CDC also works to better understand the association between marijuana use while pregnant with birth outcomes and postpartum experiences, such as depression and breastfeeding. (3) Neonatal exposure to some drugs during pregnancy can have harmful effects on development and may lead to acute adverse events, including neonatal abstinence syndrome (NAS) and infant mortality. There may be many more unpublished trial decisions, the dimensions of which we have no way of assessing. 10 states prohibit publicly funded drug treatment programs from discriminating against pregnant people. Approximately 700 women in the United States die every year . To learn more about medication-assisted treatment for opioid use disorder and considerations in pregnancy, visit https://www.samhsa.gov/medication-assisted-treatment. You should also speak to your GP, midwife or a drug support service if you're regularly taking prescribed medicines. Wisconsin provides priority access to pregnant people in both general and private programs. State laws vary, but at least 23 states and the District of Columbia articulate that substance use during pregnancy is child abuse, and virtually every state in the U.S. will open an investigation (at the very least) into a person who tests positive for substances during or shortly after pregnancy. For example, pregnant women should drink less than 1 liter (about 3 cans) of diet soda per day. Of the 24 judicial opinions, only nine directly referenced medical evidence in the form of medical expert testimony (n = 7), published medical literature (n = 3), or amicus briefs (n = 1). 1. Many substance use treatment services dont accept pregnant women, or are otherwiseinaccessibleto them, despitefederalandstateregulations that require prioritizing them for treatment. We identified 24 judicial opinions published between 1977 and 2015 in cases involving 29 women prosecuted in 19 states. These unintended consequences include keeping women from getting the treatment they need and failing to reduce the number of babies addicted to drugs. State laws now vary considerably in their approach to the problem, reflecting a deep division in public opinion. In order to to avoid the risk of withdrawal and possibly harming her fetus, M. did what many pregnant women in her situation do she continued to use illicit opioids. Support a worker-led Appeal. A study Wexelblatt led between 2012 and 2013 found 5.4% of all mothers had a positive drug test on admission and 3.2% of the mothers tested positive for opioids. Kentuckyslegislation, which also became law last month, permits termination of a mothers parental rights if her newborn exhibits signs of withdrawal, known as neonatal abstinence syndrome, as the result of illicit opioid use, unless the mother is in substantial compliance with both a drug treatment program and a regimen of postnatal care within 90 days of giving birth. In Minnesota and North Dakota, a test is required if there are drug-related complications at birth. Substance use in pregnancy is an important issue in antenatal care. Prevalence of Current Substance Use Among Pregnant People in the US. Those unable to pay may perform community service instead. Among pregnant women aged 15 to 44, the average . Healthy pregnancies are essential for the well-being of mothers, infants, families and communities. Instead of punishing women for the chronic condition of addiction, something that is unethical, ineffective and inhumane, we should invest instead in the expansion of women- and family-friendly treatment resources, said Dr. Mishka Terplan, a professor in obstetrics and gynecology and psychiatry and associate director in addiction medicine at Virginia Commonwealth University. Unfortunately, many women of childbearing age in the U.S. use some form of illegal drug. If youre using marijuana and are pregnant or are planning to become pregnant, talk to your healthcare provider. More concerning, limited evidence suggests that punitive polices may deter women from prenatal care.49,,51 These policies also disproportionately affect minority and poor women.15,52 For example, in one study, black women who tested positive for substances at birth were reported to authorities at about 10 times the rate of white women, despite similar rates of substance use.47 Advocates of the punitive approach assert that drug courts can be used to compel treatment for pregnant women with substance use disorders. Stopping your medication suddenly could be harmful for you and your baby. Convictions were upheld only in Alabama and South Carolina, involving a total of four women. Medical and public health authoritieswarn that women who fear losing their babies upon seeking medical care will bedeterredfrom seeking the care they need. Local, state, and federal government websites often end in .gov. The court held that the legislature did not intend for the relevant statute to apply to conduct during pregnancy that affected fetuses. The apparent lack of a link between the proscribed conduct and a distinct harm in a large number of the cases is one example of this significant limit to the rationale for criminalization. This claim disregards the fact that drug addiction is ahealth issuewith biological, behavioral, and genetic dimensions, and similar to other health conditions, itdoes not respond wellto artificially imposed treatment timelines or mandated treatment. The National Survey on Drug Use and Health (NSDUH), conducted annually by the Substance Abuse and Mental Health Services Administration (SAMHSA), provides nationally representative data on the use of tobacco, alcohol, and illicit drugs; substance use disorders; receipt of substance use treatment; mental health issues; and the use of mental health 2006), State v. Martinez, 137 P.3d 1195, 1198 (N.M. Ct. App. While the findings varied dependent upon county, across the board, only 18 received any kind of rehab/treatment for drug abuse as . Those efforts continue under a wide variety of laws even in states where high courts have previously rejected the prosecution approach. Establishes requirements for health care providers to encourage and facilitate drug counseling. Eighteen states have laws that say drug use during pregnancy is child abuse. Thus, it is not clear whether racial or economic bias is a factor in these cases. An official website of the State of Georgia. The mother was a drug addict. The court also referred to rulings by appellate courts in other jurisdictions that had held similarly in comparable cases. 2007), State v. Geiser, 763 N.W.2d 469 (N.D. 2009), Cochran v. Commonwealth, 315 S.W.3d 325 (Ky. 2010), State v. Stegall, 828 N.W.2d 526 (N.D. 2013), Arms v. State, 471 S.W.3d 637 (Ark. In all of the cases, the judicial decision depended on the disposition of the question of whether, for the purpose of adjudicating the criminal charges, a fetus is a child. While some papers estimate that 1-3% of birth defects are thought to be caused by medications taken during pregnancy, the authors could not find a source for this statement that was based on study d. The use of prescription drugs during pregnancy, excluding supplements, in Ethiopia was high. These cases typically involve significant civil matters, such as termination of parental rights or civil commitment to inpatient treatment facilities.55,56 There are instances where women have faced civil complaints for behavior that is consistent with current standards of care for medical treatment of addictions. Supporters of these laws blame the mothers for the dissolution of their families, arguing that the mothers need only enroll in a drug treatment program to retain custody of their children. Opioid abuse, dependence, and addiction in pregnancy, Medication assisted treatment in US drug courts: results from a nationwide survey of availability, barriers and attitudes, Maternal-fetal rights and substance abuse: gestation without representation, Pregnant women and the use of corrections restraints and substance use commitment, New Jersey Division of Child Protection & Permanency v. Fentanylis a prescription opioid that can be used to treat severe pain. Illegal drugs in pregnancy. Such inhumane responses to drug use can only exist because they are almost exclusively reserved for poor people and people of color. For access to services and immediate crisis help, call theGeorgia Crisis & Access Line(GCAL) at1-800-715-4225, available 24/7. But, for that matter, she could have been a pregnant alcoholic, causing fetal alcohol syndrome; or she could have been addicted to self abuse by smoking, or by abusing prescription painkillers, or over-the-counter medicine; or for that matter she could have been addicted to downhill skiing or some other sport creating serious risk of prenatal injury, risk which the mother wantonly disregarded as a matter of self-indulgence. Contact your healthcare provider, local Alcoholics Anonymous, or local alcohol treatment center. The vast majority ofTemporary Assistance for Needy Families (TANF) funding, or federal welfare dollars meant to help the poor, is not spent on assistance to poor families, but rather on placing and keeping children in the foster care system. The state legislature passed the law in 2014 explicitly to permit criminal assault charges for illicit substance use in pregnancy and, on conviction, imprisonment.10 The impetus for the law was rapidly rising rates of neonatal abstinence syndrome, an opioid withdrawal syndrome in infants that may require prolonged monitoring in intensive care units.12 The law expired on July 1, 2016, based on a sunset provision in the original bill.10 No other states have similar criminal statutes, but two other state legislatures recently debated criminalization to combat the opioid epidemic.13,14. The discourse about criminalization of substance use in pregnancy suggests that women are at serious risk of successful prosecution for illicit drug use during pregnancy.8,15 Based on our review of published judicial decisions, this does not appear to be the case in most jurisdictions. Prescribed medicines. "Opioids are what we worry about most," he explained. However, pregnant women with a disease called phenylketonuria shouldn't eat or drink aspartame. Briefs from medical or public health organizations were submitted to the court in seven of the cases, all supporting the defendant's position. This claim also disregards the seriousgapsin access to treatment for substance use disorders, especially for poor people, and the absence of a social safety net to even support struggling families in the first place. Tennessee is the only state that has enacted a law that targets substance use by pregnant women on the basis of presumed harm to the fetus or child. Between 2002-2003 and 2016-2017, past-month cannabis use increased from 3.4% to 7.0% among pregnant women overall and from 5.7% to 12.1% during the first trimester. Substance use providers that accept Medicaid must give pregnant people priority in accessing services. Published on September, 30, 2015. This means that first-time offenders will be issued an infraction (like a speeding ticket) instead of jail, with a maximum fine of $150. Sign In to Email Alerts with your Email Address. LEXIS 496 (Tenn. Crim. What if a pregnant woman drives over the speed limit, or as a matter of vanity doesn't wear the prescription lenses she knows she needs to see the dangers of the road? 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. In contrast, state legislatures could choose to preclude attempted efforts at prosecution with amendments that make explicit that existing laws are not meant to apply to prenatal conduct that may affect fetuses. Supporters of these laws justify the surveillance, policing, and punishment of drug-using mothers by referencing two assumptions that were touted and then discredited during and after thecrack baby scare. The report pays particular attention to the impact of the 'chemical endangerment' law in Alabama, the state that has carried out the most prosecutions against pregnant women; and Tennessee's 'fetal assault' law, which between 2014 and 2016 made it a crime to give birth to a child showing symptoms of drug exposure. Babies exposed to cocaine in the womb have a 25 percent increased chance of being born premature. Cocaine use during pregnancy poses severe issues for affected babies both short and long-term. The state argued that the drug delivery occurred via the umbilical cord in the period after birth but before the cord was clamped. The substances related to the charges included cocaine, heroin, methamphetamine, marijuana, and prescription pills. *The Alabama Supreme Court held that drug use while pregnant is considered chemical endangerment of a child. Fifteen states have laws requiring health care workers to report to authorities if they suspect a woman is abusing drugs during pregnancy. Additional factors were relevant to the stated judicial rationale in at least some of the cases. 1992), Johnson v. State, 602 So.2d 1288 (Fla. 1992), State v. Gray, 584 N.E.2d 710 (Ohio 1992), Commonwealth v. Welch, 864 S.W.2d 280, 283 (Ky. 1993), Sheriff, Washoe County, Nevada v. Encoe, 885 P.2d 596 (Nev. 1994), Collins v. State, 890 S.W.2d 893 (Tex. Mar 02, 2022. MSACD is committed to raising the awareness of thedevastating effects of alcohol and other substances whenused during pregnancy. From 2009 to 2017, the adjusted prevalence of cannabis use in the year before pregnancy increased from 6.8% to 12.5%, and the adjusted prevalence of cannabis use during pregnancy increased from 1.95% to 3.38 percent. Prosecutors have attempted to rely on a host of criminal laws already on the books to attack prenatal substance use. Although briefs from medical or public health organizations supporting the defendants' position were submitted to the court in 29 percent of the cases (n = 7), only one majority ruling directly referenced a medical or public health organization amicus brief. 297 (N.C. 2015), Arrests of and forced interventions on pregnant women in the United States, 19732005: implications for women's legal status and public health, State v. McKnight, 352 S.C. 635, 647 (S.C. 2003), Ankrom v. State, 152 So.3d 397, 411 (Ala. 2013), Moral and social issues regarding pregnant women who use and abuse drugs, A gap in the criminal justice system, creating a new class of felons in pregnant drug-addicted women, a state-by-state analysis, Prosecution of illicit drug use during pregnancy: Crystal Ferguson v. City of Charleston, From the Office of the General Counsel. These 24 cases included 29 women in 19 states who were prosecuted for criminal charges related to harm to a fetus or child as a result of substance use during pregnancy. Dehumanizing Discourse, Anti-drug Law, and Policy in America: A "Crack Mother's" Nightmare . Dr. Angelotta is Instructor of Psychiatry and Behavioral Sciences, Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL. One of the authors read six cases in random order, abstracting data into the identified categories of variables to determine the applicability of the a priori coding scheme. Kentucky ranks amongst the last in the nation in rates ofchildhood poverty. M. thought she was doing the right thing. No adverse neonatal outcomes were reported in 41 percent of the pregnancies in this study. Source: ProPublica research by Leticia Miranda and Christine Lee; Guttmacher Institute; National Advocates for Pregnant Women. Civil child abuse proceedings are explicitly permitted in 18 states.9 These may lead to termination of parental rights, but not to prison sentences. Priority applies to pregnant people referred for treatment. In 2014, Tennessee became the first (and only) state to pass a law that criminalized drug use during pregnancy, after a district court judge added an additional six years to the prison sentence of a woman who had been involved in a methamphetamine manufacturing operation while pregnant. 19 stateshave 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. 1 Unhealthy drug use is more commonly reported by young adults aged 18 to 25 . The implication for medical experts is that advocacy efforts may be most useful when focused on state legislatures that are contemplating policies to reduce harms associated with prenatal substance abuse. My distant cousin is a meth addict. Rapidly detecting fetal exposure to licit and illicit drugs is of considerable medical value. 1. How you know. Marijuana remains illegal at the federal level, even as some states have legalized it for recreational and medicinal use. She struggled every day with the unimaginable pain and grief of separation from her newborn. State Policies on Substance Use During Pregnancy. Comparisons of drug laws to alcohol laws show that the policy trajectories started in opposite directions, but by 2016, the results were the same: Punitive policies were more prevalent than supportive policies across states. Criminal or civil penalties discourage women from seeking prenatal care they need for fear of having their drug use discovered, critics say. She told her treating physician about her opioid use during pregnancy, not realizing this could precipitate call to Child Protective Services (CPS). Prescription Opioid Pain Reliever Use During Pregnancy, The US Opioid Crisis & Maternal Infant Health, Centers for Disease Control and Prevention. The pregnancies had the following outcome: no adverse effects of the substance reported (n = 12), withdrawal symptoms (n = 7), prematurity and/or small size at birth (n = 5), death in the neonatal period (n = 3), and stillbirth (n = 2). Despite several phone calls to treatment providers in her county and surrounding counties, M. could not find a provider who was willing to accept her. 24 states and the District of Columbia consider substance use during pregnancy to be child abuse under civil child-welfare statutes, and 3 consider it grounds for civil commitment.