Unfortunately, the lasting consequences of the War on Drugs have created a stigma around addiction medicine, leading to significant treatment barriers. Rather than family medicine, OB/GYN, or emergency medicine healthcare workers having to refer their patients to an addiction specialist, they could treat patients with methadone for maintenance or detoxification where they would deliver their baby. | Terms and Conditions of Use. J Urban Health Bull N Y Acad Med. [34] Additionally, newborns with neonatal abstinence syndrome who are breastfed by mothers receiving methadone or buprenorphine require less pharmacological treatment, have lower withdrawal scores, and experience shorter hospital stays. [40] Only 11 percent of the 65 percent of our nations inmates with substance use disorder receive treatment, implying that the other 89 percent were left without much-needed support to overcome their addiction. Though premature, her baby was born healthy and had no symptoms of withdrawal.. Neonatal Abstinence Syndrome Incidence and Health Care Costs in the United States, 2016. NPR recorded a podcast in 2010 highlighting a mother who used substances during pregnancy and, with early intervention, had positive outcomes. 1 in 3 women died during the first 2 months postpartum, 1 in 3 women died 2 or more months postpartum. This would incentivize people to actively seek medical care, restore the patient-physician relationship, and ensure that they take rehabilitation programs seriously. If found guilty, pregnant women could face up to 15 years in prison and lose custody of their child. The Wisconsin law is especially draconian: A woman can be detained against her will for the duration of her pregnancy, her fetus has its own court-appointed lawyer, she can lose custody of her baby after birth and the proceedings are mostly secret. The maternal lifestyle study: effects of substance exposure during pregnancy on neurodevelopmental outcome in 1-month-old infants. Appointment reminders and an immunization tracker can be used to support a woman in getting the vaccines she needs for herself during pregnancy and for her new baby. Neonatal abstinence syndrome (NAS) is itself a treatable and transient condition, and a growing body of literature confirms that one of the most effective treatments for NAS is keeping the newborn and mother together in a soothing environment while encouraging skin-to-skin contact and breastfeeding. Drug testing pregnant people is a form of medical racism. Retrieved from https://www.cdc.gov/flu/protect/vaccine/qa_vacpregnant.htm. Some suggest that addiction is a choice; therefore, those who misuse substances should not receive treatment. [11] The American College of Obstetricians and Gynecologists (ACOG) recognizes the fear those with substance use disorders face when seeking appropriate medical care and emphasizes that obstetricgynecologic care should not expose a woman to criminal or civil penalties, such as incarceration, involuntary commitment, loss of custody of her children, or loss of housing.[12] Mandatory reporting strains the patient-physician relationship, driving a wedge between the doctor and patient. 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. Dentists who are knowledgeable about periodontal disease are more likely to counsel their patients who are pregnant about periodontal health. Here is a survey of state laws. 2018;141(4):e20173520. [38] Medication-assisted treatment with methadone or buprenorphine is the first line treatment option and should be available to all pregnant women regardless of their ability to pay for medical care.[39]. ACOG recommends testing be performed only with the patient's consent and a positive test not be a deterrent to care, a disqualifier for coverage under publicly-funded programs, or the sole factor in determining family separation. On the surface, this solution seems like a quick fix. Though consent is needed to drug test pregnant women or new mothers, it's not needed to drug test their babies immediately after birth. Please try reloading page. After withdrawal, those struggling with substance use disorder may still have cravings and the likelihood of relapsing remains high without proper medical intervention. Pediatrics. Drug & Alcohol Detox & Rehabilitation Centers, involuntarily commit until the child is born, The People of the State of Illinois, Petitioner-Appellee,v. Multiple studies have shown that women who receive the flu shot during pregnancy. It is recommended, however, that every facility that provides newborn care establish their own testing protocols, including establishing unbiased guidelines to identify those who should be tested. Policies Affecting Pregnant Women with Substance Use Disorder . Black women are aboutthree timesas likely to die from a pregnancy-related condition as White women. Centers for Disease Control and Prevention. [19] The AAP found that the cost of neonatal abstinence syndrome covered by Medicaid increased from $65.4 million to $462 million from 2004 to 2014. In Minnesota and North Dakota, a test is required if there are drug-related complications at birth. Please go to www.prep4illinois.com or call the hotline at (800) 825-3518. clinicaltrials.gov; 2016. https://clinicaltrials.gov/ct2/show/study/NCT00059540, [25] Lester BM, Tronick EZ, LaGasse L, et al. During his hospitalization, he was so violent towards healthcare providers that security had to intervene. 2023, February 15. Emphasizing public health measures and adequate medical care can prevent complications and developmental issues in newborns and pregnant women with substance use disorders. [21] Currently, the impact of the COVID-19 pandemic on the prevalence of newborns with neonatal abstinence syndrome is unknown. Officials have prosecuted countless women across 45 states for exposing their unborn children to drugs. Fifteen states have laws requiring health care workers to report to authorities if they suspect a woman is abusing drugs during pregnancy. Laws on. J Addict Med. ET), 2023 Annual Clinical & Scientific Meeting, Congressional Leadership Conference (CLC), Alliance for Innovation on Maternal Health, Postpartum Contraceptive Access Initiative, Expanding Medicaid coverage from 60 days to one year after delivery, including for SUD and mental health screening and treatment and case management and outreach services, Access to medically-assisted treatment (opioid agonist pharmacotherapy), Adequate postpartum psychosocial support services including SUD treatment and relapse prevention programs, An increased focus on curbing alcohol and tobacco use during pregnancy. After repeal, the Judge did not want to terminate the respondent's parental rights because of the respondent's "outstanding" rehabilitation efforts. And his attitude toward his foster parents was so volatile that we were never sure if having them visit was comforting or agitating. This testing approach, however, may be perceived as unfairly profiling mothers, exposing the institution to legal issues. A woman can be found guilty of child abuse or neglect in Illinois if the child's blood, urine, or meconium tests positive for drugs at birth. Text4Baby Training Center: https://partners.text4baby.org/index.php/get-involved-pg/partners/training-center, Behavioral Risk Factor Surveillance System, Pregnancy Risk Assessment Monitoring System, Current Maternal Health Projects and Committees, https://www.cdc.gov/flu/protect/keyfacts.htm, https://www.cdc.gov/flu/protect/vaccine/qa_vacpregnant.htm, https://www.vaccines.gov/who_and_when/pregnant/index.html, https://www.cdc.gov/vaccines/pregnancy/hcp/guidelines.html, https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/index.html, http://immunizationforwomen.org/providers/resources/acog-resources/default.php, http://www.midwife.org/Immunization-Resources-for-Providers, https://www.cdc.gov/flu/professionals/antivirals/avrec_ob.htm, https://www.cdc.gov/flu/professionals/vaccination/, https://www.cdc.gov/flu/professionals/infectioncontrol/index.htm, https://www.cdc.gov/flu/professionals/diagnosis/index.htm, https://www.cdc.gov/flu/resource-center/freeresources/index.htm, https://www.cdc.gov/flu/professionals/training/index.htm, https://www.cdc.gov/flu/weekly/fluactivitysurv.htm, https://www.cdc.gov/vaccines/hcp/admin/storage/index.html, https://www.cdc.gov/flu/about/qa/flushot.htm, https://www.cdc.gov/vaccines/ed/patient-ed.html, https://partners.text4baby.org/index.php/get-involved-pg/partners/training-center, Tips for Good Oral Health During Pregnancy, Two Healthy Smiles: Tips to Keep You and Your Baby Healthy, National Maternal & Child Oral Health Resource Center, Resource Highlights: Oral Health During Pregnancy, 2018 Illinois Maternal Morbidity and Mortality Report, Infographic - Overcoming Breastfeeding Challenges, Grant Accountability and Transparency (GATA), receive health care before, during, and after pregnancy and childbirth, receive care for her and her infant that is consistent with generally accepted medical standards, choose a certified nurse midwife or physician as her maternity care professional, choose her birth setting from the full range of birthing options available in her community, leave her maternity care professional and select another if she becomes dissatisfied with her care, receive information about the names of those health care professionals involved in her care, receive information concerning her condition and proposed treatment, be informed if her caregivers wish to enroll her or her infant in a research study, receive information in a language in which she can communicate, receive emotional and physical support during labor and birth, freedom of movement during labor and to give birth in the position of her choice, decide collaboratively with caregivers when she and her baby will leave the birth site for home, be treated with respect at all times before, during, and after pregnancy by her health care professionals, examine and receive a reasonable explanation of her total bill for services. Her daughter, who was exposed to cocaine before birth, had a normal childhood and ended up going to college.[28]. Due to mandatory reporting, they were not confident that physicians would protect them from the law. [5], Despite being in effect for over four decades, the War on Drugs failed to achieve its intended goals. Published April 11, 2022. https://www.cdc.gov/tobacco/basic_information/health_effects/pregnancy/index.htm, [17] Abuse NI on D. What are the risks of methamphetamine misuse during pregnancy? And even if the mothers were lethargic and unresponsive while going through withdrawal, it would still have been possible to breastfeed with proper support. These results are for the calendar year 2018 births. Click here to learn more about flu vaccine safety and pregnancy: The Centers for Disease Control and Prevention (CDC, 2017) Flu Vaccine Safety and Pregnancy. No new mother should ever face such traumatic and discriminatory treatment." 1 comment . Reviews deaths resulting from homicide, suicide, or drug overdose. The penalty is up to 15 years in prison." View Drug Testing Services Marijuana Laws for Illinois Marijuana considerations are important and marijuana laws often update often, check out Marijuana in the Workplace. 1992;267(3):406-408. doi:10.1001/jama.1992.03480030084043, [24] NICHD Neonatal Research Network. 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). The medical community has long recognized that substance use disorder is not simply a character flaw or social deviance, but a complex condition that requires adequate medical attention. As always,Voices in Bioethics will publish works by leaders in the bioethics field as well as those with perspectives from fields outside of medical ethics and outside the sciences. NCDAS. All women should have an annual well-woman visit. [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. 2013;37(3):484-489. doi:10.1111/j.1530-0277.2012.01958.x, [38] Montana SB0289. Exciting advances in HIV treatment and prevention make pregnancy a safe possibility for women living with HIV. Committee members aimed to gain a better understanding of the causes of maternal mortality, to develop statewide recommendations to prevent future maternal mortalities, and to determine whether the deaths were pregnancy-associated (occurring within one year due to any cause) or pregnancy-related (occurring within one year due to pregnancy). Please go to www.prep4illinois.com or call the hotline at (800) 825-3518. Buprenorphine and Naloxone Versus Buprenorphine for Opioid Use Disorder in Pregnancy: A Cohort Study. https://drugabusestatistics.org/drug-related-crime-statistics/. Resource lists for health care providers are available inAppendix Bof the report. During the two years this law was in effect, officials arrested 124 women. There aren't any restrictions for employee drug testing of the general workforce in Illinois. You can take important steps for you and your partners health, regardless of your pregnancy wishes. IV. In fifteen states, health care workers are required to report to authorities if they suspect a woman is abusing drugs during pregnancy. This pervasive societal bias sets them up for failure from the beginning and greatly inhibits their willingness to change and mend their relationship with their providers. SYNOPSIS AS INTRODUCED: . 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. This law required medical professionals to report drug use to authorities, thereby compromising the confidentiality of the patient-physician relationship. Monitor, Analyze, and Communicate Trends. According to a report from the U.S. National Institutes of Health, self-reports of illicit drug use are often inaccurate and universal drug testing is neither practical for the clinician nor recommended by the American Academy of Pediatrics](https://www.aap.org/en-us/Pages/Default.aspx). by psmith, December 23, 2021, 01:00am, (Issue #1147) Posted in: . His past psychiatric disorders included attention deficit disorder, conduct disorder, major depressive disorder, anxiety disorder, disruptive mood dysregulation disorder, intellectual developmental disorder, and more. Maternal morbidity refers to any pregnancy or delivery complication, which may be minor or severe. Since 1973, authorities in at least 45 states have sought to prosecute women for exposing their unborn children to drugs. Tennessee is the only state with a statute that specifically makes it a crime to use drugs while pregnant. 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. A common flu symptom is fever, which may be associated with neural tube defects and other adverse outcomes for a developing baby. The two Maternal Mortality Review Committees reviewed 129 maternal deaths that occurred during 2016-2017 to develop the recommendations in the report. The court found that because the act of birth had not yet occurred, the fetus is not legally considered a child. Womens Health Issues Off Publ Jacobs Inst Womens Health. Photo by 14825144 Alita Xander | Dreamstime.com. There is no indication that preventive or restorative oral health treatment during any trimester of pregnancy can harm the mother or the developing fetus. Exposure to maternal drug use during pregnancy may lead to adverse effects such as poor neonatal development and acute adverse effects such as infant mortality and neonatal abstinence syndrome (NAS). https://states.guttmacher.org/policies/, [33] Whitesell M, Bachand A, Peel J, Brown M. Familial, Social, and Individual Factors Contributing to Risk for Adolescent Substance Use. (Guttmacher Institute 2021). From a public health standpoint, more needs to be done to prevent the complications of substance misuse during pregnancy. [3], The War on Drugs was a government-led initiative launched in 1970 by President Richard M. Nixon with the aim of curtailing illegal drug use, distribution, and trade by imposing harsher prison sentences and punishments. Despite this, routine oral health care is often avoided or postponed for the duration of pregnancy. Most women are healthy during pregnancy, meaning they experience a typical outcome with no complications. https://www.aap.org/en-us/Pages/Default.aspx, handle drug use during pregnancy differently. Alabama and South Carolina have interpreted existing child endangerment and chemical endangerment statues to all prosecution of drug-using pregnant women. The Centers for Disease Prevention and Control (CDC), the American College of Obstetricians and Gynecologists (ACOG), the American College of Nurse Midwives (ACNM), and the American Academy of Family Physicians (AAFP) recommend flu shots for all women who are or will be pregnant during the flu season, as it has been shown to help protect both the mother and the baby for several months from the flu. Addiction is like any other disease and society should regard treatment without stigma. https://drugabusestatistics.org/, [32] Institute G. Interactive Map: US Abortion Policies and Access After Roe. Antiviral treatment should be initiated as early as possible because studies show that treatment initiated early (i.e., within 48 hours of illness onset) is more likely to provide benefit. 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. Every day actions you can take to prevent the flu include: If you do get sick with flu symptoms, call your doctor immediately, as early treatment is important! Acta Paediatr. Ultimately, DCFS subjected Ms. F. and her husband to a safety plan, requiring them to have someone else in the home with Ms. F. and the baby at all times. Online only: Report finds most U.S. inmates suffer from substance abuse or addiction. Voices in Bioethics operates in partnership with Columbia University Libraries. Appointment reminders and an immunization tracker can be used to support a woman in getting the vaccines she needs for herself during pregnancy and for her new baby. ", "a judicially defined standard of conduct would have to be met. ACOG joins every leading medical and public health organization in approaching the problem of drug and alcohol use during pregnancy as a health concern thats best addressed through education, prevention and community-based treatment, not through punitive drug testing and reporting laws or criminal prosecution. Some states consider substance misuse (and even prescribed use) during pregnancy child abuse. "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. There is no simple fix to this problem, given that it involves the political, legal, and healthcare systems. or the [child neglect statute]. [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. . To promote continuity of care, health officials could include financial incentives to motivate new mothers to go to follow-up appointments. The newborns I observed during my pediatrics rotation probably could have benefited from breastfeeding rather than bottle feeding and being passed around from one nurse to the next. ACLU of Illinois Responds to Decision by Texas Court on With The Patient and Provider Protection Act, Illinois Shows Once HB 4664: Patient and Provider Protection Act. Crack and motor development of babies living in an assistance shelter. 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. PMID: 31567599. 2020;174(2):200-202. doi:10.1001/jamapediatrics.2019.4791, [22] Ghose R, Forati AM, Mantsch JR. Impact of the COVID-19 Pandemic on Opioid Overdose Deaths: a Spatiotemporal Analysis. Thus, laws intended to deter people from using substances through various punishments and incarceration may be doing more harm than good. Meconium the traditional specimen to detect and document drug use during pregnancy, while umbilical cord tissue is relatively new for testing. [15] Smoking can impede the development of the lungs and brain and lead to preterm deliveries or sudden infant death syndrome. I predict that the increase in opioid and polysubstance use during the pandemic will increase the number of newborns with neonatal abstinence syndrome, thereby significantly increasing the public burden and cost. It is a healthcare providers duty to provide non-judgmental care that prioritizes the patients well-being. [22], In the 1990s, concerns arose about the potentially irreparable damage caused by intrauterine exposure to cocaine on the development of infants, which led to the popularization of the term crack babies.[23] Although no strong longitudinal studies supported this claim at the time, it was not without merit. 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. [39] Mullins N, Galvin SL, Ramage M, Gannon M, Lorenz K, Sager B, Coulson CC. Safe Harbor and Medication-Assisted Treatment. Laws about pregnant women and substance abuse questioned Ms. F. repeatedly told staff that the only possible explanation for her false positive test was the poppy seed cake that she had eaten for an Easter celebration before entering the hospital. Across the country, hundreds of pregnant women and new mothers have been accused of child abuse or other crimes when they or their newborns tested positive for controlled substances. There should be advocation for legislative change, not by providing an opinion but by highlighting the facts and conclusions of scientific studies grounded in scientific evidence, health, security, and human rights. Recognizing that many drug policies were of political opinion, it called for drug policies that were grounded in scientific evidence, health, security, and human rights.[8]. Pregnant women with low incomes and those who are Hispanic have higher rates of tooth decay than those with higher incomes and those who are white, respectively. Access to medical care before, during, and after childbirth is essential to the health and well being of each mother. Health care providers of pregnant women play a vital role in advising patients on how to protect themselves and their developing babies against flu. Research shows that obtaining prenatal care, staying connected to the health care system, and being able to speak openly with a physician about drug problems helps improve birth outcomes. The Department is excited to announce the launch of a new PrEP Medication Assistance Program. [20] In 2020, the CDC published a paper that showed an increase in hospital costs from $316 million in 2012 to $572.7 million in 2016. [40] Drug Related Crime Statistics [2023]: Offenses Involving Drug Use. In line with the recommendations by Global Commission on Drug Policy and the lessons learned from the failed War on Drugs, one proposed change in our criminal justice system would be to require enrollment and participation in assisted alcohol cessation programs before legal punishment. [33] Fortunately, studies suggest keeping mother and baby together has many benefits. National Institute on Drug Abuse. When drug use is diagnosed or suspected, Illinois requires healthcare workers to report it. In most states, there is no law that requires hospitals to test infants and new moms for illicit substances. Pregnant People with Substance Use Disorders Need Treatment, Not Criminalization. Excessive alcohol consumption can result in fetal alcohol syndrome, characterized by growth deficiency, facial structure abnormalities, and a wide range of neurological deficiencies. 1 - 4 According to a 2013 national survey of pregnant women in the United States, 5.4% self-reported using illicit drugs, and 9.4% self-reported drinking alcohol. doi:10.1542/peds.2018-3801, [20] Winkelman TNA, Villapiano N, Kozhimannil KB, Davis MM, Patrick SW. 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. Community-based organizations should educate women on the importance of getting prenatal care. Public Health Surveillance of Prenatal Opioid Exposure in Mothers and Infants. 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. 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. 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. 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. In 1914, Congress enacted the Harrison Narcotics Tax Act to target the recreational use of drugs such as morphine and opium. Just a few feet away from his room, behind the nurses station, were the two newborns feeling the same withdrawal symptoms that this teenager likely experienced in the first few hours of his life. 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. Newborns' exposure to drugs: Discrepancies in mandatory reporting Maternal mortality is the death of a woman during pregnancy, childbirth, or the postpartum period, and it serves as a sensitive indicator of the quality of the health and health care of a community. At the hospital, I witnessed Child Protective Services removing two newborns with neonatal abstinence syndrome from their mothers custody. Office of Assistant Secretary for Planning and Evaluation. He was born with neonatal abstinence syndrome that neither the residential program nor his foster family could manage. [1] NIDA. In the past few years, Illinois and 20 other states have been working towards making significant changes by amending laws to protect the potential life of fetuses. Bulk pricing was not found for item. IDPH remains committed to identifying and reviewing maternal deaths and morbidities and will build upon these findings and recommendations over the coming years.

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