Why it’s so hard to break an opioid addiction
In an effort to combat the skyrocketing number of Kentucky newborns exposed to dangerous and addictive drugs by their pregnant mothers, state lawmakers added a section to House Bill 1 that expands the definition of child abuse in Kentucky to include neonatal abstinence syndrome, or NAS. HB 1 is set to become law in July 2019. Despite the intent of the law to protect infants from the harmful effects of substance abuse during pregnancy and in the postpartum period, criminalizing substance abuse during pregnancy is likely to harm them, instead.
Opioid misuse during pregnancy significantly increases the risk of dangerous infant health outcomes, such as low birthweight, preterm birth and mortality. And infants with opioid exposure during pregnancy face a very high risk of developing NAS, a withdrawal syndrome among exposed newborns characterized by a variety of symptoms depending on the degree of exposure, including irritability, excessive high-pitched crying, muscle rigidity, tremors, feeding difficulty, vomiting, diarrhea, seizures, heart defects, and respiratory problems.
Although the health consequences can be severe, there are effective treatments for NAS. As the opioid crisis has raged across the state, so too have its effects on the most vulnerable among us. The number of Kentucky babies born dependent on opioids increased 24-fold since 2001, from 46 babies in that year to 1,115 in 2016. Pregnant women addicted to opioids expose both themselves and their unborn infants to the dangerous effects of opioid use, but laws that punish (or threaten to punish) these women have the potential to hurt the babies they’re trying to protect.
Research has demonstrated that these laws are ineffective at improving the health of newborns as well as their mothers, and actually increase the likelihood of dangerous health outcomes. Pregnant women are already reluctant to disclose to their health care providers that they are using drugs because of the guilt and stigma associated with prenatal drug use. When this reluctance is compounded with laws that make it possible for these pregnant women to be prosecuted for their behavior or even lose their parental rights, what results is a pregnant woman that avoids prenatal care altogether – a situation that is immeasurably worse for the health and well-being of their unborn infants.
Laws that punish a pregnant woman for using drugs implicitly assume that treatment options are easily accessible to them – which often isn’t the case. Many providers who treat patients with opioid use disorder (OUD) with medication-assisted therapy (MAT), the standard of care for pregnant women with OUD, do not accept Medicaid, and wait times are often long – even several weeks – for pregnant women who want treatment. And as of the writing of this commentary, Kentucky Medicaid does not cover methadone – one of only two treatments (buprenorphine and methadone) recommended for pregnant women with OUD by the American College of Obstetricians and Gynecologists (ACOG), further limiting treatment options.
There is strong consensus from the medical and public health communities that a punitive approach to substance use during pregnancy is ineffective and potentially extremely harmful. More than 20 national organizations have come out against this approach, including the American Medical Association, the American Academy of Family Physicians, ACOG, the American Public Health Association, the American Nurses Association, the American Psychiatric Association, the National Perinatal Association, the American Society of Addiction Medicine, the March of Dimes, and the Association of Women’s Health, Obstetric and Neonatal Nurses.
Expanding the definition of child abuse in Kentucky to include NAS will not help Kentucky newborns. Instead, the new law will likely hurt their chances for successful treatment, by amplifying the stigma of substance use during pregnancy and exacerbating pregnant women’s fears of being punished for seeking treatment that would help them and their babies. Write to your legislators and demand that Kentucky prioritize the health of newborns – rather than the unproductive punishment of their mothers.
Rachel Keller Landis, MPP, is currently a PhD student in Public Policy at The George Washington University in Washington, D.C. Her research is focused on maternal and newborn health policy, specifically as it relates to substance use and mental health. Her co-authored work has been published in Health Affairs and The Journal of General Internal Medicine. She is from Harrodsburg, Kentucky, and lives in Washington, D.C