Establishes requirements for health care providers to encourage and facilitate drug counseling. If a woman is drinking alcohol during pregnancy, it is never too late to stop. There are several limitations to this study. Many advocates I interviewed in the course of my own research on this subject described the surveillance of pregnancies and non-consensual drug testing performed on pregnant women and their newborns as comparable to stop-and-frisks for young men of color. An obvious example is the recent Tennessee law that explicitly made illicit drug use during pregnancy a form of criminal assault. The city of Savannah decriminalized the possession of marijuana, effective July 1, 2018. It is, however, not known how many women, if any, have been convicted at the trial court level and not had their case heard at the appellate level. The apparent lack of a link between the proscribed conduct and a distinct harm in a large number of the cases is one example of this significant limit to the rationale for criminalization. Three of the nine mothers arrested that year tested positive for marijuana, and all were held on $100,000 bonds. 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. Opioid use disorder among pregnant women is a significant public health concern in the United States. We identified 24 judicial opinions published between 1977 and 2015 in cases involving 29 women prosecuted in 19 states. State Responses to Substance Abuse Among Pregnant Women, Concerns Mount over Punitive Approaches to Substance Abuse Among Pregnant Women. Neonatal abstinence syndrome . Drug use is an uncommon cause of birth defects, yet approximately 200,000 children (3-5% of live births) are born with birth defects each year. In 2018, an estimated 12% of U.S. residents 18 years or older reported current unhealthy drug use in a national survey. 1977), State v. Gethers, 585 So.2d 1140, 1143 (Fla. Dist. The substances being abused during pregnancy can include alcohol, cocaine, heroin, and opioid addiction. The groups listed below help people with drug abuse. In all of the cases, the judicial decision depended on the disposition of the question of whether, for the purpose of adjudicating the criminal charges, a fetus is a child. 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. Before sharing sensitive or personal information, make sure youre on an official state website. Significantly higher numbers come from the Centers for Disease Control, which in 2019 reported that some 16% of pregnant women . Comparisons of drug laws to alcohol laws show that the policy trajectories started in opposite directions, but by 2016, the results were the same: Punitive policies were more prevalent than supportive policies across states. This isaccomplished through a statewide OBHP contract withEmory University. Arizonaslegislation, which became law in April, permits termination of a mothers parental rights, either immediately when her newborn is born or within one year of her newborns birth, depending on how chronic the illicit drug use appears to the court. Wisconsin provides priority access to pregnant people in both general and private programs. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. 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. Trainings on maternal substance abuse, child development, alcohol and other drug related effects are conducted for prevention providers. Heroin is an illicit opioid. Key takeaways: In some states in the U.S., healthcare providers are required by law to report substance use during pregnancy. In the family court systems, there is no respect for medicine or science, she wrote. Unless otherwise noted, you can republish our stories for free if you follow these rules. Future professional advocacy efforts may be most beneficial when directed at state legislatures that are dealing with proposed statutes that address these questions. 1992), Johnson v. State, 602 So.2d 1288 (Fla. 1992), State v. Gray, 584 N.E.2d 710 (Ohio 1992), Commonwealth v. Welch, 864 S.W.2d 280, 283 (Ky. 1993), Sheriff, Washoe County, Nevada v. Encoe, 885 P.2d 596 (Nev. 1994), Collins v. State, 890 S.W.2d 893 (Tex. Through these efforts, the Center for MSACD continues to be a valuable resource to individuals, parents, and professionals in Georgia and the Southeast. In totality, medical expertise seemed to play relatively little role in determining the outcome of most judicial decisions. 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. A neonatologist who was an expert witness for the defense testified that the cocaine derivatives present in the children's urine were from exchange between the womb and placenta during pregnancy and that only a tiny amount of cocaine derivative could have passed through the umbilical cord during the 30- to 60-second period after the child was born and before the umbilical cord was cut. 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. In 2014, Tennessee became the first (and only) state to pass a law that criminalized drug use during pregnancy, after a district court judge added an additional six years to the prison sentence of a woman who had been involved in a methamphetamine manufacturing operation while pregnant. 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. Abstract. However, pregnant women with a disease called phenylketonuria shouldn't eat or drink aspartame. This means that first-time offenders will be issued an infraction (like a speeding ticket) instead of jail, with a maximum fine of $150. At least two states, Arizona and Kentucky, have just made it easier to terminate the rights of mothers who use controlled substances while pregnant. Critics argue law will deter women from seeking treatment. 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. State laws now vary considerably in their approach to the problem, reflecting a deep division in public opinion. Because drug use during pregnancy can potentially harm a fetus, federal law requires state CPS agencies maintain a protocol for when babies are born with drugs in their system or showing drug withdrawals. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Visitour state legislation trackerfor policy activity on all sexual and reproductive health topics. Although pregnancy is an exciting time, there are stresses and risks that come with pregnancy and the postpartum period. MSACD is committed to raising the awareness of thedevastating effects of alcohol and other substances whenused during pregnancy. "Opioids are what we worry about most," he explained. CDC twenty four seven. With the U.S. Supreme Court considering a high-profile case involving the prosecution of pregnant substance abusers, policymakers and advocates once again are confronted with the decade-old question of how best to deal with pregnant women who use drugs. Fetal Assault Laws. Illegal drugs in pregnancy. Consistent with guidance from the American College of Obstetricians and Gynecologists, CDC advises against using marijuana during pregnancy. Three courts stated that permitting prosecutions under the contested statute was counterproductive to state policy goals and public health. More mothers may soon know M.s pain. These may include the medical model of substance use disorders,4 racial disparities in substance use screening and reporting in pregnancy,47 and the difficulty of attributing a particular birth outcome to a single cause.48, Criminalization of pregnant women for substance abuse is fraught with problems related to conceptual and practical implementation, even if in theory one believes that substance use in pregnancy is both a moral dilemma and a medical problem. The implication for medical experts is that advocacy efforts may be most useful when focused on state legislatures that are contemplating policies to reduce harms associated with prenatal substance abuse. Dehumanizing Discourse, Anti-drug Law, and Policy in America: A "Crack Mother's" Nightmare . by Leticia Miranda, Vince Dixon and Cecilia Reyes An official website of the State of Georgia. Thank you for taking the time to confirm your preferences. Disclosures of financial or other potential conflicts of interest: None. To receive email updates about this page, enter your email address: We take your privacy seriously. 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. Fentanylis a prescription opioid that can be used to treat severe pain. Hence, health care providers should select relatively safe drugs. 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. Community after community has seen this in the aftermath oflocal crackdownson drug-using pregnant womenfewer women seek prenatal care and substance use treatment, even after the local authorities decide to change course. Establishes requirements for health care providers to encourage and facilitate drug counseling. Will you help us fight back with facts? Those unable to pay may perform community service instead. As part of CDCs efforts to prevent overdoses and substance use-related harms, CDC is taking specific actions to prevent opioid use disorder among pregnant women and women who could become pregnant and to make sure women with opioid use disorder get proper treatment. Drug use during pregnancy is a severe problem worldwide because it exposes not only the woman but also her developing baby to harmful substances. Local, state, and federal government websites often end in .gov. This helps clinicians better understand the prevalence of marijuana use as they care for their pregnant patients and provide screening and treatment. Support ProPublica's award-winning investigative journalism. In Minnesota and North Dakota, a test is required if there are drug-related complications at birth. Those efforts continue under a wide variety of laws even in states where high courts have previously rejected the prosecution approach. If youre using marijuana and are pregnant or are planning to become pregnant, talk to your healthcare provider. The legislators behind these laws are essentially creating a capital offense for women who give birth despite having used an illegal drug, said Erin Miles Cloud, a senior attorney at the Bronx Defenders Family Defense Practice, who has represented numerous parents facing termination of parental rights proceedings. Drug abuse has a long and storied history in the United States, and we've been "at war" with it since 1971 under the Nixon administration. A newborn infant's death nearly 15 years ago is still causing a fierce legislative battle in Arizona and other states around the country. Copyright 2023 by The American Academy of Psychiatry and the Law. Maternal Substance Abuse and Child Development Project Such inhumane responses to drug use can only exist because they are almost exclusively reserved for poor people and people of color. Learn more at Alcohol Use in Pregnancy from the Division of Birth Defects and Infant Disorders. Aspartame. MSACD collaborates with Georgias Alcohol Prevention Providers and their communities in all six of Georgias regions to raise awareness about alcohol and substance abuse among pregnant women. Twelve opinions noted that other jurisdictions ruled similarly when faced with such cases. The Guttmacher Institute is registered as a 501(c)(3) nonprofit organization under the tax identification number 13-2890727. 2006), State v. Wade, 232 S.W.3d 663, 665 (Mo. Millions ofparentswho use drugs or have substance use disorders parent their children well. 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. 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 . Eighteen states have laws that say drug use during pregnancy is child abuse. State legislators, law enforcement officials, and physicians have struggled to reach consensus on how to identify, treat, and possibly punish women who abuse illegal substances during pregnancy. Keywords: laws, policies, substance use, care, treatment, infants, neglect Created Date: 8/17/2022 9:48:14 PM Using illegal drugs during pregnancy is dangerous for an unborn baby and the mother. While the findings varied dependent upon county, across the board, only 18 received any kind of rehab/treatment for drug abuse as . 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. MSACD has currently established relationships with at least one community in every region across the state. Supporters of these laws justify the surveillance, policing, and punishment of drug-using mothers by referencing two assumptions that were touted and then discredited during and after thecrack baby scare. 2007), State v. Geiser, 763 N.W.2d 469 (N.D. 2009), Cochran v. Commonwealth, 315 S.W.3d 325 (Ky. 2010), State v. Stegall, 828 N.W.2d 526 (N.D. 2013), Arms v. State, 471 S.W.3d 637 (Ark. 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. Laws on drug testing of infants and new mothers vary, but the stakes are always high. The following information can help you understand [] In that way, this legislations attempt to punish mothers and fathers acts as a civil death penalty for families, for which children will pay the ultimate price.. 96 A 2017 opinion posted by . Fifteen states have laws requiring health care workers to report to authorities if they suspect a woman is abusing drugs during pregnancy. Tobacco and alcohol are the most commonly abused substances, followed by marijuana and cocaine. LEXIS 970 (Tenn. Crim. If you or someone you know has a drug problem, seek help. Approximately 700 women in the United States die every year . The court also referred to rulings by appellate courts in other jurisdictions that had held similarly in comparable cases. The Guttmacher Institute, which researches reproductive health issues, says 18 states consider abusing substances during pregnancy to be child abuse under civil child welfare laws, and Tennessee . Thus, it is not clear whether racial or economic bias is a factor in these cases. For each case, we recorded the charges, the substance abused, neonatal outcome, legal resolution of the case, and judicial reasoning. Although briefs from medical or public health organizations supporting the defendants' position were submitted to the court in 29 percent of the cases (n = 7), only one majority ruling directly referenced a medical or public health organization amicus brief. Reyes was charged with two counts of felony child endangerment for her heroin use This is a sad situation. To date, the United States Supreme Court has declined to hear cases that raise questions about the constitutionality of such laws. Cocaine lingers in a fetus much longer than an adult and often 5-7 days after birth. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 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. [I]t would be an anomaly, indeed, if the law were such that a pregnant woman who, by ingesting drugs, recklessly caused the death of a viable fetus would suffer no criminal liability for manslaughter but, if the child was born alive and did not die, could be imprisoned for five years for reckless endangerment [Ref. Prescription opioids may be prescribed by doctors to manage moderate to severe pain. Prosecuting Women for Drug Use During Pregnancy: The Criminal Justice System Should Step Out and the Affordable Care Act Should Step Up. Thank you for your interest in recommending The Journal of the American Academy of Psychiatry and the Law site. All information these cookies collect is aggregated and therefore anonymous. 2005), Richards v. State, 2005 Tenn. Crim. (3) It often relies on caseworker-confirmed reports of child maltreatment, despite thewell-documentedpropensity of caseworkers and family courts to base findings of child neglect on evidence of drug use alone. 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. July 14, 2014 -- Though the first mother has been charged under a new Tennessee law that makes it a crime to use drugs while pregnant, many of the most respected medical groups have opposed . 1. 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. Getty Creative. Neonatal exposure to some drugs during pregnancy can have harmful effects on development and may lead to acute adverse events, including neonatal abstinence syndrome (NAS) and infant mortality. Several methods of drug testing are efficacious in identifying and monitoring drug use during pregnancy. Marijuana use during and after pregnancy and association of prenatal use on birth outcomes: A population-based study. 31]. State law prohibits a medical provider from releasing information about a pregnant individuals drug or alcohol test without the patients consent. 488. first criminal charges brought against a woman for using drugs during pregnancy came in 1977 against Margaret Reyes. Kentuckyslegislation, which also became law last month, permits termination of a mothers parental rights if her newborn exhibits signs of withdrawal, known as neonatal abstinence syndrome, as the result of illicit opioid use, unless the mother is in substantial compliance with both a drug treatment program and a regimen of postnatal care within 90 days of giving birth. Women might use opioids as prescribed, misuse prescription opioids, use illicit opioids such as heroin, or use opioids (opioid agonists and/or antagonists) as treatment for opioid use disorder. 1 Unhealthy drug use is more commonly reported by young adults aged 18 to 25 . 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. "Among newborns exposed to opioids in utero, between 55 percent and 94 percent develop withdrawal signsand 30 to 80 . In the 22 judicial opinions wherein charges were dismissed or convictions overturned, all held that the legislature did not intend to include fetuses in the definition of a child or victim in the relevant statute. More and more states are adopting drug testing for newborns because of the recent increase in opioid use . A recent addition to the Center is Mother To Baby Georgia, a service providing evidence-based information to women about exposures to medications and other substances during pregnancy. DRH presents state and national estimates of marijuana use among pregnant women. 1. Facts are largely determined at the trial level. Despite several phone calls to treatment providers in her county and surrounding counties, M. could not find a provider who was willing to accept her.