Pregnant women with substance misuse problems who live in states that consider drug addiction ‘child abuse’ are at greater risk of having babies born with health problems like opioid withdrawals, a new study found.
As the opioid epidemic surges on in the US, the number of pregnant women with addictions quadrupled between 1999 and 2014.
Simultaneously, the number of babies born with neonatal abstinence syndrome – a form of withdrawal affecting infants exposed to opioids in the womb – has skyrocketed.
States treat these women and their babies very differently, with some treating pregnant women with medication to help them break their addictions while others treat drug use in pregnancy as neglect or even a crime.
A new RAND Corporation study found that newborns seem to suffer the health consequences at much higher rates when their addicted mothers are punished by a state’s legal system.
Punishing addicted women who use opioids during pregnancy as criminals may just drive them away from the healthcare system and raise the risks their babies will be born in withdrawal from the drugs and be sicker overall, a new study suggests (file)
In 1999, 1.5 out of every 1,000 women who delivered a baby at a hospital in the US had opioid use disorder, according to the Centers for Disease Control and Prevention (CDC).
By 2014, that number had soared to 6.5 out of every 1,000 – a four-fold increase.
And between 2004 and 2014, the number of babies born with neonatal abstinence syndrome (NAS) surged five-fold.
Now, the CDC estimates that a baby is born with NAS every 15 minutes in the US.
Babies exposed to addictive substances – most often opioids – in the womb may suffer tremors, breathing, sleeping and feeding problems, be fussy and develop fevers.
They are at greater risk of being born with low birth weights, underdeveloped or damaged livers, suffering seizures and sudden infant death syndrome (SIDS).
Scientists still aren’t sure what the long-term impacts of NAS might be, but suspect these children are at elevated risks of developmental, learning and behavioral problems, sensory and nutritional issues tend to be at greater risks of misusing drugs or alcohol themselves.
Rates of opioid misuse among pregnant women as well as NAS among there babies vary wildly from state to state.
In particular, the CDC’s 2018 report found that 28 states have had particularly sharp increases in opioid use among pregnant women.
As the opioid epidemic’s effects have expanded, so have attempts to address it, including introducing stricter laws.
By the standards of the new RAND study, 12 states had strict and ‘punitive’ policies, such as those that treated a pregnant woman’s drug use as child neglect or a crime, in 2000.
That number had more than doubled, to 25, by 2015.
The RAND researchers looked at data on eight states that introduced stricter policies during that period: Arkansas, Arizona, Colorado, Kentucky, Massachusetts, Maryland, Nevada and Utah.
In some of these states, it’s now a punishable offense to use opioids during pregnancy. In others, doctors must report pregnant women that they suspect are misusing opioids to the state.
Where pregnant women were punished for opioid use, the incidence of NAS was 57 per 10,000 births.
Where policies were more lenient, the rate was, on average, 46 per 10,000 live births – nearly 20 percent lower.
However well meaning, most public health experts agree that the legal system is not the place to address the addiction component of the opioid epidemic.
Instead, they advocate for addiction to be treated as a health problem – which it’s now widely recognized to be.
‘Our findings are consistent with other studies showing that policies that penalize pregnant women for substance use deter them from seeking necessary health care,’ said senior study author Dr Bradley Stein.
When their health care providers are required to tell the state that pregnant women do or may have issues with opioid misuse, these women inevitably shy away from the medical system in fear.
‘Disengaging from the health care system poses risks both for pregnant women and their infants,’ added Dr Stein.
At-risk populations like women who use opioids are in need of more, not less, medical care as they are at greater risk of unintended pregnancies, as well as health complications that will affect both them and their babies.
‘As policymakers adopt strategies intended to decrease the effect of substance use on infants, our findings suggest that punitive policies may have unintended consequences,’ said senior study author Dr Laura Faherty.
