In 2012, the Utah Legislature passed a law that any pregnant woman with a substance abuse disorder was guilty of child abuse. The intent of the law, of course, was to deter pregnant women from abusing opioids. But recent research points out possible unintended consequences of this legislation and provides an opportunity for lawmakers in the upcoming session to create more effective policies.
A study just conducted by the RAND Corporation (a nonprofit institution that helps improve policy and decision-making through research and analysis) analyzed eight states, including Utah, with punitive policies for drug-abusing pregnant women. The research was funded by the National Institute of Drug Abuse.
The RAND study states that punitive laws led to a roughly 30 percent higher rate of babies born with Neonatal Abstinence Syndrome, compared to states without such punitive policies against pregnant women. NAS is the term used to describe the terrible withdrawal a baby experiences when born to a mother who is opioid-dependent. The study reports that the odds of a baby’s being born with NAS were significantly greater in the year following the passage of the law and during subsequent years.
The study clearly demonstrates that not all efforts to curb opioid addiction and overdoses have had a positive impact. This may be due to policymakers' lack of accurate information — or their biases.
How best to address addictions has been the subject of long debate. Unfortunately, some people still believe that addictions are character flaws based on bad choices. From their perspective, the most effective method to address addiction is to treat those with the disease as criminals.
The truth is, addiction is a complicated, life-threatening disease. Treating people with the disease as criminals is the worst possible approach; the substance abuse treatment community has known this for years. For the first time, the RAND Corporation has provided evidence of how this applies to babies born to women who abuse opioids.
Most of the time, lawmakers do not evaluate the impact of policies after their adoption. There have been many policies over the past few years that were implemented by state legislatures, health care organizations and insurance companies that were intended to reduce harm from opioids. Almost no one has attempted to measure their unintended consequences.
In this case, we have an exception. The RAND study should provide Utah policymakers with insight on how to address the problem of substance abuse during pregnancy more effectively.
Threatening to punish a pregnant women doesn’t decrease the number of women who abuse drugs. However, it does scare many of them away from seeking the treatment they need and can deter pregnant mothers from seeking prenatal care.
Pregnant women who are opioid-dependent frequently use tobacco and other drugs that increase the risk of health problems to neonates. When these women do not seek prenatal care, it prevents health care providers from having an opportunity to address these problems. Increased cost of prolonged hospitalizations from NAS and poor prenatal care are also unintended consequences of deterring pregnant women who are abusing drugs from seeking help.
I am certain every policymaker wants to solve problems and not create harm for society. Therefore, perhaps the Utah Legislature should consider replacing the law with a policy that incentivizes pregnant women who are abusing drugs to seek prenatal care. That would be more sensible, evidence-based legislation.
Lynn Webster, M.D.
Lynn Webster, M.D., Salt Lake City, is vice president scientific affairs for PRA Health Sciences. The views expressed are his own.
