these communities to make sure they are receiving even the most basic prenatal care?”

As legislation continues to slog along at the federal level, more states are feeling a sense of urgency. “On a weekly basis, I’m receiving requests from states for help,” says Carpenter. “And often, there are so many other issues at hand besides addiction. These truly are the most vulnerable populations we have.”

Mattie covers all things health for Governing.

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