Executive Summary
The American Academy of Nursing (Academy) calls for an end to criminal prosecution and punitive civil actions against pregnant and parenting women based solely on their substance use or substance use disorder (SUD). The Academy supports a public health response to the needs of women and their children and families affected by SUDs that incorporates multi-disciplinary culturally- and trauma-responsive models of health care, child welfare, treatment and recovery supports and clinician practices that are in line with the accumulated scientific evidence.
Background
Since the 1970s, many law enforcement agencies, state legislatures, courts, and medical personnel in the United States have used punitive legal sanctions against pregnant women with the purported intent of protecting the fetus from maternal use of alcohol, tobacco, and other drugs (
Guttmacher Foundation 2018
, Jos et al., 1995
, - Jos P.H.
- Marshall M.F.
- Perlmutter M.
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
Reyes v. Superior Court 1977
). Women of color and those who are financially disenfranchised have been disproportionately targeted for drug screening and drug related charges and as a result have experienced disparities in access to needed health and social services (Amnesty International 2017
, Kunins et al., 2007
, Roberts, 1991
). The net impact of these actions on women who are using substances and on their families has been to incite fear, suppress women's disclosure of substance use, and create barriers to essential health and social services, with resulting poor outcomes (Angelotta et al., 2016
, Stone, 2015
). After more than four decades of criminal and civil actions against women who are pregnant and parenting and their families, the accumulating evidence of inherent harm and threats to maternal and child health and to women's constitutional and civil rights is undeniable (Amnesty International 2017
, Ferguson v. City of Charleston. 532U.S, 2001
, Paltrow and Flavin, 2013
). Recovery-oriented public health responses are urgently needed to institutionalize evidence-driven practice, and to permanently shift the culture of punishment to one of enduring therapeutic intent in line with a health justice framework (- Paltrow L
- Flavin J
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
Benfer, 2015
).Scientific evidence and cost-benefit analyses strongly support the use of therapeutic treatment interventions to ensure optimal health and social outcomes for women and their children (
French et al., 2002
, National Institute on Drug Abuse 2018
, Substance Abuse and Mental Health Services Administration [SAMHSA] 2018
). Clinical protocols for healthcare practitioners and best practice model programs for state agency responses also provide guidance to significantly improve the health and wellness of women and their children and families, and to direct therapeutic and humanitarian public policy actions in the U.S. (Klaman et al., 2017
, Maguire, 2014
, - Maguire D.
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
Substance Abuse and Mental Health Services Administration [SAMHSA] 2014
, Substance Abuse and Mental Health Services Administration [SAMHSA] 2016
, Substance Abuse and Mental Health Services Administration [SAMHSA] 2017a
, 2018).Criminal and civil sanctions
The available data sources indicate that since the 1970’s, more than 1000 women in the U.S. have been prosecuted for substance use during pregnancy
1
with the majority of those cases occurring since 2005 (There is no national data bank monitoring the number of prosecutions of women for substance use during pregnancy. The number of cases referenced above is derived from existing analyses of known cases in several states and is believed to be an undercount of the actual number of cases (see
Amnesty International 2017
, p. 8; Paltrow and Flavin, 2013
, pgs. 304–305).- Paltrow L
- Flavin J
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
Amnesty International 2017
, Paltrow and Flavin, 2013
). Some states and jurisdictions have created “fetal assault” laws to prosecute women with SUDs. In Alabama and Tennessee alone, several hundred women have been charged under similar statutes (- Paltrow L
- Flavin J
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
Amnesty International 2017
, Paltrow and Flavin, 2013
). Recent actions by state legislatures and county prosecutors have led to criminal charges, arrests, and incarceration (- Paltrow L
- Flavin J
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
Code of Alabama.Title 26-Infants and Incompetents 2012
, Tennessee Fetal Assault Law 2014
;Tennessee Fetal Assault Law
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.
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.
https://legiscan.com/TN/text/SB1391/2013
Date: 2014
2
The Tennessee Nurses Association in collaboration with other public health organizations played a central role in the sunset of Public Chapter 820 on July 1, 2016 through legislative testimony, alerts to Tennessee nurses, and by maintaining a continued public presence in support of treatment for Tennessee women with SUDs.
Terplan and Minkoff, 2017
). There has also been a call for the public to specifically report pregnant women who are “using drugs or alcohol” so they may be identified and arrested (Office of the County Attorney, Big Horn County, Montana 2018
).Currently, 24 states and the District of Columbia have laws enforcing the position that substance use during pregnancy constitutes child abuse under civil child welfare statutes, and three states enforce civil commitment as a means of deterrence for drug use (
Guttmacher Foundation 2018
). Although model protocols for risk evaluation exist (Centers for Disease Control and Prevention 2015
, Substance Abuse and Mental Health Services Administration [SAMHSA] 2016
, Washington State Department of Health 2016
), no requirements for in-depth clinical evaluation of parenting capacity prior to filing a report were identified in any of the child welfare statutes for the 24 states and the District of Columbia. Law enforcement, probation officers, and courts have been known to order women to discontinue medication approved by the Food and Drug Administration for treatment (Legal Action Center 2018a
, Legal Action Center 2018b
), potentially placing them at risk for relapse and/or overdose death.The impact of substance use on women, infants, children and families
Substance use during pregnancy places women at increased risk for inadequate prenatal care, infectious diseases, obstetric complications, needle-related morbidity, overdose, and death. In surveys of women who were pregnant, 5.9% report use of illicit drugs, 8.5 % report alcohol use, and 15.9% report smoking (
Substance Abuse Mental Health Services Administration 2012a
). Among women using substances, between 55% and 90% have histories of trauma (Najavits et al., 1997
) and are three times more likely to experience intimate partner violence (- Najavits L.M.
- Weiss R.D.
- Shaw S.R.
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
El Bassel et al., 2005
). Additionally, these women are more likely to have a co-occurring mental illness (Substance Abuse and Mental Health Services Administration [SAMHSA] 2014
). State reviews of pregnancy-related deaths conducted in 2015-2016 cite opioid overdose as a significant contributor to maternal deaths, ranging from 11-20% of all deaths during pregnancy (Maryland Department of Health and Mental Hygiene 2016
; Metz et al, 2016
; ).Among women who gave birth between 2000 and 2009, opioid use increased from 1.19 to 5.63 per 1,000 hospital births annually (
Smith and Lipari, 2017
). Neonatal abstinence syndrome (NAS) has increased 300% in 28 states in the past two decades (Ko et al., 2016
, - Ko J.Y.
- Patrick S.W.
- Tong V.T.
- Patel R.
- Lind J.N.
- Barfield W.D.
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
Patrick et al., 2015
, Patrick et al., 2012
) with one NAS-affected infant born every 25 minutes in the U.S. (- Patrick S.W.
- Schumacher R.E.
- Benneyworth B.D.
- Krans E.E.
- Mcallister J.M.
- Davis M.M.
Neonatal Abstinence Syndrome and Associated Health Care Expenditures.
Journal of the American Medical Association. 2012; 307https://doi.org/10.1001/jama.2012.3951
Ebell, 2010
). NAS appears within 48–72hours of birth and includes central nervous system irritability, respiratory and feeding difficulties, low birth weight, and temperature instability (Hudak and Tan, 2012
). A 2012 cost estimate of NAS-associated hospital charges noted an economic burden of $1.5 billion with 80% of costs financed by Medicaid programs (Patrick et al., 2015
). In addition to opioid-induced symptoms, prenatal exposure to alcohol, tobacco and other licit and illicit substances can also contribute to low and extremely low birth weight, prematurity, cognitive, neurological, and developmental problems, and fetal alcohol spectrum disorders.Women with SUDs and their families face multiple challenges including potential loss of child custody, mother-child separation due to incarceration, homelessness, exposure to violence, limited parenting opportunities and abilities, and trauma-related mental health conditions. Early therapeutic intervention can lead to lifelong benefits for these women and their children. Access to quality healthcare plays a vital role in long-term health and social outcomes, birth spacing, prevention of preterm delivery, and low birth weight (
Sonfield, 2014
).Responses and Policy Options
There is widespread agreement among public health organizations, as well as scientific evidence, that prosecution in lieu of treatment is ineffective and potentially harmful. Congress has taken legislative actions including the Comprehensive Addiction and Recovery Act of 2016 (CARA), [Public Law 114-198] and the Protecting Our Infants Act of 2015 (POIA), [Public Law 114-91], which emphasize the beneficial outcomes of quality treatment and recovery services during pregnancy and parenting. Government agencies including SAMHSA, and professional organizations have crafted clinical guidelines and both CARA and
Substance Abuse and Mental Health Services Administration [SAMHSA] 2017b
call for plans of safe care to address patient needs, with the conspicuous absence of beneficial outcomes arising from the imposition of punitive sanctions.Recent proliferation of therapeutic family dependency model drug courts has also demonstrated improvements in SUD treatment initiation and completion and increased rates of reunification among families at risk for child abuse and neglect where substance use is a factor (
Marlowe and Carey, 2012
, National Council of Juvenile and Family Court Judges 2018
, Substance Abuse Mental Health Services Administration 2003
). Among state responses to pregnant and parenting women with SUDs, Texas funded and disseminated the Mommies Program, a fully integrated model of care that included comprehensive treatment services, medication assisted treatment (MAT), recovery support services, housing, and specialty health services (Texas Health & Human Services Commission 2015
). In May, 2014 Ohio established the M.O.M.S. (Maternal Opiate Medical Support) model program consisting of specialty prenatal care, MAT, and behavioral health services in five care sites statewide. Today, the Ohio Perinatal Quality Collaborative is building upon the M.O.M.S. model with a program titled Maternal Opiate Medical Supports Plus (MOMS+) to optimize the maternity medical home and improve outcomes for pregnant women (Ohio Perinatal Quality Collaborative 2018
).The Academy's Position
The American Academy of Nursing (Academy) calls for an end to criminal prosecution and punitive civil actions against pregnant and parenting women based solely on their substance use or substance use disorder (SUD). The Academy supports a public health response to the needs of women and their children and families affected by SUDs that incorporates multi-disciplinary culturally- and trauma-responsive models of health care, child welfare, treatment and recovery supports and clinician practices that are in line with the accumulated scientific evidence.
Recommendations
Federal
- 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.
States
- 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.
Nurses
Nurses have a critical role as patient advocates to protect individual health, human and legal rights of patients (
ANA 2016
). Whereas law enforcement authorities have historically used a single drug test as grounds for prosecution of pregnant and parenting women with a SUD (Amnesty International 2017
), comprehensive assessments are essential to ensure the validity and integrity of clinical findings and must be upheld and protected. Nursing leadership is needed to safeguard accurate and comprehensive assessment and practice consistent with a therapeutic health justice approach.- 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
The authors thank Mary Foley, PhD, RN, FAAN, Board Secretary and Liaison to the Psychiatric, Mental Health and Substance Use Expert Panel, American Academy of Nursing and David M. Keepnews, PhD, JD, RN, FAAN for their assistance and guidance provided. Thanks also to co-author Betty J. Braxter, PhD, CNM, RN who served as an expert clinical advisor in development of this policy brief. The authors express their appreciation to the members of the Psychiatric, Mental Health and Substance Use Expert Panel, Carol Dawson-Rose, RN, PhD, FAAN, Kathleen Delaney, PhD, PMH-NP, FAAN, Deborah Finnell, DNS, CARN-NP, FAAN, Kris A. McLoughlin, DNP, APRN, PMH CNS-BC, FAAN, Madeline Naegle, PhD, CNS-PMH, BC, FAAN and Frieda Outlaw, PhD, RN, FAAN. We also thank Cindy Greenberg, DNSc, RN, CPNP-PC, FAAN, Co-Chair of the Child, Adolescent, and Family Expert Panel; Deborah Walker, PhD, CNM, WHNP-BC, FACNM, FAAN and Carole Kenner, PhD, RN, FAAN, FNAP, ANEF, Co-Chairs of the Maternal and Infant Expert Panel; Judith Berg, PhD, RN, WHNP-BC, FAAN, FAANP, member of the Women's Health Expert Panel, and Jose Alejandro, PhD, RN, FAAN, Co-Chair of the Cultural Competence and Health Equity Expert Panel.
The authors express appreciation to Michael Marcotte, MD, Director of Quality and Safety for Women's Services at TriHealth, Cincinnati, Ohio and Lisa Ramirez, Project Director of the Texas Targeted Opioid Response, Behavioral Health Services Section, Texas Department of Health Services. Thanks also to Wilhemina Davis, Manager, Government Affairs, Tennessee Nurses Association, and Matt Tierney ANP, PMHNP, FAAN, Clinical Director, Substance Use Treatment and Education, Office of Population Health, UCSF Health. The authors also thank the National Advocates for Pregnant Women for data on prosecutions of women with substance use disorders.
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:)
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