Tennessee Holds Parents Accountable For Children Born Addicted

NPR's Arun Rath talks to Tennessee obstetrician Jessica Young about a recent law that allows police to arrest mothers who give birth to a child testing positive for drugs.

ARUN RATH: Treating drug addicts is a complicated business. The aims of doctors and law enforcement can clash when a patient's behavior involves breaking the law. The situation gets even messier when the addict is a pregnant woman whose baby faces health risks from withdrawal when born. In Tennessee, which has one of the highest rates of opiate addiction in the country, a new law charges mothers for assault if their babies test positive for illegal substances. But there's an existing law on the books, the Safe Harbor Act, which protects mother who seek treatment for drug abuse. Jessica Young is an obstetrician specializing in treating mothers with opiate abuse at Vanderbilt University and has to navigate the seemingly contradictory laws. Dr. Young, welcome to the program.

JESSICA YOUNG: Thank you.

RATH: How bad is the problem of opiate abuse in Tennessee, especially with mothers? What kind of cases have you seen?

YOUNG: Yes. We have a huge problem with opiate addiction in the state of Tennessee, in general. One of the ways we have really seen this is our rate of neonatal abstinence syndrome, which is a baby being born dependent - physically dependent on opiates, has doubled in and in some cases, in some counties, almost quadrupled, compared to the national average.

RATH: So when you're presented with a patient - a pregnant woman who has an opiate addiction, what's the standard medical treatment?

YOUNG: The standard medical treatment during pregnancy is maintenance therapy, and that is either with methadone maintenance or with buprenorphine maintenance. The recommendation is for them to stay on that maintenance therapy throughout the course of their pregnancy and then for at least six months after delivery, in order to get them past the initial postpartum period. That can be stressful and can put them at risk for postpartum depression.

RATH: Just to be clear on this - the replacement drugs, like methadone - they're still opiates, and so they come up on the test as opiates, so it's all the same thing as far as the law is concerned.

YOUNG: Well, you can differentiate between them on the tests, but if the woman has a history of actually using an illicit substance in pregnancy, there is no distinction between whether the neonatal abstinence syndrome was caused by the maintenance medication or by what she did prior to getting treatment.

RATH: So as a doctor, does that put you in an ethical bind? Are you putting them at risk for prosecution by treating them?

YOUNG: I think the confusing thing about this law is that it doesn't take into account maintenance medication and that that itself is the standard of care - medical care, nationally. So a baby can have neonatal abstinence syndrome from their treatment medicine, and the woman can have done everything appropriate. But if her drug screen comes back for either an illicit medicine that they took prior to getting treatment or for an illicit substance, like marijuana, that woman can be prosecuted regardless of whether she was doing well in her treatment program.

RATH: And in terms of what they're actually - what they're specifically scared about, is it that they're going to have their babies taken away from them? They'll be prosecuted?

YOUNG: Yes. They're afraid that their babies will be taken away from them. They're afraid that they will be prosecuted, put in jail, that they'll lose custody to the other children that they have, often in their households. Unfortunately, though I can - I can tell them that by getting in treatment and staying in treatment - that that is a defense for them under this law. It does not eliminate the chance that they could be prosecuted, which is not very reassuring to them.

RATH: Dr. Young, thanks very much.

YOUNG: Thanks. You, too.

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