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Drug addiction in pregnancy is not a criminal problem

I recently wrote an article about opioid use in pregnancy, and about whether or not using medications such as oxycodone or morphine is safe for mom or baby in pregnancy. Like so many things in medicine, it’s not a straightforward topic. 

It’s also one that I know people feel very strongly about. In my social media feeds, I’ve seen well-meaning, educated people say that babies should be taken away from any mom who uses a narcotic in pregnancy to the degree that her baby is born addicted. It seems very black-and-white to them: mom can’t get herself together. Mom harms her baby in utero. Baby should be taken away. Mom should go to jail.

Well, of course that’s an oversimplification. That mom probably had a rough start to her own life — no one just decides they want to be addicted to oxycodone. Maybe her parents were addicted to alcohol or something else. Maybe she was sexually abused. Maybe she was prescribed oxycodone for a minor injury that never needed such a strong treatment, and because she carries a genetic tendency toward addiction, she’s now hooked and can’t get clean. Maybe she didn’t have access to birth control, but then got pregnant and now rather than stop using and go into withdrawal (which is quite unsafe for mom and baby), her doctor got her into a methadone maintenance treatment program.

The upside is that she delivered at term an otherwise healthy baby boy, and during her pregnancy she didn’t buy drugs off the street, or trade sex for drugs, or get exposed to HIV. The downside is that now her baby suffers from neonatal abstinence syndrome and needs treatment.

Do we judge this woman, throw her in jail (as one Tennessee law states), and take her baby away? Or in my imaginary perfect world, do we treat mom and her baby, get her into an intensive treatment center that includes daily addiction treatment and counseling, parenting classes, and ensure that she has coverage for the IUD she desperately wants so she doesn’t have another unplanned pregnancy? Do we help pay for her GED so she can get a good job and break the poverty cycle for her son, so he can grow up and not fall into the same traps his mother did?

Criminalizing addiction doesn’t work

I vote for the latter plan, but I know many friends and colleagues who wouldn’t. They would criminalize this woman, and by doing so ensure that she wouldn’t ever get the treatment she needs. Her son would be stuck bouncing around the foster care system. They wouldn’t support the kind of healthcare that allows access to free birth control. I guarantee you … in this scenario, I’m delivering her next baby in about 15 months. And maybe this time she’s moved on to heroin because it’s cheaper.

You can choose to be critical of these women and say, “She’s an adult! She should be thrown in jail. How dare she do this to her baby?” You can choose to ignore the opioid epidemic in this country, which is really a result of poverty and the push by certain drug companies to profit from narcotic medications (History buff? Read this book). You can choose to not see that insurance companies won’t reimburse for physical therapy, but you can bet that oxycodone is covered for a $5 co-pay.

But if you choose to have that tunnel vision, then you’d be ignoring the public health crisis that is drug addiction in America. Our pregnant mothers and their babies are not spared from this sad epidemic. Let’s stop demonizing them and instead help when we can and break the cycle when we are able. Our most precious citizens — our babies — depend on us for this.

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