Pregnant opioid users need treatment, not jail, pediatricians say


Every 25 minutes, a drug-addicted baby is born in the USA

To try to protect the youngest victims of the nation’s opioid epidemic, Tennessee enacted a law that new mothers to prison for the abuse of the substance, while the other states use existing child abuse laws to punish prenatal drug users, and the removal of their children.

But the sanctions have backfired, serving only to drive pregnant women away from necessary prenatal care and substance-use treatment, pediatricians say in three new papers.

In a published this week in Pediatrics, the American Academy of Pediatrics encourages policymakers to support a public health approach instead of a punitive response to opioid use in pregnancy.

“I do not think that these laws are in the best interest of the mama’s and babies,” Dr. Stephen Patrick, lead author of the report in Pediatrics, said in an interview. “Opioid use disorder is a medical problem and not a moral failure.”

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Patrick is a professor at the Vanderbilt University School of Medicine in Nashville, Tennessee, where he treats infants suffering withdrawal from opioids.

Instead of prison, he called for a better access to long-term contraceptives, and substance-treatment programs designed to care for pregnant women.

About 100 substance-using new mothers went to jail in Tennessee between 2014 and 2016 under a fetal assault law is no longer in force, Patrick said.

The law called as much fear in the pregnant addicts and that some refused to go to the hospital to give birth at home, in the car or on the side of the road, ” he said.

Meanwhile, the number of pregnant women who use opioids and the number of babies born with withdrawal symptoms continues to rise.

Patrick estimated that as many as 440,000 substance-exposed infants that are born in the united states each year, and said: “We are not going to arrest 440,000.”

Dr. Mary Beth Sutter, a professor at the University of New Mexico in Albuquerque, working with pregnant addicts in her country, where prosecutors charge pregnant drug users under the child-abuse laws, she said in a telephone interview.

“That women in the prison, and taking their babies away to try to prevent the misuse of the substance is really not working,” she said. “It does nothing to help these women and children, but it tends to take them away from care.”

Newborns who stay with their mothers require fewer days in the hospital, cutting the costs in half, de Sutter writes in a new review in the journal Obstetrics and Gynecology Clinics of North America.

Doctors can better help drug-addicted baby when they know that mothers are the use of illegal substances. But expectant mothers worry so much about the fact that stigma, imprisoned, and their babies taken from them that they often fail to disclose drug use, the Sutter writes.

The baby motivates substance users to quit. “If ever there was a time in which the well is to help people with substance abuse,” Sutter said, “it’s the pregnancy.”

But the demand for substance-treatment programs designed to meet the unique needs of pregnant women and their babies transcends their availability. Only 19 states have such programs.

New Mexico has only one in-patient treatment program with only six beds for pregnant and parenting women in the entire state, Sutter said.

Medication-assisted therapy with methadone or buprenorphine is the care for pregnant women with opioid use disorder, Patrick writes. But women who fear losing custody of their babies sometimes prevent the treatment so not to raise suspicion, according to a new report in the Journal of Substance Abuse Treatment.

Psychologist Dennis Hand, a professor of obstetrics and gynecology at the Thomas Jefferson University in Philadelphia, examined the use of opioids in pregnancy in the US and found the problem is particularly acute in the South.

The southern states have fewer drug-treatment facilities, and more women take benzodiazepines, a class of sedatives and anti-anxiety medications together with opioid drugs, with the Hand found. The combination complicates the treatment for mothers and babies.

Southern women are also less likely to have health insurance, and the South has even less of the treatment programs for pregnant women than other areas, with the Hand said. Tennessee does not cover methadone, and Mississippi has only one methadone clinic, in comparison with California, which has a total of 138, ” he said.

The number of infants experience opioid withdrawal after birth, or neonatal abstinence syndrome, grew almost fivefold in the past ten years, Patrick writes.

Many of the mothers of newborns that Patrick and Sutter treated had no idea that taking a doctor prescribed painkillers can lead them and their babies to addiction. Sutter said her patients are often prescribed opiates following car accidents, dental interventions and caesarean sections for the previous births.

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