AAP calls for public health approach to treat opioid-dependent pregnant women
A policy statement issued by the AAP has encouraged a public health approach to treat pregnant women with substance use disorder and decrease the risk for neonatal abstinence syndrome.
Supported as an educational tool by the American College of Obstetricians and Gynecologists, this policy statement opposes the use of criminal justice approaches to treating substance abuse in pregnancy.
“The issues surrounding substance abuse in pregnancy are complex and merit a thoughtful public health response focused on prevention, expansion of treatment to women with substance use disorder and improved funding for child welfare systems to improve the health of the substance-exposed mother-infant dyad,” Stephen W. Patrick, MD, MPH, FAAP, an assistant professor of pediatrics and health policy at Vanderbilt University School of Medicine, and colleagues wrote.
Although the researchers note that there is very little evidence that punitive approaches during pregnancy are ineffective and possibly harmful for both parent and child, “there has been a recent increase in the number of states passing and considering criminal prosecution laws that selectively target pregnant women with substance use disorders.”
In addition, the researchers acknowledged that pregnant women with substance use disorders may also avoid prenatal care for fear of being reported to the police or child protective services.
The policy statement provides recommendations on how to better treat substance use disorders in pregnant women:
- Treatment of pregnant women with substance use disorder requires a coordinated, evidence-based, public health approach.
- Primary prevention strategies should be bolstered to educate the public about the addictive potential of prescription opioids and enhance access to reproductive health services, including forms of contraception.
- Substance use screening of all pregnant women via validated screening tools such as questionnaires should occur at routine health care visits and throughout prenatal care regardless of race, age, ethnicity or socioeconomic status. If urine testing is needed, physicians must show reasonable efforts to obtain patient’s consent before collecting the sample.
- Access to medication-assisted treatment and gender-specific substance use programs that provide nonjudgmental, trauma-informed services should be improved.
- Health care providers caring for these patients should be aware of their state’s reporting mandates around illicit drug use and educate women prenatally about the requirements. In addition, states need to clarify which substances are required as mandated reporting and explicitly define the provider’s role in reporting.
- Social support services and child welfare systems need additional funding to ensure the safety of substance-exposed infants.
“The literature suggests that pregnancy can motivate women with substance use disorders to seek treatment,” the researchers wrote. “However, there remains a dearth of comprehensive treatment programs geared toward pregnant and parenting women. Only 19 states have treatment programs specifically designed for pregnant women. Furthermore, only 15% of current treatment centers across the country offer specific services for pregnant women with substance use disorders, and the majority of these are located in urban areas.” – by Ryan McDonald
Disclosure: The researchers report no relevant financial disclosures.