Pubdate: Mon, 28 Dec 2015
Source: Los Angeles Times (CA)
Copyright: 2015 Los Angeles Times


Pregnant Women Using Illegal Drugs Are Avoiding Prenatal Care for 
Fear of Facing Charges After Births.

As the abuse of opioids, including prescription painkillers and 
heroin, has risen in Tennessee, the number of babies born dependent 
on drugs has skyrocketed, increasing fifteen-fold during the last 10 
years. In an effort to combat this troubling trend, the state 
approved a controversial new law in 2014 to allow women who give 
birth to babies "harmed by" illegal drug usage to be charged with 
misdemeanor assault.

Under the law, "harm" can mean various things, but the impetus for it 
was the number of babies being diagnosed with neonatal abstinence 
syndrome - a painful but treatable condition whose long-term effects 
have yet to be determined. Other states have found ways to prosecute 
pregnant women for harming their newborns through drug use, but 
Tennessee is the first state to pass a specific law allowing women to 
be charged with a crime if their children are born drug-dependent.

Legislators saw the law as a way to push women into getting 
treatment. But that's not what is happening, say critics, including 
the American Civil Liberties Union of Tennessee and the Tennessee 
Assn. for Alcohol, Drug and other Addiction Services. They say the 
law has had the perverse effect of making pregnant women afraid to 
get prenatal care, lest they be arrested down the road. Some have 
avoided Tennessee hospitals altogether, leaving the state or even, in 
some cases, giving birth in cars.

The evidence may be anecdotal, but it's plentiful. Jessica Young, a 
physician who runs the Obstetrics Drug Dependency Clinic at 
Vanderbilt University, says patients regularly tell her that they 
have tried to detox on their own (not medically advised for pregnant 
users) and have avoided seeing a doctor for prenatal care for fear of 
having their addiction revealed. Some only relented and showed up at 
her clinic late in their pregnancies - or when they were in labor. Or 
some women come to Young for treatment through their pregnancies and 
then deliver elsewhere in what Young suspects is an attempt to avoid 
being identified as a drug abuser.

As of early this year, 30 women had been arrested under the law. Only 
one spent time in jail. Many of the others went through drug treatment.

The American Medical Assn. is on the record opposing the 
criminalization of maternal drug addiction. And the American College 
of Obstetricians and Gynecologists issued an opinion in 2011 stating 
that jail or the threat of jail was "ineffective" in reducing alcohol 
and drug abuse.

And not every drug-using pregnant woman is a law breaker. Some are 
taking painkillers or antidepressants under a doctor's care. Others 
are in recovery programs taking methadone or buprenorphine. But 
taking any of these drugs regularly, whether legally or illegally, 
gives the baby a 50% chance of being diagnosed with neonatal 
abstinence syndrome. Under the Tennessee law, a mother can defend 
herself by saying she was legally taking the drugs, but she might be 
charged first and then have to go to court to exonerate herself. That 
seems not only unfair, but needlessly costly for the defendants, 
courts and taxpayers. Of 895 reported cases of neonatal abstinence 
syndrome reported this year in Tennessee, about half the mothers were 
only using drugs that had been prescribed for them.

But here is the biggest problem with this law: There's not enough 
space in Tennessee's drug treatment programs to accommodate all the 
women currently seeking treatment. Of the 39 licensed residential 
detox facilities in Tennessee, only 11 take pregnant women. What's 
more, methadone programs do not accept Tennessee's version of 
Medicaid. Treatment with buprenorphine - another drug used to wean 
people off narcotics - is covered by Medicaid, but there are not 
enough doctors certified to prescribe it to meet the current need.

When the law was passed last year, legislators set it to expire in 
July 2016 so they could reevaluate it. That was wise. In their 
upcoming legislative session, they should let the law sunset and 
concentrate on expanding the availability of treatment rather than on 
locking up addicts with children. The best way for Tennessee and 
other states to get pregnant addicts into treatment is to make it 
easier for them to find it, not to incarcerate them if they don't.
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