Pregnant women suffering from addiction should be treated compassionately, not like criminals


With a crying baby and suffering from severe pain, a mother could be facing more than just a typical day for a new mom. She could be misusing opioids, something that may have begun during her pregnancy. Her baby could have neonatal abstinence syndrome. And she could be going to jail. 

The all too common story of opioid addiction is percolating throughout our country. Every age and every geographic demographic are affected by this scourge, but one especially vulnerable group that is often overlooked is pregnant women. Rates of their opioid misuse have been increasing at an alarming rate with use of prescription opioids postpartum possibly leading to first time users becoming addicted during subsequent pregnancies.

{mosads}This is especially pronounced in pregnant Medicaid-eligible women. A fifth of pregnant wom­en enrolled in Medicaid in 2007 filled a prescription for an opioid pain reliever according to a study in Obstetrics and Gynecology. Not only are Medicaid-enrolled pregnant women more likely to use prescription opioids during pregnan­cy than those above the federal poverty level, they are also more likely to be offered and fill prescription opioid pain relievers to address postpar­tum pain.


Some states have adopted laws that criminalize substance use during pregnancy. Yes, we need to stem the tide of this trend. However, we know that fear of punishment dis-incentivizes women from accessing the treatment that they need and as a result, places their babies at increased risk.

For example, while only three states consider substance use during pregnancy as a crime, 44 states will prosecute women for prenatal illicit drug use. Several states consider prenatal drug use as child abuse or neglect (24 states and the District of Columbia) and grounds for civil commitment (four states). Lastly, many states collect federal child abuse prevention funds which require clinicians to report maternal drug use to child protective services. If clinicians suspect a pregnant woman is using drugs, 23 states and the District of Columbia require clinicians to report women and seven states re­quire clinicians to drug test women, which can be used during child-welfare court proceedings. 

Opioid treatment programs should be considered as alternatives for criminal penalties, prosecution, and incarceration of pregnant and postpartum women. The criminal penalties and state laws currently on the books pose a barrier for pregnant and postpartum women misusing opioids to receive the care and treatment they need. 

Furthermore, viewing substance use disorders as chronic medical conditions enables those who are suffering from opioid addiction to receive behavioral therapy and medication-assisted treatment specific to pregnancy and postpartum conditions in a timely manner. This will prevent overdose deaths and reduce societal and health care costs associated with opioid misuse.

Given that Medicaid covers roughly half of all births in the U.S. and that the ma­jority of Medicaid beneficiaries are enrolled in Medicaid managed care organizations, the Medicaid health plan industry stands ready to offer practical solutions to the epidemic affecting those most at risk, including supporting the decriminalization of opioid misuse in pregnant women.

Those mothers-to-be suffering from addiction should be treated with compassion, not with the heavy and misguided hand of the law, for the sake of both mother and child.

Jeff M. Myers is the president and CEO of Medicaid Health Plans of America, the national trade association representing the Medicaid managed care industry.

The views expressed by contributors are their own and are not the views of The Hill. 


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