Deterring and Healing as Responses to Pregnant Women Who Use Illicit Drugs
The number of pregnant women with opioid use disorder documented at delivery increased 7-fold in the United States from 1999 to 2014. Infants exposed to opioids in utero may be born with neonatal abstinence syndrome (NAS), which can be severe and often requires long, expensive hospital stays. Scientific evidence has received insufficient attention in ongoing policy debates about whether the wisest response to pregnant women’s drug use is to expand addiction treatment, increase punishment, or both.
In states with punitive policies, drug use during pregnancy is grounds for criminal penalties, termination of parental rights, or civil commitment (e.g., involuntary inpatient treatment); these policies are associated with 24-30% higher rates of NAS.
Half of U.S. states and the District of Columbia require health care providers to report suspected drug use during pregnancy; this policy does not appear to be associated with the number of infants born with NAS.
Laws that define illicit opioid use during pregnancy as child abuse are associated with 35% lower utilization of evidence-based addiction treatment among pregnant women.
Forty states and the District of Columbia have substance use disorder treatment programs targeted toward or prioritizing pregnant women. Treating opioid use disorder during pregnancy can improve health outcomes for mother and baby.
Enacting policies that punish pregnant women for drug use is associated with a higher number of infants born with NAS, whereas policies requiring health provider reporting of drug use during pregnancy are not. Expanding addiction treatment may benefit pregnant women who choose to seek help. Addiction treatment during pregnancy improves outcomes for both mothers and infants.
Key Policy Evidence:
A 2019 study found that infants born in states with punitive policies for drug use during pregnancy were more likely to have NAS compared to infants born in states without these policies
A 2016 study found that in states with punitive laws, 35% fewer pregnant women with opioid use disorder received medication for addiction treatment compared to states without punitive laws
Clinical guidelines from the Substance Abuse and Mental Health Services Administration recommend treating opioid use disorder during pregnancy.