Talking points for meeting with legislators:

May 15, 2014

  1. The Tennessee bill and similar legislative proposals punishes pregnant women and their families because the mother suffers with drug addiction. We know that drug addiction is a physical and mental health condition, which if monitored by capable medical professionals, is often manageable. Cure of addiction spans well beyond the duration of the pregnancy. No one is “cured from drug use” and babies don’t escape injury due to these laws.
  2. Such legislation does not support a woman’s right to parent her child and raises serious constitutional concerns about equal treatment under the law for poor women, minority women, and other marginalized women.
  3. The major impact of these laws will be to harm babies by making pregnant women fear seeking medical care. They may forego receiving prenatal care, which is associated with increased risk of complications associated with delivery. If they do receive prenatal care, they may attempt to hide their drug use from their care providers. This may result in newborns with neonatal abstinence syndrome going unrecognized and untreated. It could also lead some women to have abortions to avoid criminal penalties or loss of custody of older children.
  4. The wording: “a child dependent on drugs” is very vague. It appears to make only the last few weeks of the pregnancy and the first two weeks of the neonatal period appear important. Furthermore, “drugs” may reflect any medication which crosses the placenta, including needed antidepressants, analgesics that are prescribed, and any medication that potentially may alter neonatal behavior.
  5. “Harm” is extremely vague. Will any birth defect in a baby born to a woman who uses drugs in pregnancy serve as motivation for termination of parental rights? Will premature delivery be seen as “harm” to the child, even if the birth defects and prematurity cannot be linked to the drug usage?
  6. Risks of narcotics to the newborn have probably been exaggerated. With proper management, symptoms of withdrawal can be effectively treated with no long-term adverse consequences. Long-term outcomes for opiate-exposed fetuses have been surprisingly positive, compared to fetuses exposed to alcohol during pregnancy.
  7. Many versions of such legislation do not distinguish patients who are in treatment programs vs the illicit user. Patients may be driven from the use of methadone and buprenorphine if such legislation is put in place. Furthermore, some opiate use is required for patients with chronic pain syndromes- chronic back pain, severe migraine headaches, fibromyalgia. Careful prescribing and monitoring of these patients leads to successful pregnancy outcomes.
  8. Current models of care of addicted pregnant women do not encourage sudden cessation of opiate use during pregnancy due to higher risks of miscarriage and stillbirth. Relapse risks are extremely high. Women should be encouraged to enroll in treatment programs such as methadone or buprenorphine clinics.
  9. The obstetric care provider, pediatrician, and hospital are placed in difficult positions balancing protection of their patients’ best interests and requirements for reporting. Will we face criminal penalties if we determine our patients should receive treatment instead of prosecution?
  10. Criminalization is a cost burden to taxpayers. Rehabilitation programs are a better investment of taxpayer dollars than incarceration. Estimated costs of treatment programs are a fraction of what it costs to incarcerate someone (about $54,800 compared to $517,000 per year). Our state’s economy will be stronger when parents have access to the health resources and education. Putting children in foster care is not only expensive, it can create worse mental health outcomes and further unravel the thread of pediatric and family development.
  11. Prosecutors should have no role in overseeing prenatal care. These laws don’t attempt to address well documented risks to pregnancy, such as alcohol, cigarettes, housing and nutritional insecurity.
  12. What is important is that we create environments where we are decreasing the stigma and the barriers for women who often have a lot of shame and guilt about their substance abuse disorders.
  13. It is understandable that the Legislature wants to provide assistance to help with the scourge of drug use in pregnancy. However, there are positive ways to provide this support.
  14. Provide additional financial support for drug treatment programs that provide support to pregnant women through outpatient and residential treatment facilities. These programs are habitually underfunded. Many hospitals have closed their programs due to the financial strain on institutional viability. No one gets rich providing drug treatment and rehabilitation!
  15. It is difficult to write legislation to ensure an adequate number of physicians and nurses who understand and treat drug addiction. It is upon the medical establishment’s shoulders to educate and train physician, nurses, and associate staff on pregnancy drug addiction best practices. There are many counties in the state of Wisconsin in which capable drug treatment is not available, particularly for pregnant women. Provide additional funding for education and training programs in drug treatment. Encourage training and education in drug abuse as part of licensure requirements has been utilized in many states.
  16. Encourage Child Protection Services and healthcare providers to form partnerships that attempt to focus first on treatment and only secondarily require separating families. Working together provides the best opportunity for best outcomes.
  17. Develop programs to allow women to receive vocational and educational assessment at our outstanding system of community colleges. Provide grants for training programs. Pregnancy alters a woman’s “life line”. This is the perfect time to show her a future that doesn’t involve drugs.
  18. Maintain an open dialogue with treatment experts and drug addicts to identify opportunities for improvement of our systems.