Punishment for Opioid Abuse Linked to Increase in Newborn Opioid Withdrawal

This article, in a slightly edited form, first appeared on Pain News Network on November 23, 2019.

According to Guttmacher Institute, about half the states in the United States are willing to punish pregnant women in order to spare their babies the agony of being born with Neonatal Abstinence Syndrome (NAS). Ironically, their efforts are having the opposite effect.

Twenty-three states and the District of Columbia have passed legislation that criminalizes substance abuse during pregnancy. Additionally, twenty-five states along with the District of Columbia require health care providers to report expectant mothers who may be illegally using substances. In eight states, pregnant women who are suspected of substance abuse must undergo drug testing.

The huge number of babies born to mothers dependent on opioids have driven policymakers to find ways to deter pregnant women from abusing opioids. But recent research points out possible unintended consequences of this legislation. It provides lawmakers insights on how  to create more effective policies that result in positive, not punitive, outcomes.

RAND’s New Study Analyzes the Effects of Punitive Laws

A study published recently in the journal JAMA Network Open examined 4.6 million births from 2000 to 2014. During this time, the diagnosis of NAS increased sevenfold.

The study was conducted by the RAND Corporation (a nonprofit institution that helps improve policy and decision-making through research and analysis). It analyzed eight states with punitive policies for drug-abusing pregnant women. The research was funded by the National Institute of Drug Abuse.

According to a RAND press release, Arkansas, Arizona, Colorado, Kentucky, Massachusetts, Maryland, Nevada, and Utah adopted either punitive penalties for drug use during pregnancy or policies that required health care providers to report pregnant women with suspected illegal substance use.

RAND researchers found that the annual rate of NAS increased from 46 cases per 10,000 live births compared to 60 cases per 10,000 in years subsequent to legislation enactment. This is an alarming 30% increase of NAS cases that appears to be due to punitive laws.

This is not the first study that has shown political efforts to curb opioid addiction and overdoses have not had a positive impact. We have seen the harm associated with forced tapers and dose limits adversely affecting millions of pain patients.

It is hard to understand why these destructive policies are put in place, but it may be because policymaker are misinformed or biased. Regardless, it reflects a systemic flaw for governments to fail to evaluate the efficacy and outcomes of the very policies they create.

How best to address addictions has long been the subject of debate. For example, a state hospital in South Carolina had illegally obtained the diagnostic tests of pregnant women in an effort “to obtain evidence of a patient’s criminal conduct for law enforcement purposes” (this was the case of Ferguson v. Charleston). Unfortunately, some people still believe that addictions are volitional or character flaws. They are misguided when they believe addiction is criminals behavior rather than a disease.

Why Criminalizing Addiction Is a Terrible Idea

Indisputably, addiction is a complicated, life-threatening disease. Treating people with the disease as criminals is the worst possible approach. Most experts in the substance abuse treatment community have known this for years. Fortunately, the RAND Corporation has now provided evidence of how this applies to babies born to women who abuse opioids.

Typically, lawmakers do not evaluate the impact of the policies they pass. There have been many policies over the past few years that were implemented by state legislatures, healthcare organizations, and insurance companies that were intended to reduce harm from opioids. Almost no one has attempted to measure their effectiveness or unintended consequences.

Fortunately, in this case, we have an exception. We have a unique opportunity as a result. The RAND study should provide policymakers with insights on how to more effectively address the problem of substance abuse during pregnancy.

Threatening to punish a pregnant women does not 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 other illegal substances that risk the health of their babies. There should not be more barriers for pregnant women to receive prenatal care. Infants born after exposure to opioids often require prolonged hospitalizations to manage their needs, with those cumulative costs totaling more than $500 million by 2014. More importantly, babies with NAS suffer needlessly.

It should go without saying that every policymaker wants to solve problems and not create additional harm for new mothers or to babies born to them. Hopefully, this study will be used as it is intended: to help create policies that actually reduce harm from opioids.


Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, The Painful Truth,” and co-producer of the documentary,It Hurts Until You Die.” Opinions expressed here are those of the author alone and do not reflect the views or policy of PRA Health Sciences.

You can find him on Twitter: @LynnRWebsterMD.


Leave a Comment