Drug Use During Pregnancy Policies in the United States From 1970 to 2016

Abstract

As U.S. states legalize marijuana and as governmental attention is paid to the "opioid crisis," state policies pertaining to drug use during pregnancy are increasingly important. Little is known about the scope of state policies targeting drug use during pregnancy, how they have evolved, and how they compare to alcohol use during pregnancy policies. Method: Our 46-year original data set of statutes and regulations in U.S. states covers the entirety of state-level legislation in this policy domain. Data were obtained through original legal research and from the National Institute on Alcohol Abuse and Alcoholism's Alcohol Policy Information System. Policies were analyzed individually as well as by classification as punitive toward or supportive of women. Results: The number of states with drug use during pregnancy policies has increased from 1 in 1974 to 43 in 2016. Policies started as punitive. By the mid-to late 1980s, supportive policies emerged, and mixed policy environments dominated in the 2000s. Overall, drug/pregnancy policy environments have become less supportive over time. Comparisons of drug laws to alcohol laws show that the policy trajectories started in opposite directions, but by 2016, the results were the same: Punitive policies were more prevalent than supportive policies across states. Moreover, there is a great deal of overlap between drug use during pregnancy policies and alcohol/pregnancy policies. Conclusion: This study breaks new ground. More studies are needed that explore the effects of these policies on alcohol and other drug use by pregnant women and on birth outcomes.

Costs associated with policies regarding alcohol use during pregnancy: Results from 1972-2015 Vital Statistics

“…The actual prevalence and associated costs indicate that the harms related to alcohol/pregnancy policies are not only statistically significant, but also significant from a public health and public policy perspective. As most alcohol/pregnancy policies (with the exception of MWS) also apply to drugs [1], findings from this study for all policies other than MWS can be interpreted as applying to alcohol+drug/pregnancy policies rather than specific to alcohol/pregnancy policies. The MWS finding in particular, though, suggests that as states continue to legalize recreational cannabis, public health policy makers may want to exercise caution before expanding MWS to apply to cannabis.…”

“…These include mandatory warning signs (MWS), giving pregnant women priority for substance abuse treatment (PTPREG), giving pregnant women and women with children priority for substance abuse treatment (PTPREGWC), requiring reporting for either child welfare purposes (RRCPS) or data collection and treatment purposes (RRDTx), limiting criminal prosecution (LCP), allowing civil commitment (CC), and defining drinking during pregnancy as child abuse/neglect (CACN). Most of these, with the exception of MWS, apply to both alcohol and drug use during pregnancy [1].…”

“…For example, in 2019, the Michigan legislature is considering adopting a MWS policy for alcohol and the Tennessee legislature is considering re-adopting a law criminalizing drug use during pregnancy [3, 4]. Other states are expanding extant policies to cover new substances, e.g., coinciding with state-level cannabis legalization, a few states have expanded MWS policies to include cannabis [1]. State policies are being challenged in court as well; in December 2018, a legal challenge to the Pennsylvania CACN law as it related to opioid use during pregnancy resulted in the Pennsylvania Supreme Court ruling that behavior (e.g., substance use) while pregnant does not constitute child abuse under state law [5].…”

Implications of Tennessee's Opioid Legislation for Neonatal Abstinence Syndrome

“…Between 1974 and 2016, the number of states that developed policies focused on drug use during pregnancy increased from 1 to 43 (Thomas, Treffers, Berglas, Drabble, & Roberts, 2018). Policies range from supportive (i.e., focused on treatment) to punitive, with punitive being the most frequent (Thomas et al, 2018). In 2015, policymakers in three states (Tennessee, Alabama, and South Carolina) considered substance abuse during pregnancy a crime (Krans & Patrick, 2016).…”

Optimizing Outcomes for Women With Substance Use Disorders in Pregnancy and the Postpartum Period

“…Punitive responses to drug use have contributed to the dramatic increase in the number of incarcerated women in the United States (Kruttschnitt, 2010). Fear of criminal prosecution and prior interactions with child protective services deter women from seeking prenatal care and treatment that could improve pregnancy outcomes (Thomas, Treffers, Berglas, Drabble, & Roberts, 2018).…”