Dr. Rahul Gupta is the senior vice president and chief medical and health officer at March of Dimes.
If some state lawmakers have their way, pregnant women who misuse opioids or other drugs will soon face criminal charges if their babies are born exposed to drugs – making Tennessee among a handful of states to impose punitive measures that can have dangerous and lasting consequences for moms and babies.
In February, state Rep. Terry Lynn Weaver and state Sen. Janice Bowling introduced HB1168/SB0659, which would allow the state to prosecute pregnant women using drugs illegally if her child is born “addicted to or harmed by” her drug use.
It’s an impractical approach to tackling the disturbing number of babies entering the world with neonatal abstinence syndrome or NAS, a tragic condition in which newborns go through drug withdrawal in the first days or weeks of life. Unfortunately, this is not the first time some Tennessee lawmakers have pursued this misguided approach.
As our nation grapples with a growing opioid epidemic, NAS is clearly on the rise and March of Dimes, like so many others, is deeply concerned. In 2017, NAS cases represented 1.35 percent of all live births in Tennessee, an increase of 15.4 percent since surveillance began in 2013. NAS can result from the appropriate use of prescriptions, such as opioid-based painkillers, as well as from use of other legal or illegal drugs, such as heroin.
Research shows that babies exposed to opioids in utero have increased risk of poor birth outcomes, such as low birthweight and prematurity. Not all babies develop NAS, regardless of their exposure levels.
It’s critical that patients are able to talk openly with their providers during prenatal care visits. In doing so, providers can assess whether there’s a potential problem related to substance use disorder and link women with effective treatment. Under this bill, drug-dependent pregnant women will shun the critical care they need to avoid being stigmatized, prosecuted and having their newborns taken away.
That’s exactly the scenario that played out in 2014 when Tennessee became the first state to criminally charge pregnant women using narcotics under Public Chapter 820. Years earlier, the American College of Obstetricians and Gynecologists stated that incarceration or the threat of it has “proved to be ineffective in reducing the incidences of alcohol and drug abuse,” in pregnant women.
Warnings from doctors and others like us were ignored. Only after vigorous effort from maternal and child health advocates, including March of Dimes, was the law allowed to sunset in 2016.
State lawmakers must understand that addiction is a chronic brain disease for which people need treatment, understanding and compassion. Pregnant women suffering from substance use disorder are often suffering from other psychosocial risk factors that need to be addressed in order to ensure that they are able to receive the most optimum treatment. Once pregnant, these therapeutic interventions are most successful when a woman receives them in the due course of her prenatal care – intended to improve the bond between her and her child without the threat of facing criminal charges.
The Safe Harbor Act – which allows prescription drug dependent moms to retain custody of their child by remaining in treatment – represents a good public health approach to a serious problem.
We need more policy initiatives like this that are aimed at providing care and support for mother and baby. Pregnant women need access to comprehensive services, including prenatal care, drug treatment, and social support services. We should also provide pregnant women priority access into drug treatment programs, and immunity during prenatal visits. Additionally, providers should be educated on the most updated substance use screening tools and the standard of care for all obstetric patients.
The health of mothers and their babies are intertwined, and drug addiction threatens them both. Let’s avoid repeating the mistakes we already corrected and ensure that Tennessee is on the right side of this issue so every woman can have the support she needs to have a healthy baby.
Dr. Rahul Gupta is the senior vice president and chief medical and health officer at March of Dimes. He previously served as assistant professor of medicine at Meharry Medical College and Vanderbilt University.