Moreover, there is a great deal of overlap between drug use during pregnancy policies and alcohol/pregnancy policies. In 2018, an estimated 12% of U.S. residents 18 years or older reported current unhealthy drug use in a national survey. Three courts stated that permitting prosecutions under the contested statute was counterproductive to state policy goals and public health. Marijuana is the most widely used illegal drug during pregnancy in the U.S., and marijuana use is on the rise among all adult age groups, both sexes, and pregnant women. Kentucky similarly struggles with poverty, poor access to substance use treatment services, and a child protective system that spends more resources on placing children in foster care than keeping them with their families. Good reproductive health policy starts with credible research. Only four states (North Dakota, Minnesota, Iowa and Kentucky) require hospitals to test both new mothers and their children if medical professionals suspect drug use. Studies show when a pregnant woman uses illegal drugs during pregnancy it can result in miscarriage, low birth weight, premature labor, placental abruption, seizures, respiratory problems, feeding difficulties, and death of the baby and the mother. More about smoking in pregnancy and drinking alcohol in pregnancy. The substances related to the charges included cocaine, heroin, methamphetamine, marijuana, and prescription pills. Illegal drugs in pregnancy. In 2014, Tennessee made national news when it became the first state in the country to pass a law specifically making it a crime to use drugs while pregnant. She had become dependent on opioids, but when she learned she was pregnant, she immediately tried to enroll in a medication assisted treatment (MAT) program. This is all exacerbated by a series of measures Arizona has undertaken to constrict its social safety net, leaving families struggling with inadequate access to cash, food, housing, child care, and transportation. At issue is whether the continued drug use of a newborn's mother is tantamount to "child abuse" that would give child protective services workers and law enforcement officers the ability to remove the child from the mother's care - even if the . Video Transcribed: Life imprisonment for using drugs while pregnant.I'm Tulsa criminal defense attorney James Wirth, and we're talking about a new law in Oklahoma.And that became effective in September of 2020, and it essentially provides that mothers to be who use drugs or CDS, while pregnant, can be prosecuted for child neglect, receiving up to life imprisonment. She was charged with chemical endangerment of a child. Saving Lives, Protecting People, https://www.samhsa.gov/medication-assisted-treatment, prevent overdoses and substance use-related harms, Learn about the Division of Reproductive Healths efforts to address opioid use disorder to improve maternal and infant health, CDC Guideline for Prescribing Opioids for Chronic Pain, A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders, Opioid Use and Opioid Use Disorder in Pregnancy, Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and their infants, Final Report: Opioid Use, Misuse, and Overdose in Women, What We Can Do About Opioid Use Disorder in Pregnancy, SAMHSAs Behavioral Health Treatment Services Locator, guidance from the American College of Obstetricians and Gynecologists, What You Need to Know About Marijuana Use and Pregnancy, The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research (2017), Prevalence and patterns of marijuana use among pregnant and nonpregnant women of reproductive age. Most states do not have a law that requires hospitals to test infants and new moms for controlled substances. Terminating a mothers rights to her newborn is an especially brutal drug war tactic that research and experience show will inflict far more harm than good on the children and families it allegedly aims to protect. Source: ProPublica research by Leticia Miranda and Christine Lee; Guttmacher Institute; National Advocates for Pregnant Women. Heavy use of marijuana - that is, marijuana with high amounts of THC - has been linked to decreased fertility in both men and women. A total of 24 published judicial opinions met the inclusion criteria (Table 1). Those efforts continue under a wide variety of laws even in states where high courts have previously rejected the prosecution approach. CDCs Division of Reproductive Health (DRH) provides scientific leadership in the surveillance of marijuana use during pregnancy. Such inhumane responses to drug use can only exist because they are almost exclusively reserved for poor people and people of color. Charges included child endangerment (n = 11), child abuse (n = 6), drug delivery (n = 4), attempted aggravated child abuse (n = 2), chemical endangerment of a child (n = 2), child neglect (n = 1), child mistreatment (n = 1), homicide (n = 1), manslaughter (n = 1), and reckless injury to a child (n = 1). Aspartame is an artificial sweetener in some food and drinks and small amounts may be safe during pregnancy. For example, the Maryland state law that permits manslaughter or murder charges if a person kills a viable fetus has an exception that does not permit a woman to be charged with manslaughter for actions that led to the death of her own viable fetus. Wisconsin provides priority access to pregnant people in both general and private programs. Several methods of drug testing are efficacious in identifying and monitoring drug use during pregnancy. In contrast, state legislatures could choose to preclude attempted efforts at prosecution with amendments that make explicit that existing laws are not meant to apply to prenatal conduct that may affect fetuses. But, for that matter, she could have been a pregnant alcoholic, causing fetal alcohol syndrome; or she could have been addicted to self abuse by smoking, or by abusing prescription painkillers, or over-the-counter medicine; or for that matter she could have been addicted to downhill skiing or some other sport creating serious risk of prenatal injury, risk which the mother wantonly disregarded as a matter of self-indulgence. Support a worker-led Appeal. Abstract. Apr 20, 2022, M. Forrest Behne, Craig Waleed, Meghan Peterson, and Lauren Brinkley-Rubinstein 2015), The prevalence of illicit-drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida, Substance use during pregnancy and postnatal outcomes, Punishing pregnant drug users: enhancing the flight from care, Women's perspectives on screening for alcohol and drug use in prenatal care, Drug use and limited prenatal care: an examination of responsible barriers, Universal screening for alcohol and drug use and racial disparities in child protective services reporting, The American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women and American Society of Addiction Medicine, Committee Opinion No 524. Prenatal drug exposure may also contribute to long-term behavioral effects and developmental deficits. 1 However, pregnant women with a disease called phenylketonuria shouldn't eat or drink aspartame. Quitting early or before pregnancy is best, but its never too late to quit smoking. Getty Creative. To date, the United States Supreme Court has declined to hear cases that raise questions about the constitutionality of such laws. Opioids can be prescription or illicit. The state argued that the drug delivery occurred via the umbilical cord in the period after birth but before the cord was clamped. If you regularly use drugs, it's important to tackle this now you're pregnant. Many substance use treatment services dont accept pregnant women, or are otherwiseinaccessibleto them, despitefederalandstateregulations that require prioritizing them for treatment. The use of prescription drugs during pregnancy, excluding supplements, in Ethiopia was high. For example, Amanda Kimbrough's child was born prematurely and died shortly after birth, having tested positive for methamphetamine. The use of illicit substances such as cocaine and heroin during pregnancy is common. If you are pregnant or trying to get pregnant and cannot stop drinking, get help. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. Substance use providers that accept Medicaid must give pregnant people priority in accessing services. Using drugs while pregnant and addiction is a grave concern because it puts two lives at risk. And in order to receive federal child abuse prevention funds, states must require health care providers to notify child protective services when the provider cares for an infant affected by illegal substance use. Drugs with evidence of fetal harm were widely used. Of the 24 judicial opinions, only nine directly referenced medical evidence in the form of medical expert testimony (n = 7), published medical literature (n = 3), or amicus briefs (n = 1). She struggled every day with the unimaginable pain and grief of separation from her newborn. App.3d 214 (Cal. Four courts noted that allowing a conviction would result in an absurd punishment scheme. 2023 Guttmacher Institute. Opioid abuse, dependence, and addiction in pregnancy, Medication assisted treatment in US drug courts: results from a nationwide survey of availability, barriers and attitudes, Maternal-fetal rights and substance abuse: gestation without representation, Pregnant women and the use of corrections restraints and substance use commitment, New Jersey Division of Child Protection & Permanency v. Question by Miss Crickett: Az law on drug use during pregnancy? Eighteen states have laws that say drug use during pregnancy is child abuse. Those unable to pay may perform community service instead. As of last year, they were still apart, and M. has since lost touch with her lawyer. 1995), State v. Dunn, 916 P.2d 952 (Wash. Ct. App. A November study published in the Journal of the American Medical Association tracked the rise of laws that criminalized taking drugs while pregnant, as well as classifying drug use during pregnancy as child abuse that could result in loss of custody rights or as grounds for a civil commitment. Future professional advocacy efforts may be most beneficial when directed at state legislatures that are dealing with proposed statutes that address these questions. The research that does claim to link substance use to maltreatment of children is not authoritative. Six ruled that the contested application of the statute to conduct during pregnancy violated due process, which requires that criminal offenses be defined in plain language so that an ordinary person has fair notice about the actions proscribed. State laws vary, but at least 23 states and the District of Columbia articulate that substance use during pregnancy is child abuse, and virtually every state in the U.S. will open an investigation (at the very least) into a person who tests positive for substances during or shortly after pregnancy. Trainings on maternal substance abuse, child development, alcohol and other drug related effects are conducted for prevention providers. Across the country, hundreds of pregnant women and new mothers have been accused of child abuse or other crimes when they or their newborns tested positive for controlled substances. From 2009 to 2017, the adjusted prevalence of cannabis use in the year before pregnancy increased from 6.8% to 12.5%, and the adjusted prevalence of cannabis use during pregnancy increased from 1.95% to 3.38 percent. Sign In to Email Alerts with your Email Address. Babies exposed to cocaine in the womb have a 25 percent increased chance of being born premature. The vast majority ofTemporary Assistance for Needy Families (TANF) funding, or federal welfare dollars meant to help the poor, is not spent on assistance to poor families, but rather on placing and keeping children in the foster care system. Some research shows that marijuana use during pregnancy is linked to health concerns, including high use of other substances that may impact pregnancy and infant health such as tobacco, and developmental problems in adolescents. Three of the nine mothers arrested that year tested positive for marijuana, and all were held on $100,000 bonds. Anonymous screening of consecutive urine samples testing positive for pregnancy from a UK inner-city clinic demonstrated that approximately 16% of the women had taken one or more illicit substances (Sherwood et al, 1999). Webster v. Reproductive Health services: the AMA position, Prosecuting pregnant women for drug use during pregnancy: the criminal justice system should step out and the affordable care act should step up, People v. Morabito, 580 N.Y.S.2d 843 (N.Y. City Ct. 1992), Reyes v. Superior Court, 75 Cal. Learn about the Division of Reproductive Healths efforts to address opioid use disorder to improve maternal and infant health. A new study co-authored by a University of Central Florida researcher shows that laws that punish substance use during pregnancy actually do more harm than good. Published on September, 30, 2015. 1991), State v. Luster, 419 S.E.2d 32 (Ga. Ct. App. State Policies on Substance Use During Pregnancy. Among pregnant women aged 15 to 44, the average . All of these cases were appellate decisions except for one published trial court decision,24 which we discuss separately, given that trial court decisions are not typically published and do not resolve matters of law. Learn more about e-cigarettes and pregnancy. It's best not to stop abruptly without first seeking medical advice as there may be . The number of pregnant women with opioid use disorder at labor and delivery more than quadrupled from 1999 to 2014, according to a recent CDC analysis. Enter multiple addresses on separate lines or separate them with commas. Although this may be the case, the medical care mandated by many drug treatment courts falls well below the standard of care required for some pregnant women.53,54, Of note, the cases loosely reflect epidemiological trends in patterns of drugs of choice. Indeed, few, if any, middle- or upper-class women who use drugs during pregnancy will ever experience a child abuse and neglect proceeding, let alone a termination of parental rightsthough drug use is common among people of all socioeconomic levels. Tennessee is the only state with a statute that specifically makes it a crime to use drugs while pregnant. Further research is needed to better understand how marijuana may affect pregnant women and developing babies. The pregnancies had the following outcome: no adverse effects of the substance reported (n = 12), withdrawal symptoms (n = 7), prematurity and/or small size at birth (n = 5), death in the neonatal period (n = 3), and stillbirth (n = 2). The report also found that Kentuckys child protection agency was not making enough efforts to prevent removal or re-entry to foster care. 1 Unhealthy drug use is more commonly reported by young adults aged 18 to 25 . State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. Substance use providers that accept Medicaid must give pregnant people priority in accessing services. The Center for MSACD also provides training, workshops, and other informational services concerning prenatal exposure to alcohol, nicotine, illicit drugs, and prescription drugs. As is true across the nation, rural areas have limited, if any, access to MAT. Opioid use disorder is a problematic pattern of opioid use that can result in health problems, disability, or failure to meet major responsibilities at work, school or home. As of 2018, 38 states had . NAS is a group of withdrawal symptoms that most commonly occurs in newborns after exposure to opioids during pregnancy.If you are pregnant and using opioid pain medications, CDC recommends you talk to your provider before starting or stopping any medications to help you understand all of the risks and make the safest choice for you and your pregnancy. To learn more about medication-assisted treatment for opioid use disorder and considerations in pregnancy, visit https://www.samhsa.gov/medication-assisted-treatment. Fetal or infant toxicology was reported in 24 of the pregnancies, and included positive findings for cocaine (n = 13), heroin (n = 1), and methamphetamine (n = 8) and one case wherein testing was negative for the relevant drug oxycodone, but the infant nonetheless displayed signs of withdrawal.31. Professional advocacy may best be directed at state legislatures. It found that parents face long wait lists when accessing substance use treatment services and often dont have the means to pay. Keywords: laws, policies, substance use, care, treatment, infants, neglect Created Date: 8/17/2022 9:48:14 PM Visitour state legislation trackerfor policy activity on all sexual and reproductive health topics. To learn about CDC activities to educate the public about the harms of tobacco use, visit Tips From Former Smokers (Tips) from the Office on Smoking and Health. Prosecutors have attempted to rely on a host of criminal laws already on the books to attack prenatal substance use. LEXIS 970 (Tenn. Crim. Another major concern is addressing the harm that a child of any age can \ suffer when a parent's use of alcohol or other substances leads to neglect of the child, or the child is exposed to illegal drug activity. Research projects funded by both state and federal agencies continue to examine effects of prenatal exposure on development, evaluate intervention programs, and describe the clinic population using comprehensive databases. All information these cookies collect is aggregated and therefore anonymous. Since the late 1980s, policymakers have debated the question of how society should deal with the problem of substance use during pregnancy. The Guttmacher Institute is registered as a 501(c)(3) nonprofit organization under the tax identification number 13-2890727. Based on results of this analysis, the authors jointly finalized the coding scheme, which was then applied to all of the identified cases. Consistent with guidance from the American College of Obstetricians and Gynecologists, CDC advises against using marijuana during pregnancy. Reproductive rights are under attack. The city of Savannah decriminalized the possession of marijuana, effective July 1, 2018. Convictions were upheld only in Alabama and South Carolina, involving a total of four women. In the medical model, treatment, not punishment, is the remedy to reduce consumption of substances during pregnancy.4 Medical and public health experts are widely opposed to efforts to criminalize substance use by pregnant women.5,,8, Reflecting societal uncertainty about the best approach, legal penalties for substance use during pregnancy because of harm to the fetus or child vary significantly among the states. Before sharing sensitive or personal information, make sure youre on an official state website. You will be subject to the destination website's privacy policy when you follow the link. App. 2005), Richards v. State, 2005 Tenn. Crim. "Opioids are what we worry about most," he explained. However, fentanyl has also been manufactured illicitly, and its distribution is on the rise. Facts are largely determined at the trial level. How some hospitals are drug testing new mothers without consent, How Alabamas meth lab law is unfairly punishing pregnant women, Mothers: tell us about drug testing at your hospital. Tennessee is the only state that has enacted a law that targets substance use by pregnant women on the basis of presumed harm to the fetus or child. Intellectual & Developmental Disabilities, Applications for New & Existing Providers, Improving Health Outcomes Initiative Collaborative Learning Center, How to Report a Concern or Complaint about the Quality of Care or Safety, Facebook page for Georgia Department of Behavioral Health and Developmental Disabilities, Twitter page for Georgia Department of Behavioral Health and Developmental Disabilities, Linkedin page for Georgia Department of Behavioral Health and Developmental Disabilities, The Maternal Substance Abuse and ChildDevelopment, Maternal Substance Abuse and Child Development Project. Stopping your medication suddenly could be harmful for you and your baby. *The Alabama Supreme Court held that drug use while pregnant is considered chemical endangerment of a child. -- A Tennessee woman is the first to be charged under a new state law that specifically makes it a crime to take drugs while pregnant . Psychiatrists should be involved with drug treatment courts to ensure that any court-compelled treatment meets the complex medical and psychosocial needs of pregnant women with substance use disorders. Ct. App. Arizona also has the strictest TANF timeline in the nation, kicking families off welfare after one year. Criminal Charges for Child Harm from Substance Use in Pregnancy, Journal of the American Academy of Psychiatry and the Law Online, Substance and shadow: women and addiction in the United States, Pregnancy and drug use: the dangerous and unequal use of punitive measures, Fetal protection laws: moral panic and the new constitutional battlefront, Clinical, ethical, and legal considerations in pregnant women with opioid abuse, American Academy of Pediatrics Committee on Substance Abuse, Council on Addiction Psychiatry, American Psychiatric Association, Position statement on the care of pregnant and newly delivered women addicts, ACOG Committee Opinion No 473. More concerning, limited evidence suggests that punitive polices may deter women from prenatal care.49,,51 These policies also disproportionately affect minority and poor women.15,52 For example, in one study, black women who tested positive for substances at birth were reported to authorities at about 10 times the rate of white women, despite similar rates of substance use.47 Advocates of the punitive approach assert that drug courts can be used to compel treatment for pregnant women with substance use disorders. Experts recognize that pregnancy and childbirth present an especially opportune moment to connect a woman with services, including substance use disorder treatmentyet threats of punishment onlyisolatepregnant women. Pregnancy. Twelve opinions noted that other jurisdictions ruled similarly when faced with such cases. The decisions do not go so far as to say that it would be unlawful for the legislature explicitly to prohibit substance use during pregnancy, although questions about the constitutionality of such an approach have been raised in the legal literature.2,3,20 Rather, most of the decisions simply found that the legislature did not intend for the existing criminal laws to apply to prenatal conduct. Quitting smoking is one of the most important ways you can protect your health and the health of your baby. Thank you for taking the time to confirm your preferences. Drug use during pregnancy is a severe problem worldwide because it exposes not only the woman but also her developing baby to harmful substances. Arizona's legislation, which became law in April, permits termination of a mother's parental rights, either immediately when her newborn is born or within one year of her newborn's birth, depending on how chronic the illicit drug use appears to the court. They also found that cocaine users were more likely to use alcohol or other drugs during pregnancy: 88 percent of pregnant cocaine users smoked, 80 percent consumed alcohol, 72 percent smoked marijuana, 14 percent used opiates and 9 percent used other illicit drugs. The search yielded 77 published cases, of which, on closer review, 16 were found to be relevant. 10 states prohibit publicly funded drug treatment programs from discriminating against pregnant people. An official website of the State of Georgia. The Florida Supreme Court found the medical testimony inadequate to support the trial court's finding that a delivery occurred during the birth process, even if the criminal statute had been applicable.29 In Arms v. State, Arms was also convicted of a drug delivery charge that was overturned by the state supreme court, in part on the grounds that the relevant statute, does not expressly criminalize the passive bodily processes that results in a mother's use of a drug entering her unborn, or newborn child's system.45. We conducted a LexisNexis search of published U.S. state and federal cases in these categories using the following search terms: pregnant OR pregnancy AND cocaine OR methadone OR heroin OR controlled substance OR methamphetamine OR narcotic AND child abuse OR child neglect OR child endangerment OR assault OR homicide OR murder OR manslaughter. In 2005, the Tennessee Court of Appeals overturned convictions based on guilty pleas for aggravated child abuse for methamphetamine use during pregnancy in two cases combined as Richards v. State.37 The judicial reasoning was that the women received ineffective assistance of counsel, in that their attorneys should have argued that their conduct fell outside the scope of the law, which at that time was intended to apply only to conduct that affected children, not fetuses. Further research is needed to better understand how marijuana may affect pregnant women and developing babies. MSACD is committed to raising the awareness of thedevastating effects of alcohol and other substances whenused during pregnancy. 2007), State v. Hudson, 2007 Tenn. Crim. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Opioid use disorder during pregnancy has been linked with serious negative health outcomes for pregnant women and developing babies, including preterm birth, stillbirth, maternal mortality, and neonatal abstinence syndrome (NAS). For example, pregnant women should drink less than 1 liter (about 3 cans) of diet soda per day. Eighteen states have laws that say drug use during pregnancy is child abuse. Prosecuting Women for Drug Use During Pregnancy: The Criminal Justice System Should Step Out and the Affordable Care Act Should Step Up. Illegal Drugs Marijuana (Cannabis) More research needs to be done on how marijuana use during pregnancy could impact the health and development of infants, given changing policies about access to marijuana, significant increases in the number of pregnant women seeking substance use disorder treatment for marijuana use, and confounding effects of polysubstance use. This claim also disregards the seriousgapsin access to treatment for substance use disorders, especially for poor people, and the absence of a social safety net to even support struggling families in the first place. More and more states are adopting drug testing for newborns because of the recent increase in opioid use . The use of tobacco and alcohol are common (these are discussed in Sections 12 and 13) but the use of illicit substances and the misuse of prescription medications is also important. Finally, a number of states have placed a priority on making drug treatment more readily available to pregnant individuals, which is bolstered by federal funds that require prioritized access to treatment programs for anyone who is pregnant. Applying CDCs Guideline for Prescribing Opioids: Substance Abuse and Mental Health Services Administration: American College of Obstetricians and Gynecologists (ACOG) Committee Opinion: The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. App. Thank you for your interest in recommending The Journal of the American Academy of Psychiatry and the Law site. She had given birth approximately one year earlier to a child who had also tested positive for cocaine. To receive email updates about this page, enter your email address: We take your privacy seriously. For example, a woman in New Jersey faced civil child abuse and neglect proceedings for complying with her doctor's recommendation to stay on methadone treatment while pregnant,57 the gold standard treatment for opioid dependency during pregnancy.53 The proceedings against her were ultimately thrown out by an appellate court. A newborn infant's death nearly 15 years ago is still causing a fierce legislative battle in Arizona and other states around the country. Fentanylis a prescription opioid that can be used to treat severe pain. Instead of punishing women for the chronic condition of addiction, something that is unethical, ineffective and inhumane, we should invest instead in the expansion of women- and family-friendly treatment resources, said Dr. Mishka Terplan, a professor in obstetrics and gynecology and psychiatry and associate director in addiction medicine at Virginia Commonwealth University. International Perspectives on Sexual and Reproductive Health (19752020), Perspectives on Sexual and Reproductive Health (19692020). The balance in the courts in favor of treating substance use during pregnancy as a medical problem depends on the definition of a child for the purposes of criminal statutes. Approximately 700 women in the United States die every year . These cases typically involve significant civil matters, such as termination of parental rights or civil commitment to inpatient treatment facilities.55,56 There are instances where women have faced civil complaints for behavior that is consistent with current standards of care for medical treatment of addictions. In three states Minnesota, South Dakota and Wisconsin women who use drugs during pregnancy can be involuntarily committed to a treatment program. Many substance use treatment centers do not offer MAT due to the stigma associated with it, and those centers that do provide MAT have not necessarily fulfilled their responsibility toprioritizepregnant women. All types of alcohol are equally harmful, including all wines and beer.
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