Pregnant People with Substance Use Disorders Need Treatment, Not Criminalization. Risk-based testing uses hospital-defined criteria such as maternal history or signs of drug use, social risk factors, limited or absent prenatal care, and symptoms of withdrawal. [2], As a medical student, I have observed the importance of a rehabilitative approach to addiction medicine. The Centers for Disease Prevention and Control (CDC), the American College of Obstetricians and Gynecologists, the American College of Nurse Midwives, and the American Academy of Family Physicians have not changed their recommendations and all continue to recommend flu vaccination for pregnant women. With renewed focus on academic strength, we aim to contribute to the array of bioethics literature by continuing to publish op-eds and research essays that challenge the reader to explore novel viewpoints. Medication assisted treatment under the supervision of medical professionals can help inmates achieve and maintain sobriety in a healthy and safe way. "Lawmakers in Tennessee last year increased drug screenings of expectant mothers and passed a law allowing prosecutors to charge a woman with aggravated assault against her unborn baby if she was caught using illicit drugs. Avoid close contact with those who are sick, Avoid touching your eyes, nose or mouthafter you have touched objects that could possibly be contaminated, Clean/disinfect frequently touched surfacesat home, school or work, especially when someone is ill, Eat nutritious foods and drink plenty of fluids. Seasonal Influenza Vaccination Resources for Health Professionals: Infection Control in Health Care Facilities: Clinical Description & Lab Diagnosis of Influenza: Seasonal Flu vaccine information/Vaccine Composition: Materials that can be used to educate patients. [10] And if a woman tried to stop using drugs before seeking care to avoid detection, she often ended up delaying or avoiding care. Published December 14, 2020. https://www.pregnancyjusticeus.org/tennessees-fetal-assault-law-understanding-its-impact-on-marginalized-women/, [10] Roberts SCM, Nuru-Jeter A. Womens perspectives on screening for alcohol and drug use in prenatal care. [27], While I have witnessed this behavior in the teenage patient during my pediatrics rotation, not all newborns with intrauterine drug exposure are inevitably bound to have psychiatric and behavioral issues later in life. J Addict Med. Newborns' exposure to drugs: Discrepancies in mandatory reporting The report identifies statewide trends in maternal deaths and provides recommendations to help prevent maternal mortality. Four similar cases had occurred in the preceding month. Maternal morbidity refers to any pregnancy or delivery complication, which may be minor or severe. In Alabama and South Carolina, high courts have interpreted existing child endangerment and chemical endangerment statutes to allow prosecution of drug-using pregnant women and new mothers. Identification of newborns exposed to illicit substances can alert the practitioner to problems one might encounter in the delivery room and nursery, such as intoxication, withdrawal syndromes, and long-term needs for exposed neonates. The Maternal Lifestyle Study (NCT00059540) was a prospective longitudinal observational study that compared the outcomes of newborns exposed to cocaine in-utero to those without. https://drugpolicy.org/issues/brief-history-drug-war, [5] The Harrison Narcotic Act (1914) https://www.druglibrary.org/Schaffer/library/studies/cu/cu8.html, [6] The War on Drugs. After repeal, the Judge did not want to terminate the respondent's parental rights because of the respondent's "outstanding" rehabilitation efforts. On the surface, this solution seems like a quick fix. National Advocates for Pregnant Women (NAPW) and the ACLU of Illinois filed a charge against St. Alexius Medical Center for a discriminatory, non-consensual drug test against a first-time mother, Ms. F., before she went into labor. There aren't any restrictions for employee drug testing of the general workforce in Illinois. [26] Long-term follow up from the study showed that at seven years old, children with high intrauterine cocaine exposure were more likely to have externalizing behavior problems such as aggressive behavior, temper tantrums, and destructive acts. However, some women experience pregnancy complications, which may be minor or severe, and may cause significant short- and/or long-term consequences to a womans health. https://www.acog.org/en/clinical/clinical-guidance/committee-opinion/articles/2011/01/substance-abuse-reporting-and-pregnancy-the-role-of-the-obstetrician-gynecologist, [13] R. Ghertner, G Lincoln The Opioid Crisis and Economic Opportunity: Geographic and Economic Trends. States need to enact laws that protect these women from being reported to authorities. During 2018, a total of 2,175 recent mothers were sampled and Millions of flu vaccines have been given for decades, including to pregnant women, with a good safety record. There can be no significant change if society continues to view those with substance use disorders as underserving of care. https://drugabusestatistics.org/drug-related-crime-statistics/. Submissions about the COVID-19 pandemic should address racial disparity, access to education or health care, vaccination ethics, pandemic preparation or prevention, and issues as the intersection of law, policy, economics, and liberty. Nations Health. Substance Use While Pregnant and Breastfeeding. And for example, see Crack Babies: Twenty Years Later : NPR https://www.npr.org/templates/story/story.php?storyId=126478643, [15] Williams JF, Smith VC, the Committee on Substance Abuse. [16] Stimulants like methamphetamine can also cause preterm delivery, delayed motor development, attention impairments, and a wide range of cognitive and behavioral issues. Drug & Alcohol Detox & Rehabilitation Centers, involuntarily commit until the child is born, The People of the State of Illinois, Petitioner-Appellee,v. J Addict. To progress as a society, physicians and interprofessional teams must work together to truly understand the needs of patients with substance use disorders and provide support from prenatal to postnatal care. View Marijuana Laws Centers for Disease Control and Prevention. or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 County hospitals that mainly serve lower socioeconomic patients encounter more patients without consistent health care access and those with substance use disorders. Intensive oral hygiene regimens decrease the incidence of gingivitis among pregnant women. ACOG calls on federal and state legislators to look to science-based guidelines and decades of medical evidence to craft appropriate public health interventions that will optimize health outcomes for moms and babies. Tennessee is the only state with a statute that specifically makes it a crime to use drugs while pregnant. Oral health is essential to overall health in the prenatal period. Further, the law states that it is not illegal for employers to require drug tests from employees who have been or are in a drug rehabilitation program. [30] So far, laws are not associated with a decrease in the misuse of drugs during pregnancy. States were questioned about their policies with respect to genetic counseling, CVS, and amniocentesis testing for pregnant women. Drug Testing in Illinois Testing locations are available in all areas. Introduced 9/3/2021, by Rep. Bob Morgan - Kambium Buckner - Kelly M. Cassidy . The practice of drug testing pregnant women without their knowledge or consent is common in New York, according to NAPW and NYCLU, but is not supported by leading medical organizations. In many places, women lose their children or end up in behind bars, sometimes even if the drug was prescribed. [40] Drug Related Crime Statistics [2023]: Offenses Involving Drug Use. Oral health care during pregnancy is a shared responsibility among prenatal care health professionals, oral health professionals, and pregnant women. Whether these studies will lead to stricter regulations and punishments on pregnant women is highly debatable. Those currently serving sentences in prisons and jails can treat their substance use disorder through medication assisted treatment, cognitive behavioral therapy, and programs like Self Taught Empowerment and Pride (STEP). Pregnancy, Law, Abortion, Opioids, Baby, Alcohol, Substance Use Disorder, Neonatal Abstinence Syndrome, Newborn, Addiction, Medicine, Supreme Court, Roe v Wade, Smoking, Medication Assisted Treatment, Safe Harbor, Development, Mother, States, War on Drugs, Pediatrics, OBGYN, Reproductive Ethics, Bioethics. [13] These hospitals are facing the consequences of the worsening opioid pandemic. [9] The fear that this law instilled in pregnant women with substance use disorder can still be seen across the US today. In Illinois, substance abuse is not a crime. Yes! His past psychiatric disorders included attention deficit disorder, conduct disorder, major depressive disorder, anxiety disorder, disruptive mood dysregulation disorder, intellectual developmental disorder, and more. Hospitals should provide training and resources to staff on racism, implicit bias, and stigma. No new mother should ever face such traumatic and discriminatory treatment." 1 comment . The report identifies statewide trends in maternal deaths and provides recommendations to help prevent maternal mortality. The state of Illinois, where this study was conducted, . Eighteen states have laws that say drug use during pregnancy is child abuse. From December 2017 through March 2019, a 12-question marijuana and drug use supplement was added to the PRAMS survey. During this period, I saw a teenager brought to the pediatric floor due to worsening psychiatric symptoms. There is no simple fix to this problem, given that it involves the political, legal, and healthcare systems. Centers for Disease Control and Prevention. There are ways you and your partner can prevent passing HIV to one another or to your baby. Elizabeth Nolan Brown | 4.23.2021 8:30 AM. . Pediatrics. [1] NIDA. No, Illinois does not require testing over suspicions. Since 1973, authorities in at least 45 states have sought to prosecute women for exposing their unborn children to drugs. This article highlights some misconceptions and underscores the challenges they face as they navigate the justice and healthcare systems while also providing possible solutions to address their underlying addiction. DHHS Revised September 11, 2018 https://aspe.hhs.gov/reports/economic-opportunity-opioid-crisis-geographic-economic-trends, [14] Midon, M. Z., Gerzon, L. R., & de Almeida, C. S. (2021). Some suggest that addiction is a choice; therefore, those who misuse substances should not receive treatment. For example, Virginia considers substance use during pregnancy child abuse and mandates that healthcare providers report it. Society needs to change from the mindset of tackling a problem after it occurs to taking a proactive approach by addressing upstream factors, thereby preventing those problems from occurring in the first place. Pediatrics. No one ever informed her of, nor asked her permission for, a drug test. It is the first charge of its kind in Illinois. Unfortunately, policy makers did not heed these recommendations. The charge alleges that Saint Alexiuss practice of drug testing pregnant women without their knowledge or consent and in the absence of a medical justification discriminated against Ms. F. on the basis of sex and pregnancy. Efforts to inform health professionals about the connection between oral health and overall health during pregnancy should focus on effectively disseminating strategies that translate evidence-based guidelines into clinical practice, with the ultimate goal of improving oral-systemic health among women and children. Under Public Act 101-0445, effective January 1, 2020, the Medical Patient Rights Act was amended by requiring information about rights with regard to pregnancy and childbirth to be posted on this website. Published July 27, 2021. https://www.cdc.gov/nccdphp/dnpao/features/breastfeeding-benefits/index.html, [35] Welle-Strand GK, Skurtveit S, Jansson LM, Bakstad B, Bjark L, Ravndal E. Breastfeeding reduces the need for withdrawal treatment in opioid-exposed infants. Illinois was the first state to extend continuous eligibility for full Medicaid benefits from 60 days to 12 months postpartum. Photo by 14825144 Alita Xander | Dreamstime.com. Incidence and Costs of Neonatal Abstinence Syndrome Among Infants with Medicaid: 20042014. Resource lists for women and their families are available inAppendix Aof the report. The Pennsylvania Supreme Court ruled in 2018 that prenatal exposure to substances does not constitute child abuse under the state's Child Protective Services Laws. Buprenorphine and Naloxone Versus Buprenorphine for Opioid Use Disorder in Pregnancy: A Cohort Study. by psmith, December 23, 2021, 01:00am, (Issue #1147) Posted in: . Emphasizing public health measures and adequate medical care can prevent complications and developmental issues in newborns and pregnant women with substance use disorders. The employer may conduct drug tests without affecting individual rights. 19 states have either created or funded drug treatment programs specifically targeted to those who are pregnant, and 17 states and the District of Columbia provide pregnant people with priority access to state-funded drug treatment programs. If a woman cannot take care of herself, one might wonder how she can take care of another human being. No, substance abuse during pregnancy is not grounds for civil commitment. Some avoided arrest by delivering their babies in other states or at home, while others opted for abortions or attempted to go through an unsafe withdrawal prior to receiving medical care, sacrificing the mother's and fetus's wellbeing. For additional quantities, please contact [emailprotected] The court of Kane County found the respondent to be an unfit parent and sought to terminate her parental rights to her son when her son was born with cocaine in his system. Excessive alcohol consumption can result in fetal alcohol syndrome, characterized by growth deficiency, facial structure abnormalities, and a wide range of neurological deficiencies. Yet I felt for the new mothers and realized that heart-wrenching custody loss is not the best approach. He was born with neonatal abstinence syndrome that neither the residential program nor his foster family could manage. Due to mandatory reporting, they were not confident that physicians would protect them from the law. Pregnancy-Related Death- The death of a woman during pregnancy or within one year of the end of a pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy. The Illinois Department of Public Health supports two Maternal Mortality Review Committees, which: Reviews deaths suspected to be medically related to pregnancy. Many of the current laws and regulations that policy makers initially created due to nave political opinion and unfounded bias to serve the War on Drugs need to be changed to provide these opportunities. [32] For someone who may or may not have access to reliable transportation, traveling to another state might be impossible. During the two years this law was in effect, officials arrested 124 women. [4] However, it is worth noting that one can trace the roots of this initiative back further. Please go to www.prep4illinois.com or call the hotline at (800) 825-3518. Crack and motor development of babies living in an assistance shelter. 102ND GENERAL ASSEMBLY State of Illinois 2021 and 2022 HB4116 . There is no indication that preventive or restorative oral health treatment during any trimester of pregnancy can harm the mother or the developing fetus. The Pregnancy Risk Assessment Monitoring System (PRAMS) collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy. Infants exposed to drugs prenatally have an increased risk of complications, stillbirth, and life-altering developmental disabilities. . During his hospitalization, he was so violent towards healthcare providers that security had to intervene. Health outcomes during pregnancy and the postpartum period occur across a continuum. Many pregnant women with substance use disorders stated that they feared testing positive for drugs. Thus, laws intended to deter people from using substances through various punishments and incarceration may be doing more harm than good. Illinois newborn drug testing laws mandate cases to be reported to the Department of Children and Family Services (DCFS) and the Department of Public Health (DPH), where an investigation will begin. After withdrawal, those struggling with substance use disorder may still have cravings and the likelihood of relapsing remains high without proper medical intervention. J Urban Health Bull N Y Acad Med. Two modes of testing are available: umbilical cord tissue and meconium. . Text4baby is a free mobile health information service for pregnant women and new parents with infants under the age of 1 year. The results of the investigation determine whether the baby is taken permanently. Ms. F. arrived at the hospital on April 4, 2021, at 34 weeks pregnant when her blood pressure rose It must be asked, by what judicially defined standard would a mother have her every act or omission while pregnant subjected to State scrutiny? During this time, a DCFS agent and another state employee came regularly to Ms. F.s home to check in on her and the baby. 2015;136(5):e20153113. Some states consider substance misuse (and even prescribed use) during pregnancy child abuse. Our submissions guidelines, requirements, and tips can be found here. 3 Bulk pricing was not found for item. PMID: 31567599. Meconium is the earliest stool of an infant composed of materials ingested while the infant is still in the uterus. For many women, motherhood is a rewarding experience. NCDAS. However, they said states could define and protect potential human lives as long as there are "important legitimate reasons." The Global Commission on Drug Policy. Eighteen states have laws that say drug use during pregnancy is child abuse. Our pieces cover all aspects of bioethics from clinical to philosophical, addressing timeless ethical dilemmas as well as current challenges. IDPH will continue to support the Maternal Mortality Review Committees and will use new data tools to look at social and community factors influencing maternal health. [24] One of its studies revealed one month old newborns with cocaine exposure had lower arousal, poorer quality of movements and self-regulation, higher excitability, more hypertonia, and more nonoptimal reflexes.[25] Another study showed that at one month old, heavy cocaine exposure affected neural transmission from the ear to the brain. Montana, for example, passed a law in 2019 that provides women with substance use disorders safe harbor from prosecution if they seek treatment for their condition. Policy makers must place emphasis on the safety of the patient and baby rather than the cessation of substance use. Instead of deterring drug use, the law discouraged pregnant women with substance use disorder from seeking prenatal care. [5], Despite being in effect for over four decades, the War on Drugs failed to achieve its intended goals. They must treat these mothers with the same empathy and respect as any other patient, even if they are experiencing withdrawal. Many different definitions of maternal mortality are used to track and analyze deaths in different contexts, but Illinois uses the following standard definitions from the Centers for Disease Control and Prevention (CDC): Pregnancy-Associated Death- the death of a woman during pregnancy or within one year of the end of a pregnancy from any cause. [33] Fortunately, studies suggest keeping mother and baby together has many benefits. Please go to www.prep4illinois.com or call the hotline at (800) 825-3518. Future interventions should focus on improving the oral health knowledge of dentists and other health professionals about the importance of comprehensive oral health care, including periodontal treatment when needed, for all pregnant women. ABCS Health Sciences, 46, e021215-e021215. Breastfeed Med Off J Acad Breastfeed Med. 2022;99(2):316-327. doi:10.1007/s11524-022-00610-0, [23] Mayes LC, Granger RH, Bornstein MH, Zuckerman B. In 1973, The Supreme Court ruled that the word "person" in the 14th Amendment does not include fetuses in Roe v. Wade. 1 in 3 women died during the first 2 months postpartum, 1 in 3 women died 2 or more months postpartum. For more information, contact:[email protected], 2021 Maternal Morbidity and Mortality Report, 2018 Maternal Morbidity and Mortality Report, Behavioral Risk Factor Surveillance System, Pregnancy Risk Assessment Monitoring System, Current Maternal Health Projects and Committees, Grant Accountability and Transparency (GATA), Determine if the death was pregnancy-related, Develop recommendations to prevent deaths.
