Punishing Pregnant Opioid Users Increases Risks to Newborn: Study

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The American opioid crisis has devastated families for years, impacting a substantial number of pregnant women and their unborn children. Now, according to a RAND study, the crisis has been exacerbated by the punitive measures adopted by some states.

The study, published by the journal JAMA Network Open, found that the children of pregnant opioid abusers who live in criminal punishment-oriented states were more likely to experience neonatal abstinence syndrome (NAS), or opioid withdrawal symptoms, which could potentially lead to long-term health and developmental problems.

The punitive measures can range from confinement behind bars to taking the baby away after birth.

“As policymakers adopt strategies intended to decrease the effect of substance use on infants, our findings suggest that punitive policies may have unintended consequences,” wrote Dr. Laura J. Faherty, lead author of the study and a physician-researcher at RAND.

“Punishing pregnant women for substance use may cause them to disengage from the health care system, and make them less likely to seek prenatal care and substance use treatment.”

A significant part of this “disengagement” is because of a punitive policy that requires health care professionals to report suspected prenatal substance use to authorities. The women become afraid of seeing a doctor, and continue using opioids, resulting in NAS affected children, the study suggests.

RAND researchers used data from the Healthcare Cost and Utilization Project’s State Inpatient Databases, compiled by the Agency for Healthcare Research and Quality to take a closer look at 4.6 million births from eight punishment-oriented states from 2003 to 2014. Then, newborn baby data was filtered to look for NAS cases.

The average amount of NAS cases in the U.S. is 46 per 10,000 births, according to the study.

Those eight punishment-oriented states—Arkansas, Arizona, Colorado, Kentucky, Massachusetts, Maryland, Nevada, and Utah—all had higher rates of NAS in babies the year following the establishment of a punitive policy (57 cases per 10,000), which only increased in subsequent years (60 cases per 10,000).

But state policymakers aren’t aware of the negative correlation, the study noted.

“The number of states with such punitive policies increased from 12 in 2000 to 25 in 2015,” the study found. Moreover, “the number of states with reporting policies increased from 12 to 23 over the same period.”

Instead of resorting to criminal punishment, the RAND researchers say it would be more productive for policymakers to instead take a preventative approach, and, “pursue approaches that encourage pregnant women to seek evidence-based treatment for substance use disorder.”

Prevention approaches include:

      • Expanding access to drug treatment programs designed for pregnant women;
      • Advocating for responsible prescribing of opioids to women of childbearing age; and
      • Increasing access to family planning services for women that “align with their reproductive goals, considering most pregnancies among women with opioid use disorder are unplanned.”

The full study can be accessed here.

Andrea Cipriano is a staff writer for The Crime Report.

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