Tuesday, May 17, 2022

Policies That Criminalize Perinatal Substance Use Linked to Poor Outcomes in Mothers

State policies that criminalize or punish pregnant women and adolescent girls for prenatal substance abuse may have a negative impact on outcomes such as opioid overdose and seeking treatment for opioid use disorder (OUD), a study in the Journal of Substance Abuse Treatment has found. The study also found that state policies that support treatment and early intervention may result in better outcomes for pregnant women and adolescent girls.

Angélica Meinhofer, Ph.D., of Weill Cornell Medicine and colleagues analyzed data from 164,538 females between the ages of 15 and 45 years who had a diagnosis of OUD between 2006 and 2019, of which 13% were pregnant at least once during that time. The researchers compared changes in outcomes in pregnant women and adolescent girls in states with and without a prenatal substance use policies, before and after the implementation of the policies. They defined punitive policies as those that criminalize prenatal substance use (that is, defining prenatal substance exposure as child maltreatment in child welfare statutes or as grounds for termination of parental rights) or use other punitive approaches. They defined supportive prenatal substance use policies as those policies that create or fund targeted substance use disorder (SUD) treatment programs specifically for pregnant females or make SUD treatment for pregnant females a priority.

The researchers found that after states implemented punitive policies, the proportion of pregnant females receiving psychosocial services for SUD and methadone services decreased. Furthermore, opioid overdoses increased 45% in states that implemented policies that criminalize pregnant females for using substances. In contrast, following the implementation of supportive policies that fund targeted SUD programs for pregnant females, the proportion of opioid overdoses decreased 45% and the proportion of pregnant females taking any medication for the treatment of OUD increased 11%. However, the researchers found that policies that made SUD treatment for pregnant females a priority were not associated with statistically significant changes in outcomes such as use of medications for OUD.

“[O]ur findings highlight the nation’s trend toward more punitive [policies] as a cause of concern, as our findings suggest that some punitive policies may negatively impact perinatal health outcomes,” the researchers wrote. “Our findings support the recommendations made by leading medical organizations who oppose punitive policies and emphasize efforts that focus on rehabilitation and treatment to minimize adverse health outcomes associated with substance use disorder.”

For related information, see the Psychiatric News article “Statutes Prosecuting Pregnant Women with OUD May Backfire.”

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