Although the intent of a recent Kentucky law is to protect neonates from the harmful effects of substance abuse during pregnancy, Rachel Keller Landis, MPP, argues that the rule is more likely to harm newborns. In an opinion piece published in the Lexington Herald Leader, she discusses her concerns about the rule and urges readers to request that their representatives reconsider the law.
As Landis explains in her opinion piece, Kentucky state lawmakers added a section to House Bill 1 that essentially expanded the definition of child abuse in the state to include neonatal abstinence syndrome, or NAS. HB 1 became law in July 2018. The law explicitly included NAS diagnosis as grounds for terminating parental rights.
The number of Kentucky babies born dependent on opioids has 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,” Landis writes.
Landis acknowledges that 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, Landis stresses that effective treatments for NAS exist. Additionally, research has demonstrated that laws which punish pregnant women for opioid use are ineffective at improving either the women’s health or that of their newborns. Instead, the laws 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,” Landis explains. “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.”
As Landis explains, 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,” Landis says.
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, the editorial explains. It lists many of the more than 20 national organizations have come out against this approach.
“Expanding the definition of child abuse in Kentucky to include NAS will not help Kentucky newborns,” Landis concludes. “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.”
Rachel Keller Landis, MPP, is currently a PhD student in the Health Policy track at The George Washington University Trachtenberg School of Public Policy and Public Administration’s Public Policy program. 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, DC.