With the growing number of pregnant women who use opioids during pregnancy, some state governments have prosecuted and jailed the mothers for substance use. A new policy statement from the American Academy of Pediatrics says the punitive measures provide no proven health benefits for mother or child – and may lead to avoidance of prenatal care and substance use treatment.
The report calls for a national effort to provide the best care for all substance using mothers independent of where they live, what kind of insurance they have, and their ethnicity. It also discusses improving access to contraceptives to prevent unplanned pregnancies for women who abuse opioids. While it's been found that anywhere from 30 to almost 50 percent of US pregnancies are unintended, research suggests that for women with opioid use disorder, the proportion of unintended pregnancies was higher than 85 percent.
The American Congress of Obstetricians and Gynecologists also supports this report as an educational tool.
“Over the last two decades, use of opioids surged throughout the U.S., and as they did, we have seen an increase in opioid-related complications in nearly every population, including pregnant women and their infants,” said Stephen Patrick, MD, MPH, MS, FAAP, a co-author of the report in a statement.
“Our response should be grounded in public health. We should be bolstering efforts targeted at primary prevention, like prescription drug-monitoring programs, and expanding treatment tailored to the specific needs of pregnant women and their families.”
There are successful programs for substance using mothers in the U.S. especially with opiate affected mothers. Loretta Finnegan, MD, started one at Thomas Jefferson University over 40 years ago involving converting mothers to medically prescribed methadone and providing a truly comprehensive and positive environment that remains ongoing, but such programs are not universal and rarely available in suburban and rural settings where the massive increase in opiate addiction is growing the fastest. This program also tries to introduce long-term pregnancy prevention immediately after the birth of a substance effected child. Such prevention is rare because of economic barriers in most situations.
The AAP suggests the following to address the issue:
- Coordinated non-punitive public health base programs such as described above are in everyone's best interest since punishing the mother legally does not improve outcomes
- Wide-spread substance abuse preventive programs
- Universal substance screening via oral screening at multiple times in all pregnancies, regardless of factors such as age, race, and socioeconomic status. If a urine test is taken, a reasonable effort should be made to get consent before, and the woman should know the results and who will have access to them.
- Access to comprehensive prenatal care for all those with prenatal substance use no matter where they live or who they are.
- Health care providers caring for women who use substances during pregnancy should be knowledgeable about their state’s reporting mandates around illicit drug use and educate pregnant women prenatally about these requirements.
- Adequate funding for social support services and child welfare systems nationally to make all this happen
All these ideas are good, but at this moment there are no structures in place to make this happen in many cities and in almost no rural areas. The report does not give details of how to make all of this happen. It is my hope programs like those started by Dr. Finnegan continue to spread and a growing awareness of this issue will help direct funding to help these mothers and their babies.