Opioid use disorder (OUD) has gone up more than 4 times among pregnant women. OUD can cause many negative health outcomes for mothers and their babies, both during pregnancy and after delivery. Infants can be born with breathing and feeding problems, and mothers are at risk of opioid-related overdoses. Prenatal opioid exposure has resulted in a 7-fold increase in neonatal abstinence syndrome (NAS) from 2000 to 2014.
Many states have enacted a range of policies intended to reduce opioid use in pregnancy, the proximal cause of most cases of NAS. The availability of treatment for women with substance use disorder including opioids has increased, but such programs are not always readily accessible. Many states have also enacted policies that potentially punish women by a considering substance use during pregnancy to be child abuse or neglect. As 2015, 25 states have these punitive policies and 23 states require health care professionals to report suspected prenatal drug abuse to child protective services or health officials. The question is whether there is any correlation between these punitive or reporting policies and NAS. Data are scant.
JAMA Network Open recently reported from that cross-sectional study of over 4 million births in 8 states. Policies that criminalized substance use during pregnancy, considered it grounds for civil commitment, or considered it child abuse or neglect were associated with significantly greater rates of NAS in the first full year after enactment and more than 1 full year after enactment. In contrast, policies that required reporting of suspected prenatal substance use were not associated with rates of NAS. Punitive policies that were intended to deter women from using substances during pregnancy actually deterred them from seeking prenatal care. Reporting policies did not significantly increase nor decrease NAS.
The authors did recognize limitations to their study. For example, there may be other policies associated with maternal opioid use that were not addressed in this study. However, based on the evidence, the authors conclude that punitive policies likely increase rather than decrease NAS. Furthermore, they recommend that policy makers follow the guidance of public health experts who believe that the focus should be on be primary prevention of opioid use disorder. Examples of such prevention policies include: (1) responsible opioid prescribing (2) preconception and antenatal physical and behavioral healthcare and (3) ensuring family planning access to women with OUD (as 9 out 10 pregnancies in this population group are unplanned).
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