Executive Summary
Background
- Jos P.H.
- Marshall M.F.
- Perlmutter M.
- Paltrow L
- Flavin J
- Maguire D.
Criminal and civil sanctions
- Paltrow L
- Flavin J
- Paltrow L
- Flavin J
- Paltrow L
- Flavin J
SB 1391. Public Chapter 820. Title: As enacted, provides that a woman may be prosecuted for assault for the illegal use of a narcotic drug while pregnant, if her child is born addicted to or harmed by the narcotic drug.
The impact of substance use on women, infants, children and families
- Najavits L.M.
- Weiss R.D.
- Shaw S.R.
- Ko J.Y.
- Patrick S.W.
- Tong V.T.
- Patel R.
- Lind J.N.
- Barfield W.D.
- Patrick S.W.
- Schumacher R.E.
- Benneyworth B.D.
- Krans E.E.
- Mcallister J.M.
- Davis M.M.
Responses and Policy Options
The Academy's Position
Recommendations
- 1Increase funding for SAMHSA State Targeted Response to the Opioid Crisis grants (Opioid STR) and Opioid STR Supplement grants that include SUD services for pregnant and parenting women and that develop community-based partnerships to ensure safe access to health services including prevention, treatment, and recovery supports for women, their children, and families.
- 2SAMHSA should conduct widespread targeted dissemination of Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and their Infants (Substance Abuse Mental Health Services Administration 2012a).
- 3SAMHSA should advance ongoing training and technical assistance for service design to ensure cultural competence and sensitivity in SUD treatment and recovery approaches for women and families and to eliminate disparities based on race in terms of entry to and retention in treatment and recovery supports.
- 4The CDCP and state Offices of Maternal and Child Health should collect comprehensive data on maternal deaths due to opioid and other drug overdose including decedents’ associated behavioral health conditions, SUD and mental health treatment history, and preventability of death. The data should be made available to the public for research and to inform prevention and SUD treatment and recovery support policy approaches.
- 1Increase state funding to ensure accessible community-based treatment, recovery supports, and health and social services for women, their children, and families affected by substance use regardless of immigration status or ability to pay for services.
- 2Pass legislation to improve integrated comprehensive SUD services that include a continuum of gender- and trauma-responsive programming comprised of prenatal care, accessible MAT, individual and group therapy, trauma recovery, case management, psychosocial support, parent skills training, family education, pediatric health care and developmental services, and transition to ongoing women's health and wellness care, preventive health services, and family planning.
- 1Working with their health care institutions, Chief Nursing Officers, Nurse Administrators, and Nurse Managers in women's health settings should lead the implementation and adoption of five essential actions in their clinical sites:
- aUse of an objective protocol for clinical assessment of all women who are pregnant or of childbearing age at entry into care that includes a valid substance use screening instrument, and conduct screening of all pregnant and postpartum women for anxiety, depression, and substance use (Substance Abuse and Mental Health Services Administration [SAMHSA] 2018).
- bUse of a standardized NAS scoring instrument for assessment and use of standardized protocols for treatment of NAS in infants (Substance Abuse and Mental Health Services Administration [SAMHSA] 2018).
- cConduct maternal drug testing when the indication for testing is based on objective clinically observable criteria. Obtain informed consent for drug testing and provide education on testing procedures and the meaning of drug test results (Substance Abuse and Mental Health Services Administration [SAMHSA] 2018). Ensure that the drug testing process used by the healthcare setting employs a secure chain of sample custody and the option for confirmatory testing (Substance Abuse and Mental Health Services Administration 2012b,Substance Abuse and Mental Health Services Administration [SAMHSA] 2018).
- dPromote maternal-child bonding through the use of in-hospital rooming-in (McMillan et al., 2018), breastfeeding support (
- McMillan K.D.L.
- Rendon C.P.
- Verma K.
- Riblet N.
- Washer D.B.
- Volpe Holmes A.
Association of rooming-in with outcomes for neonatal abstinence syndrome: A systematic review and meta-analysis.Journal of the American Medical Association Pediatrics. 2018; 172 (Apr1): 345-351https://doi.org/10.1001/jamapediatrics.2017.5195American College of Obstetrics and Gynecology and the American Society of Addiction Medicine 2017,McGlothen and Cleveland, 2018,- McGlothen K.
- Cleveland L.
The right to Mother's milk: A call for social justice that encourages breastfeeding for women receiving medication-assisted treatment for opioid use disorder.Journal of Human Lactation. 2018; https://doi.org/10.1177/0890334418789401Substance Abuse and Mental Health Services Administration [SAMHSA] 2018), and education on infant care and growth and development (Abrahams et al., 2007). - eEnsure that discharge planning includes a referral to accessible community-based SUD treatment and recovery supports and to parenting programs.
- a
- 2Join community-based and state coalitions addressing the welfare of children affected by prenatal SUD to promote evidence-based therapeutic family and child interventions for the health and safety of children and to maintain family cohesion.
- 3Work with law enforcement, district attorneys, and judges to unite and align these stakeholders in therapeutic responses to pregnant and parenting women with SUDs and their children and families.
- 4Contribute expertise to collaborate on a national nurses training project to disseminate evidence-based practices for healthcare settings on clinical management and adoption of health justice-based policy approaches in the assessment, treatment and recovery supports for pregnant and parenting women with SUDs.
Acknowledgments
References
- Rooming-in compared with standard care for newborns of mothers using methadone or heroin.Canadian Family Physician. 2007; 53: 1722-1730
- Opioid Use and Opioid Use Disorders in Pregnancy.(Number 711, August. Retrieved from:)
- The Nurse's role in ethics and human rights: Protecting and promoting individual worth, dignity and rights in practice settings.(ANA Center for Ethics and Human Rights. Retrieved from:)
- Criminalizing pregnancy: Policing women who use drugs in the U.S.A.(Retrieved from)
- A moral or medical problem? The relationship between legal penalties and treatment Practices for opioid use disorders in pregnant women.Women's Health Issues. 2016; 26: 595-601https://doi.org/10.1016/j.whi.2016.09.002
- Health justice: A framework (and call to action) for the elimination of health inequity and social injustice.American University Law Review. 2015; 65: 275-351
- CHOICES A Program for Women about Choosing Healthy Behaviors: A Facilitator Guide.(Retrieved from:)
- Chapter 15-Child Abuse Generally. §26-15-3.2. Chemical endangerment of exposing a child to an environment in which controlled substances are produced or distributed.(Retrieved from:)
- AHRQ White Paper: Use of clinical decision rules for point-of-care decision support.Medical Decision Making. 2010. 2010; 30: 712-721https://doi.org/10.1177/0272989X10386232
- Relationship between drug abuse and intimate partner violence: a longitudinal study among women receiving methadone.American Journal of Public Health. 2005; 95: 465-470
- Retrieved June, 2018 from:) (
- Benefit‐cost analysis of addiction treatment in Arkansas: Specialty and standard residential programs for pregnant and parenting women.Substance Abuse. 2002; 23: 31-51https://doi.org/10.1080/08897070209511473
- State Laws and Policies: Substance Use During Pregnancy.(Retrieved from:)
- Committee on Drugs; Committee on Fetus and Newborn; American Academy of Pediatrics. Neonatal drug withdrawal.Pediatrics. 2012; 129: 540-560https://doi.org/10.1542/peds.2011-3212
- The Charleston policy on cocaine use during pregnancy: A cautionary tale.The Journal of Law, Medicine & Ethics. 1995; 23: 120-128https://doi.org/10.1111/j.1748-720x.1995.tb01341.x
- Treating Women Who Are Pregnant and Parenting for Opioid Use Disorder and the Concurrent Care of Their Infants and Children.Journal of Addiction Medicine. 2017; 11: 178-190https://doi.org/10.1097/adm.0000000000000308
- Incidence of Neonatal Abstinence Syndrome — 28 States, 1999–2013.MMWR. Morbidity and Mortality Weekly Report. 2016; 65: 799-802https://doi.org/10.15585/mmwr.mm6531a2
- The Effect of Race on Provider Decisions to Test for Illicit Drug Use in The Peripartum Setting.Journal of Women's Health. 2007; 16: 245-255https://doi.org/10.1089/jwh.2006.0070
- Department of Justice addresses MAT discrimination.(Retrieved from:)
- Advocating for your recovery when ordered off addiction medication.(Retrieved from:)
- Drug addiction in pregnancy: Disease not moral failure.Neonatal Network: The Journal of Neonatal Nursing. 2014; 33: 11-18https://doi.org/10.1891/0730-0832.33.1.11
- Research update on family drug courts.National Association of Drug Court Professionals. 2012; (Retrieved from:)
- Prevention and Health Promotion Administration. Maryland maternal mortality review: 2016 annual report. Annapolis (MD): Department of Health and Mental Hygiene.(Retrieved from:)
- Maternal deaths from suicide and overdose in Colorado, 2004-2012.Obstet Gynecology. 2016; 128: 1233-1240https://doi.org/10.1097/AOG.0000000000001695
- The right to Mother's milk: A call for social justice that encourages breastfeeding for women receiving medication-assisted treatment for opioid use disorder.Journal of Human Lactation. 2018; https://doi.org/10.1177/0890334418789401
- Association of rooming-in with outcomes for neonatal abstinence syndrome: A systematic review and meta-analysis.Journal of the American Medical Association Pediatrics. 2018; 172 (Apr1): 345-351https://doi.org/10.1001/jamapediatrics.2017.5195
- The link between substance abuse and posttraumatic stress disorder in women.The American Journal on Addictions. 1997; 6: 273-283https://doi.org/10.1111/j.1521-0391.1997.tb00408.x
- Child abuse and neglect model court profiles.(Retrieved from:)
- Principles of drug addiction treatment: A research-based guide (Third Edition).(Retrieved from:)
- January 11. Public Notice/Press Release. Big Horn County Attorney Announces Immediate Crackdown on Pregnant, Expecting Mothers Consuming Alcohol or Dangerous Drugs, Particularly Methamphetamine and Opioids. Retrieved from:) (
- Maternal Opiate Medical Supports Plus Program.(Retrieved from:)
- Arrests of and forced interventions on pregnant women in the United States (1973-2005): The implications for women's legal status and public health.Journal of Health Politics, Policy and Law. 2013; 38: 299-343https://doi.org/10.1215/03616878-1966324
- Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012.Journal of Perinatology. 2015; 35: 650-655https://doi.org/10.1038/jp.2015.36
- Neonatal Abstinence Syndrome and Associated Health Care Expenditures.Journal of the American Medical Association. 2012; 307https://doi.org/10.1001/jama.2012.3951
- 75 Cal. App. 3d.Cal. Rptr. 1977; 214: 712
- Punishing Drug Addicts Who Have Babies: Women of Color, Equality, and the Right of Privacy.Harvard Law Review. 1991; 104: 1419-1481
Smith, K. and Lipari, R.N. (2017). Women of childbearing age and opioids. The CBHSQ Report: January 17, 2017. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD.
- Beyond preventing unplanned pregnancy: The broader benefits of publicly funded family planning services.(Retrieved from:)
- Pregnant women and substance abuse: fear, stigma and barriers to care.Health and Justice. 2015; 3 (doi.org/10.1186/s40352-015-0015-5): 1-15
- National Center on Substance Abuse and Child Welfare. Framework and policy tools for improving linkages between alcohol and drug services, child welfare services and dependency courts.(Retrieved from:)
Substance Abuse Mental Health Services Administration. (2012a). Center for Behavioral Health S Quality: National Survey on Drug Use and Health. Inter-university Consortium for Political and Social Research (ICPSR). United States Department of H, Human Services.
- Clinical Drug Testing in Primary Care. Technical Assistance Publication (TAP) 32. HHS Publication No.(SMA) 12-4668.Substance Abuse and Mental Health Services Administration, Rockville, MD2012 (Available at:)
- Mental and Substance Use Disorders.(Retrieved from)
- A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders. HHS Publication No. (SMA) 16-4978.Substance Abuse and Mental Health Services Administration, Rockville, MD2016 (Available at:)
- National Registry of Evidence-based Programs and Practices. Learning Center Evidence Summary: Substance Use Treatment for Pregnant and Postpartum Women. Retrieved from:) (
- Protecting Our Infants Act: Report to Congress. Behavioral Health Coordinating Council Subcommittee on Prescription Drug Abuse.(Retrieved from:)
- Clinical Guidance for Treating Pregnant and parenting Women with Opioid Use Disorder and Their Infants. HHS Publication No. (SMA) 18-5054. Rockville, MD. Retrieved from:) (
- SB 1391. Public Chapter 820. Title: As enacted, provides that a woman may be prosecuted for assault for the illegal use of a narcotic drug while pregnant, if her child is born addicted to or harmed by the narcotic drug.(Retrieved from:)https://legiscan.com/TN/text/SB1391/2013Date: 2014
- Neonatal abstinence syndrome and ethical approaches to the identification of pregnant women who use drugs.Obstetrics & Gynecology. 2017; 129: 164-167https://doi.org/10.1097/aog.0000000000001781
- Legacy Department of State Health Services, State of Texas. The Mommies toolkit: Improving outcomes for families impacted by neonatal abstinence syndrome.(Retrieved from:)
- Office of the Chief Medical Examiner. Pregnancy-associated deaths from drug overdose in Virginia, 1999-2007: a report from the Virginia maternal mortality review team. Richmond (VA): Department of Health. Retrieved from:) (
- Substance abuse during pregnancy: Guidelines for screening.(Retrieved from:)