Alexandra Laird.PNG

Alexandra Laird

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A 21-year-old woman has spurred a stand-off this week between health experts and prosecutors over the care and punishment of pregnant addicts, who face prosecution more often in Alabama than any other state.

The case also raises questions about the limits of a chemical endangerment law initially designed to safeguard young children from home-based meth labs as a tool to protect unborn children.

In the middle sits Alexandra Laird, who is currently under the care of physicians at UAB Hospital, who have decided not to discharge her to the jail as ordered by Bessemer Judge David Hobdy. Members of the treatment team at UAB have raised concerns about Laird's safety at the jail, which they say is not designed to treat a pregnancy complicated by heroin addiction.

The case began earlier this year after Laird was arrested for chemical endangerment. She had given birth to a child in 2015 who tested positive for opioids and amphetamines. Laird was out on bond on that charge when she became pregnant and tested positive for heroin.

Hobdy revoked her bond in early September and ordered Laird confined to jail for the rest of her pregnancy.

"This court is very concerned about the welfare of the unborn child,'' Hobdy said.

The decision pushed Alabama's toughest-in-the-nation pregnancy drug laws into uncharted territory. Although women often receive stiff sentences in Alabama after a conviction for using drugs while pregnant, it is the first high-profile case where a pregnant woman faced months in jail before her case even came to trial.

It also alarmed addiction treatment specialists who argue that treatment - not jail - typically produces better outcomes for newborns and pregnant women struggling with drugs. Those concerns became even more dire when Laird was transported to UAB from the jail after a fall and doctors learned she hadn't been receiving the standard pharmaceutical treatment for pregnant opioid users. Doctors typically use Subutex or methadone to prevent withdrawal, which can damage the developing fetus.

"Opiate withdrawal in pregnancy can affect fetal blood flow causing harm during periods of fetal development," wrote Dr. Peter Lane, medical director of the Addiction Recovery Program at UAB, in a letter to Hobdy.

Lane and other addiction experts urged the judge to reinstate bond and release Laird to Aletheia House, which runs a treatment program for pregnant women.

"The whole idea is if we can change mom's life, you can help that kid's life," said Dr. Peter Lane, medical director for the Addiction Recovery Program at UAB.

Alabama is one of just a handful of states where law enforcement officers arrest and charge women who use drugs during pregnancy - and the most aggressive, according to an analysis last year by Al.com and ProPublica.

Lawmakers passed a law against chemical endangerment of a child in 2006, which made it illegal for parents to expose children to the byproducts of home-based meth labs. Soon, prosecutors also began bringing chemical endangerment cases against women who used drugs during pregnancy.

About 500 women have been charged with chemical endangerment in Alabama since 2006, according to the analysis. Medical organizations have opposed laws that criminalize drug use during pregnancy because they might keep women from seeking prenatal care or treatment for addiction, potentially exposing unborn babies to more risky behavior.

But Alabama isn't the only state to tackle the issue with tough laws. After a spike in babies born dependent on opioids, Tennessee lawmakers passed a law against fetal assault to punish drug-using mothers. Lawmakers in Tennessee decided not to renew it earlier this year after a vigorous lobbying effort by doctors and women's groups.

Laird's case was unusual for Jefferson County, where chemical endangerment charges are fairly rare. The charge is much more common in Etowah County. Even there, where law enforcement leaders have taken a tough stance against drug use during pregnancy, jail officials usually prioritize treatment over jail for pregnant women, said Emuni Sanderson, outreach coordinator for Aletheia House.

She said it was unusual for a jail to refuse a treatment bed offered by Aletheia House.

"Etowah and Calhoun charge with chemical endangerment more often, but their thing is we want to get them into treatment," Sanderson said. "The goal is not to keep them in jail."

Bessemer District Attorney Bill Veitch argued that Laird could not be trusted inside an unlocked drug treatment facility. Her first child required one month of hospital treatment for withdrawal symptoms after she was born, he said. Given her history of drug use during pregnancy, Veitch urged the judge to keep Laird in jail so she could not get access to heroin.

"Couldn't she just walk out the door?" he asked several times.

Lane and others argued that Laird needed more than just Subutex, which the jail agreed to provide, but also counseling and life skills training.

"Sending somebody back to jail is traumatic," Lane said. "Without anything else, it just makes it more likely for them to use."

Dr. Michael Chandler, chief medical officer for the Jefferson County Sheriff's Office, said medical staff at the jail could continue to treat Laird with Subutex and provide psychiatric counseling. The Bessemer jail, which houses female inmates, has about eight pregnant women incarcerated right now. The jail has a medical staff that includes nurses, doctors, psychiatrists and social workers, he said.

"It's a sterile environment," Chandler said. "It's a jail. There's no flowers anywhere like Aletheia House."

The American College of Obstetricians and Gynecology has taken a strong stand in support of medication-assisted treatment for pregnant women, and against laws that criminalize drug use during pregnancy. Lane said that most studies show that Subutex, administered alongside a regimen of therapy and counseling, has a high rate of success.

"All the medical literature says Subutex by itself does nothing - it just keeps them from withdrawal," Lane said.

Laird's attorney, Jeff Huseman, said his client has not been found guilty, but is already being punished. She is a about half-way through her pregnancy and could spend five more months behind bars. Susan Staats-Combs, owner and director of the Shelby County Treatment Center in Alabaster, said Laird suffers from a disease. All of her criminal charges are related to drug use and possession.

"It's punishing her for a disease she has," Staats-Combs said.

Hobdy urged the treatment providers to collaborate with jail staff on a treatment plan for Laird, but instead her physicians have decided not to discharge her from the hospital. If she is discharged, she will have to return to jail, but that may not happen until after the baby is born.

If she returns to the jail, the medical director said employees can provide medicine and counseling, in a secure setting that Laird cannot leave.

"The mother might not be as happy," Chandler said. "But the baby doesn't know the mother's in jail."