It is part of the non-profit Organization of Teratology Information Specialists (OTIS), a national information network. It found that parents face long wait lists when accessing substance use treatment services and often dont have the means to pay. If you or someone close to you needs help for a substance use disorder, talk to your healthcare provider or call SAMHSAs National Helpline at1-800-662-HELP. The federal Department of Health and Human Services recently released areportreviewing Kentuckys child welfare system. Fetal Assault Laws. Cookies used to make website functionality more relevant to you. Substance use in pregnancy is an important issue in antenatal care. Opioid use during pregnancy can affect women and their babies. 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. Good reproductive health policy starts with credible research. LEXIS 970 (Tenn. Crim. Such policies are rooted in stigma and gross indifference to what the best available science tells us about how to compassionately and effectively serve pregnant women struggling with drug use disorders and their families. Heavy use of marijuana - that is, marijuana with high amounts of THC - has been linked to decreased fertility in both men and women. The use of prescription drugs during pregnancy, excluding supplements, in Ethiopia was high. donate today. We developed categories of relevant variables to code a priori. This conclusion should not be a surprise, given that appellate decisions are based on interpretation of law, not facts. In males, marijuana is thought to decrease sperm quality and testosterone levels. Cocaine lingers in a fetus much longer than an adult and often 5-7 days after birth. Drug use during pregnancy is a severe problem worldwide because it exposes not only the woman but also her developing baby to harmful substances. 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. Support ProPublica's award-winning investigative journalism. Published on September, 30, 2015. Maternal Substance Abuse and Child Development Project | Georgia Department of Behavioral Health and Developmental Disabilities For access to services and immediate crisis help, call the Georgia Crisis & Access Line (GCAL) at 1-800-715-4225, available 24/7. Ct. App. 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. These 24 cases included 29 women in 19 states who were prosecuted for criminal charges related to harm to a fetus or child as a result of substance use during pregnancy. For tips and advice to quit smoking, you can also visit How to Quit and Pregnancy, Motherhood, and Smoking. Eighteen states have laws that say drug use during pregnancy is child abuse. Prescription Opioid Pain Reliever Use During Pregnancy, The US Opioid Crisis & Maternal Infant Health, Centers for Disease Control and Prevention. The substances related to the charges included cocaine, heroin, methamphetamine, marijuana, and prescription pills. 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. A number of states require health care professionals to report or test for prenatal drug exposure, which can be used as evidence in child-welfare proceedings. In Minnesota and North Dakota, a test is required if there are drug-related complications at birth. 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. Further, some states, under the rubric of protecting the fetus, authorize civil commitment (such as forced admission to an inpatient treatment program) of pregnant people who use drugs; these policies sometimes also apply to alcohol use or other behaviors. 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. Dr. Angelotta is Instructor of Psychiatry and Behavioral Sciences, Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL. Opioid use disorder among pregnant women is a significant public health concern in the United States. In totality, medical expertise seemed to play relatively little role in determining the outcome of most judicial decisions. More about smoking in pregnancy and drinking alcohol in pregnancy. 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. 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. 19 states have either created or funded drug treatment programs specifically targeted to those who are pregnant, and 17 states and the District of Columbia provide pregnant people with priority access to state-funded drug treatment programs. For example, onestudyfound that parents who use opiates find babies less cutewhile conceivably notable, this finding does not meet the legal standard for terminating a parents rights. Moreover, there is a great deal of overlap between drug use during pregnancy policies and alcohol/pregnancy policies. The child was placed with CPS and now is in the custody of the great grandmother. 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. Learn more about e-cigarettes and pregnancy. This isaccomplished through a statewide OBHP contract withEmory University. 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. 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. 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. In 2018, an estimated 12% of U.S. residents 18 years or older reported current unhealthy drug use in a national survey. 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. The South Carolina Supreme Court held that a viable fetus is a "person" under the state's criminal child-endangerment statute and that "maternal acts endangering or likely to endanger the life, comfort, or health of a viable fetus" constitute criminal child abuse. We reviewed legal decisions regarding women charged with a crime against a fetus or child as a result of substance use during pregnancy. These same legislators would be hard-pressed to take babies away from mothers who were struggling with medical treatment for hypertension or diabetes. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. Civil child abuse proceedings are explicitly permitted in 18 states.9 These may lead to termination of parental rights, but not to prison sentences. Since 1973, authorities in at least 45 states have tried to prosecute women for exposing unborn children to drugs. LEXIS 496 (Tenn. Crim. Disclosures of financial or other potential conflicts of interest: None. The Tips campaign features information about how smoking and secondhand smoking affect specific groups, including pregnant women or women planning to have a baby. While the findings varied dependent upon county, across the board, only 18 received any kind of rehab/treatment for drug abuse as . Exposing how the U.S. criminal legal system fails to keep people safe and perpetuates harm. SUBSTANCE USE DURING PREGNANCY CONSIDERED: WHEN DRUG USE DIAGNOSED OR SUSPECTED, STATE REQUIRES: Pregnant People Given Priority Access in General Programs, Pregnant People Protected from Discrimination in Publicly Funded Programs. "Among newborns exposed to opioids in utero, between 55 percent and 94 percent develop withdrawal signsand 30 to 80 . 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. The state legislature passed the law in 2014 explicitly to permit criminal assault charges for illicit substance use in pregnancy and, on conviction, imprisonment.10 The impetus for the law was rapidly rising rates of neonatal abstinence syndrome, an opioid withdrawal syndrome in infants that may require prolonged monitoring in intensive care units.12 The law expired on July 1, 2016, based on a sunset provision in the original bill.10 No other states have similar criminal statutes, but two other state legislatures recently debated criminalization to combat the opioid epidemic.13,14. That said, there are a few things you should know about "drugs-while-pregnant" law across the U.S.: Most states have tried, at one point or another, to prosecute women for drug use during pregnancy. Yet despite the country's best efforts to fight it, the problem is getting worse, and is exacerbated by the COVID-19 pandemic. Georgia Marijuana Statutes Federal Drug Laws. Despite progress in the criminal legal system, the drug war remains almost unchallenged in the child protection system, and it is wreaking havoc on families. For example, Amanda Kimbrough's child was born prematurely and died shortly after birth, having tested positive for methamphetamine. The infant was born prematurely. This means that first-time offenders will be issued an infraction (like a speeding ticket) instead of jail, with a maximum fine of $150. It's best not to stop abruptly without first seeking medical advice as there may be . 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. 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. by Leticia Miranda, Vince Dixon and Cecilia Reyes In three states Minnesota, South Dakota and Wisconsin women who use drugs during pregnancy can be involuntarily committed to a treatment program. 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. Those efforts continue under a wide variety of laws even in states where high courts have previously rejected the prosecution approach. Three of the nine mothers arrested that year tested positive for marijuana, and all were held on $100,000 bonds. Consistent with guidance from the American College of Obstetricians and Gynecologists, CDC advises against using marijuana during pregnancy. 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. Severalstudiesdocument that hospital staff disproportionately drug test and report to child protective services low-income women andwomen of color. 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. The South Carolina Supreme Court in McKnight v. State17 referenced its earlier decision in Whitner v. South State16 when it opined that, in several cases this Court has specifically held that the Legislature's use of the term child includes a viable fetus. The court also pointed out that, after the Whitner decision, the legislature did not modify the statute to exclude viable fetuses from its definition of child. A representative example of this due process reasoning was expressed by the court in State v. Martinez: To expand the ordinary meaning of this statute would deny Defendant reasonable notice that her actions were criminal, thereby violating her due process rights.39 Six courts held that allowing the contested statute to apply to prenatal drug use would in effect permit it to be applied to a range of prenatal conduct not previously considered illegal, in effect opening the floodgates to prosecution of pregnant women. Illegal drugs in pregnancy. Both stand to undermine the medical treatment of pregnant women with substance use disorders and potentially increase harm to mothers and children. There may be many more unpublished trial decisions, the dimensions of which we have no way of assessing. "Opioids are what we worry about most," he explained. Keywords: laws, policies, substance use, care, treatment, infants, neglect Created Date: 8/17/2022 9:48:14 PM 1. In the family court systems, there is no respect for medicine or science, she wrote. Reyes was charged with two counts of felony child endangerment for her heroin use 1991), People v. Hardy, 469 N.W.2d50 (Mich. Ct. App. 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. Given the opposition of medical and public health professionals to the criminalization of substance use during pregnancy, an understanding of both the range of criminal charges pregnant substance users may face and the role, if any, that medical expertise has played in the adjudication of these cases would inform understanding of the problem and of medical professional advocacy efforts. However, fentanyl has also been manufactured illicitly, and its distribution is on the rise. Those unable to pay may perform community service instead. Criminalization has taken many forms including, but not limited to, the passage of fetal assault laws, policies that punish or penalize pregnant people for substance use during pregnancy, and the practice of judicial intervention or legal attempts at coercion for refusal of care during pregnancy. 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. What if a pregnant woman drives over the speed limit, or as a matter of vanity doesn't wear the prescription lenses she knows she needs to see the dangers of the road? Before sharing sensitive or personal information, make sure youre on an official state website. State Policies on Substance Use During Pregnancy. Twelve opinions noted that other jurisdictions ruled similarly when faced with such cases. We did not examine judicial decisions regarding women who have faced civil child abuse proceedings related to prenatal substance use. Ct. App. Medical and public health experts who are desirous of seeing a greater focus on treatment of substance-abusing pregnant women must stay particularly alert to legislative efforts to expand the legal definition of a child to include fetuses or to define prenatal substance use explicitly as a form of child abuse. Tennessee is the only state with a statute that specifically makes it a crime to use drugs while pregnant. Kansas and Nebraska have no reporting or testing requirements, the survey says. She was charged with chemical endangerment of a child. More about medicines in pregnancy. Prenatal drug exposure may also contribute to long-term behavioral effects and developmental deficits. Cases of Women Charged With Child Abuse-Related Crimes for Substance Use During Pregnancy The substances related to the charges were cocaine ( n = 15), methamphetamine ( n = 10), heroin ( n = 2), marijuana ( n = 1), oxycodone ( n = 1), and unspecified prescription pills ( n = 1). In the three judicial opinions that upheld convictions, the court determined that the legislature intended to include fetuses in the definition of child for the purposes of the relevant statute. "Georgia Supreme Court Orders C-Section Mother Nature Reverses on Appeal." . Mar 02, 2022. The report pays particular attention to the impact of the 'chemical endangerment' law in Alabama, the state that has carried out the most prosecutions against pregnant women; and Tennessee's 'fetal assault' law, which between 2014 and 2016 made it a crime to give birth to a child showing symptoms of drug exposure. Criminalization of substance use during pregnancy because of harm to the fetus or child is fiercely debated. 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. Trainings on maternal substance abuse, child development, alcohol and other drug related effects are conducted for prevention providers. Aspartame. State laws now vary considerably in their approach to the problem, reflecting a deep division in public opinion. 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. 2005), Kilmon v. State, 905 A.2d 306, 314 (Md. Future professional advocacy efforts may be most beneficial when directed at state legislatures that are dealing with proposed statutes that address these questions. 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. Prescription opioids may be prescribed by doctors to manage moderate to severe pain. To view abstracts of recent publications in PubMed, see Prevalence and patterns of marijuana use among pregnant and nonpregnant women of reproductive age and Marijuana use during and after pregnancy and association of prenatal use on birth outcomes: A population-based study. 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. If youre using marijuana and are pregnant or are planning to become pregnant, talk to your healthcare provider. Convictions were upheld only in Alabama and South Carolina, involving a total of four women. To receive email updates about this page, enter your email address: We take your privacy seriously. 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. Additionally, e-cigarettes and other tobacco products containing nicotine (the addictive drug found in tobacco) are not safe to use during pregnancy. Tobacco and alcohol are the most commonly abused substances, followed by marijuana and cocaine. Later in the pregnancy, these illicit drugs may cause. 1995), State v. Dunn, 916 P.2d 952 (Wash. Ct. App. A total of 24 published judicial opinions met the inclusion criteria (Table 1). The Guttmacher Institute is registered as a 501(c)(3) nonprofit organization under the tax identification number 13-2890727. Some policymakers and law enforcement officials argue that criminal punishment deters substance use among pregnant women.1,,3 In contrast, the medical model of addiction views substance use disorders as chronic, relapsing diseases, with substance abuse during pregnancy an unfortunate, but common occurrence. Nicotine is a health danger for pregnant women and developing babies and can damage a developing babys brain and lungs. Opioids can be prescription or illicit. 10 states prohibit publicly funded drug treatment programs from discriminating against pregnant people. Prosecuting Women for Drug Use During Pregnancy: The Criminal Justice System Should Step Out and the Affordable Care Act Should Step Up. Along with counseling and behavioral therapy, opioid medications (buprenorphine, methadone, and naltrexone) may be used in medication assisted therapy (MAT) to treat opioid use disorder. App.3d 214 (Cal. MAT is the standard of care for treating people with opioid use disorder especially pregnant women, as quitting opioids too suddenly during pregnancy can result in complications. Quitting early or before pregnancy is best, but its never too late to quit smoking. An official website of the State of Georgia. In three of the cases in which medical expert testimony was referenced, the expert testimony was contradictory. Using illegal or street drugs during pregnancy, including cannabis, ecstasy, cocaine and heroin, can have a potentially serious effect on your unborn baby. Most states do not have a law that requires hospitals to test infants and new moms for controlled substances. While some papers estimate that 1-3% of birth defects are thought to be caused by medications taken during pregnancy, the authors could not find a source for this statement that was based on study d. Learn more at Alcohol Use in Pregnancy from the Division of Birth Defects and Infant Disorders. 24 states and the District of Columbia consider substance use during pregnancy to be child abuse under civil child-welfare statutes, and 3 consider it grounds for civil commitment. 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. Unless otherwise noted, you can republish our stories for free if you follow these rules. Hair has been recognized as a possible alternate test specimen, but wider acceptance of hair testing must await . Substance abuse reporting and pregnancy: the role of the obstetriciangynecologist, Board of Trustees, American Medical Association, Legal interventions during pregnancy: court-ordered medical treatments and legal penalties for potentially harmful behavior by pregnant women, Tennessee voices: drug use in pregnancy is an epidemic, Prenatal Drug Use/Criminal Offense S.B. So the very condition that Kentucky believes should trigger fast-tracked termination of parental rights is in fact often most effectively treated by close, consistent contact between the mother and newborn. A mother taking illegal drugs during pregnancy increases her risk for anemia, blood and heart infections, skin infections, hepatitis, and other infectious diseases. The Supreme Courts in Alabama and South Carolina have upheld convictions ruling that an individuals substance use in pregnancy constitutes criminal child abuse. Maternal Substance Abuse and Child Development Project Apr 20, 2022, M. Forrest Behne, Craig Waleed, Meghan Peterson, and Lauren Brinkley-Rubinstein 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.

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