Cover: Pregnant Women with Substance Use Disorders

Pregnant Women with Substance Use Disorders

The Harm Associated with Punitive Approaches

Published in: The New England Journal of Medicine, Volume 384, No. 25, pages 2364–2367 (2021). doi: 10.1056/NEJMp2101051

Posted on Aug 31, 2021

by Rebecca Lee Haffajee, Laura J. Faherty, Kara Zivin

Evidence-based approaches to treating SUDs during pregnancy, including highly effective medications for OUD, have become increasingly available. The United States doesn't criminalize or punish pregnant women with other health conditions—such as diabetes, epilepsy, or obesity—that can affect them and their children. Rather, clinicians treat these conditions during routine prenatal care. States have also increasingly decriminalized substance use for the general population, such as the use of small amounts of marijuana and, in Oregon, the use of all controlled substances. Yet punitive laws still apply to pregnant women in most jurisdictions. Amid increasing rates of behavioral health conditions in this population, persistent adverse maternal health outcomes, and the Covid-19 pandemic (during which overdose deaths have spiked), we need policies that draw women into care and help them recover, not policies that push them away from care and into the criminal justice system. Punishing pregnant women with SUDs has been ineffective; it's time to prioritize approaches that support pregnant women and their families.

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