Thank you for your interest in recommending The Journal of the American Academy of Psychiatry and the Law site. Psychiatrists should be involved with drug treatment courts to ensure that any court-compelled treatment meets the complex medical and psychosocial needs of pregnant women with substance use disorders. 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. Cases wherein charges resulted in civil proceedings only (e.g., custody proceedings) were not included. Arizona also has the strictest TANF timeline in the nation, kicking families off welfare after one year. Several leading medical organizations opposed the legislation and cautioned that it would have a negative public health effect of scaring women away from seeking medical help. Cases were decided by state supreme courts (n = 15) and state courts of appeals (n = 14). The vast majority ofTemporary Assistance for Needy Families (TANF) funding, or federal welfare dollars meant to help the poor, is not spent on assistance to poor families, but rather on placing and keeping children in the foster care system. 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). 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. Arizonaslegislation, which became law in April, permits termination of a mothers parental rights, either immediately when her newborn is born or within one year of her newborns birth, depending on how chronic the illicit drug use appears to the court. Clear evidence suggests that recognizing the substance exposed infant and . At the present time, the Center for MSACD fulfills several roles in Georgia by sponsoring clinical, prevention, and research programs. LEXIS 496 (Tenn. Crim. In Kilmon v. State, the court said, 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. At issue is whether the continued drug use of a newborn's mother is tantamount to "child abuse" that would give child protective services workers and law enforcement officers the ability to remove the child from the mother's care - even if the . 2005), Kilmon v. State, 905 A.2d 306, 314 (Md. The number of pregnant women with opioid use disorder at labor and delivery more than quadrupled from 1999 to 2014, according to a recent CDC analysis. 2015), The prevalence of illicit-drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida, Substance use during pregnancy and postnatal outcomes, Punishing pregnant drug users: enhancing the flight from care, Women's perspectives on screening for alcohol and drug use in prenatal care, Drug use and limited prenatal care: an examination of responsible barriers, Universal screening for alcohol and drug use and racial disparities in child protective services reporting, The American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women and American Society of Addiction Medicine, Committee Opinion No 524. She was charged with chemical endangerment of a child. If you are pregnant or trying to get pregnant and cannot stop drinking, get help. by Leticia Miranda, Vince Dixon and Cecilia Reyes Theresearchis also clear that the results of a drug test alone are not an appropriate proxy for determining parental fitness. With the U.S. Supreme Court considering a high-profile case involving the prosecution of pregnant substance abusers, policymakers and advocates once again are confronted with the decade-old question of how best to deal with pregnant women who use drugs. 10 states prohibit publicly funded drug treatment programs from discriminating against pregnant people. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. 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. How you know. In 2014, Tennessee made national news when it became the first state in the country to pass a law specifically making it a crime to use drugs while pregnant. She struggled every day with the unimaginable pain and grief of separation from her newborn. Despite a lack of criminal statutes specifically targeting substance use by pregnant women in other states, women have been charged and, infrequently, convicted of a range of criminal offenses for illicit substance use while pregnant, including child abuse, assault, manslaughter, and murder.15 In two states, South Carolina and Alabama, these convictions have been upheld by the state supreme court.16,,18 The effect of these rulings is to permit women to be convicted for substance use during pregnancy under existing laws that are not specific to pregnancy. In other instances, where medical expertise was referenced, it did not necessarily support the defendants' position. remove barriers to pregnant women with substance use disorders from getting evidence-based treatment that's tailored to their unique needs. Otherstudieshave found that babies exposed to cocaine in utero perform better on several developmental measures when left with their mothers than do those removed to foster care. Studies show when a pregnant woman uses illegal drugs during pregnancy it can result in miscarriage, low birth weight, premature labor, placental abruption, seizures, respiratory problems, feeding difficulties, and death of the baby and the mother. Nicotine is a health danger for pregnant women and developing babies and can damage a developing babys brain and lungs. Georgia drug possession laws treat the crime very seriously and a conviction for possession of even a small amount of an illegal drug can subject you to serious penalties. My distant cousin is a meth addict. Medical and public health authoritieswarn that women who fear losing their babies upon seeking medical care will bedeterredfrom seeking the care they need. Substance use providers that accept Medicaid must give pregnant people priority in accessing services. The Wisconsin law is especially draconian: A woman can be detained against her will for the duration of her pregnancy, her fetus has its own court-appointed lawyer, she can lose custody of her baby after birth and the proceedings are mostly secret. 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. The laws can vary widely from state to state in terms of reporting requirements and consequences of reporting. It is part of the non-profit Organization of Teratology Information Specialists (OTIS), a national information network. We identified 24 judicial opinions published between 1977 and 2015 in cases involving 29 women prosecuted in 19 states. Smoking during pregnancy increases the risk of health problems for developing babies, including preterm birth, low birth weight, and birth defects of the mouth and lip. Every pregnant woman facing substance use disorder deserves to get the help she needs so that she and her infant have the best possible chance to thrive. 1994), Reinesto v. Superior Court, 894 P.2d 733 (Ariz. Ct. App. As of last year, they were still apart, and M. has since lost touch with her lawyer. donate today. Terminating a mothers rights to her newborn is an especially brutal drug war tactic that research and experience show will inflict far more harm than good on the children and families it allegedly aims to protect. Cookies used to make website functionality more relevant to you. Abstract. We also identified judicial references to expert or fact witness medical testimony and to medical literature or medical or public health-related amicus briefs. Women might use opioids as prescribed, misuse prescription opioids, use illicit opioids such as heroin, or use opioids (opioid agonists and/or antagonists) as treatment for opioid use disorder. Such laws may discourage people from seeking prenatal care. Under states child abuse law, a parent is considered unfit if they test positive for substances within eight hours after delivery and have previously been convicted of child abuse or neglect or if they failed to complete a drug treatment program recommended by Child Protective Services. There may be many more unpublished trial decisions, the dimensions of which we have no way of assessing. Source: ProPublica research by Leticia Miranda and Christine Lee; Guttmacher Institute; National Advocates for Pregnant Women. In the medical model, treatment, not punishment, is the remedy to reduce consumption of substances during pregnancy.4 Medical and public health experts are widely opposed to efforts to criminalize substance use by pregnant women.5,,8, Reflecting societal uncertainty about the best approach, legal penalties for substance use during pregnancy because of harm to the fetus or child vary significantly among the states. Defense attorneys who represent women charged for prenatal conduct may benefit from resources that clarify the relevant medical concerns. Smoking during and after pregnancy also increases the risk of sudden infant death syndrome (SIDS). On June 13, 1997, the governor of Tennessee signed House Bill 1413, making it a Class A misdemeanor for child abuse where: (1) a woman consumes alcohol or illegal drugs during pregnancy with knowledge or the reason to know that such consumption may result in harm to her child; and (2) the child is born addicted to alcohol or drugs. Learn about the Division of Reproductive Healths efforts to address opioid use disorder to improve maternal and infant health. State law prohibits a medical provider from releasing information about a pregnant individuals drug or alcohol test without the patients consent. Babies exposed to cocaine in the womb have a 25 percent increased chance of being born premature. All types of alcohol are equally harmful, including all wines and beer. While a robust body of literature supports a causal connection between prenatal exposure to alcohol or tobacco (or lead or poverty for that matter) and negative postnatal health outcomes, thescientific literaturehas not conclusively demonstrated any long-term negative effect of prenatal exposure to opioids. In Tennessee, this law carries a maximum penalty of 15 years in prison. "Complex Calculations: How Drug Use during Pregnancy Becomes a Barrier to Prenatal Care." . The infant was born prematurely. Millions ofparentswho use drugs or have substance use disorders parent their children well. Since the late 1980s, policymakers have debated the question of how society should deal with the problem of substance use during pregnancy. The Florida Supreme Court found the medical testimony inadequate to support the trial court's finding that a delivery occurred during the birth process, even if the criminal statute had been applicable.29 In Arms v. State, Arms was also convicted of a drug delivery charge that was overturned by the state supreme court, in part on the grounds that the relevant statute, does not expressly criminalize the passive bodily processes that results in a mother's use of a drug entering her unborn, or newborn child's system.45. State legislators, law enforcement officials, and physicians have struggled to reach consensus on how to identify, treat, and possibly punish women who abuse illegal substances during pregnancy. More concerning, limited evidence suggests that punitive polices may deter women from prenatal care.49,,51 These policies also disproportionately affect minority and poor women.15,52 For example, in one study, black women who tested positive for substances at birth were reported to authorities at about 10 times the rate of white women, despite similar rates of substance use.47 Advocates of the punitive approach assert that drug courts can be used to compel treatment for pregnant women with substance use disorders. Priority applies to pregnant people referred for treatment. The implication for medical experts is that advocacy efforts may be most useful when focused on state legislatures that are contemplating policies to reduce harms associated with prenatal substance abuse. (3) Georgia Marijuana Statutes Exposing how the U.S. criminal legal system fails to keep people safe and perpetuates harm. About half of the states treat drug use during. App. This conclusion should not be a surprise, given that appellate decisions are based on interpretation of law, not facts. 1991), State v. Luster, 419 S.E.2d 32 (Ga. Ct. App. Under states child abuse law, a parent is considered unfit if they test positive for substances within eight hours after delivery and have previously been convicted of child abuse or neglect or if they failed to complete a drug treatment program recommended by Child Protective Services. App. Establishes requirements for health care providers to encourage and facilitate drug counseling. Aspartame. Using these drugs during pregnancy may affect your baby's growth and puts you at higher risk of miscarriage, early labour, and placental abruption, where the placenta comes away from the wall of the womb . To learn about CDC activities to educate the public about the harms of tobacco use, visit Tips From Former Smokers (Tips) from the Office on Smoking and Health. Disclosures of financial or other potential conflicts of interest: None. Later in the pregnancy, these illicit drugs may cause. Drug abuse has a long and storied history in the United States, and we've been "at war" with it since 1971 under the Nixon administration. It found that parents face long wait lists when accessing substance use treatment services and often dont have the means to pay. You can also go to SAMHSAs Behavioral Health Treatment Services Locator. 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. Maternal deaths in the United States are increasing. 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. Prosecuting Women for Drug Use During Pregnancy: The Criminal Justice System Should Step Out and the Affordable Care Act Should Step Up. The first case was adjudicated in 1977 and the last case in 2015. More and more states are adopting drug testing for newborns because of the recent increase in opioid use . They help us to know which pages are the most and least popular and see how visitors move around the site. Across the country, hundreds of pregnant women and new mothers have been accused of child abuse or other crimes when they or their newborns tested positive for controlled substances. State Responses to Substance Abuse Among Pregnant Women, Concerns Mount over Punitive Approaches to Substance Abuse Among Pregnant Women. No adverse neonatal outcomes were reported in 41 percent of the pregnancies in this study. You can review and change the way we collect information below. Drug Use by State: Problem Areas. These same legislators would be hard-pressed to take babies away from mothers who were struggling with medical treatment for hypertension or diabetes. Although this may be the case, the medical care mandated by many drug treatment courts falls well below the standard of care required for some pregnant women.53,54, Of note, the cases loosely reflect epidemiological trends in patterns of drugs of choice. To learn more about medication-assisted treatment for opioid use disorder and considerations in pregnancy, visit https://www.samhsa.gov/medication-assisted-treatment. Fifteen states have laws requiring health care workers to report to authorities if they suspect a woman is abusing drugs during pregnancy. Not coincidentally, in the aftermath of the 2008 financial crisis, as Arizonas social safety net shrank, its foster care numbers soared. From 2009 to 2017, the adjusted prevalence of cannabis use in the year before pregnancy increased from 6.8% to 12.5%, and the adjusted prevalence of cannabis use during pregnancy increased from 1.95% to 3.38 percent. In 2018, an estimated 12% of U.S. residents 18 years or older reported current unhealthy drug use in a national survey. Establishes requirements for health care providers to encourage and facilitate drug counseling. Unless otherwise noted, you can republish our stories for free if you follow these rules. Those efforts continue under a wide variety of laws even in states where high courts have previously rejected the prosecution approach. For example, Amanda Kimbrough's child was born prematurely and died shortly after birth, having tested positive for methamphetamine. Katie Jane Fernelius Civil child abuse proceedings are explicitly permitted in 18 states.9 These may lead to termination of parental rights, but not to prison sentences. A neonatologist who was an expert witness for the defense testified that the cocaine derivatives present in the children's urine were from exchange between the womb and placenta during pregnancy and that only a tiny amount of cocaine derivative could have passed through the umbilical cord during the 30- to 60-second period after the child was born and before the umbilical cord was cut. An obvious example is the recent Tennessee law that explicitly made illicit drug use during pregnancy a form of criminal assault. Published on September, 30, 2015 Across the country, hundreds of pregnant women and new mothers have been accused of child abuse or other crimes when they or their newborns tested positive for. The survey also notes that if prenatal drug use is suspected, Illinois, Michigan, Ohio and Wisconsin require health professionals to report it while Indiana requires pregnant women to be tested; Iowa, Minnesota, North Dakota and South Dakota require both. 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. Drug addiction is a serious problem, especially when the drug addict is pregnant. Illegal Drug Use and Pregnancy. Good reproductive health policy starts with credible research. There is no known safe amount of alcohol use during pregnancy or while trying to get pregnant. In Johnson v. State, the defendant was charged and convicted of two counts of delivery of a controlled substance to a minor via the umbilical cord after she reported to the treating obstetrician that she had smoked marijuana and crack cocaine the day she went into labor. Arizona now has one of the highest foster care placement rates in the nation. The search yielded 77 published cases, of which, on closer review, 16 were found to be relevant. Indeed, few, if any, middle- or upper-class women who use drugs during pregnancy will ever experience a child abuse and neglect proceeding, let alone a termination of parental rightsthough drug use is common among people of all socioeconomic levels.
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