Pregnant and Scared to Get Treatment: When Conception Meets Addiction

By Brian Barnett MD 02/27/19

If one needs proof that addiction is a disease and not a moral failing, look into the eyes of a woman who knows her behavior is harming her baby but still can’t stop.

Pregnant woman with opioid addiction, scared to get treatment
Tragically, pregnant women with addictions are less likely to receive prenatal care. Photo 89438014 © Dragana Gordic -

With one in three individuals with opioid use disorder passing through the criminal justice system annually, court dockets across the country are overflowing with cases of illegal behavior fueled by addiction. Though such cases wrangle with the complexities of punishing individuals afflicted with what is increasingly seen as a disease that erodes free will, they are the bread and butter of the legal system. However, the recent Pennsylvania Supreme Court case known as In the Interest of L.J.B. adds another level of intricacy to the court's decision-making process. The question asked in the case—Does drug use during pregnancy constitute child abuse? —is unpleasant to contemplate, but it is one of absolute importance.

The defendant in the case, a woman referred to as A.A.R., tested positive for illicit opioids, benzodiazepines, and marijuana when she gave birth to her infant, L.J.B., in January 2017. L.J.B. then required 19 days of inpatient treatment for drug withdrawal and was placed in the custody of Children and Youth Services, which alleged that her mother’s drug use during pregnancy was child abuse. On December 28, in a 5-2 decision, Pennsylvania’s Supreme Court ruled in favor of L.J.B.’s mother, stating that Pennsylvania’s child abuse law clearly excludes fetuses in its definition of a child. While the issue may be settled in Pennsylvania, there is little doubt that similar cases will be heard across the country amidst the opioid epidemic.

Pregnant Women with Opioid Addiction — Overlooked and Undertreated

The case of L.J.B. and her mother has drawn national attention to women who simultaneously carry a child and the burden of an addiction—a group that has often been overlooked or ignored in the national discussions about the opioid epidemic. Few individuals in our society bear such a stigma as these women. As an addiction psychiatrist, I’ve heard harsher judgment passed on these patients—even from fellow healthcare workers—than on any others. This stigma permeates our medical and legal systems, creating dire consequences not only for these women, but also for their unborn children.

Pregnancy is unparalleled in its ability to motivate women towards healthier behavior, but approximately four percent of pregnant women still use addictive drugs. When I’m asked to evaluate a woman who is pregnant, I know her disease is severe before I’ve even laid eyes on her. If one needs proof that addiction is a disease and not a moral failing, look into the eyes of a woman who knows her behavior is harming her baby but still can’t stop. There is no better example of the ability of a chemical to overpower the deepest-rooted human instincts.

A recent report released by the CDC revealed that opioid addiction among women in labor quadrupled from 1999 to 2014, signifying the need for immediate action. Opioid addiction during pregnancy can create many problems for mother and child, including preterm labor, neonatal abstinence syndrome, and even fetal death. Tragically, pregnant women with addictions are less likely to receive prenatal care. Aware of society’s disdain, many don’t want to be stigmatized at the doctor’s office. Some mothers-to-be can’t even find a physician willing to treat them, and others are afraid of being reported to authorities due to laws that have arisen out of prejudice and misinformation.

Harsh Laws Harm Mother and Child

Twenty-three states already consider drug use during pregnancy child abuse. In three states, it’s grounds for involuntary civil commitment. Though some people think such laws deter women from using drugs during pregnancy, they don’t. If a woman’s addiction is so severe that it is active during pregnancy, laws that threaten arrest or loss of custody will not bring about remission. They also rarely bring about legal punishment, since the charges are dismissed or the convictions are overturned 85 percent of the time.

All that these laws do is cause pregnant women with addictions to avoid prenatal care visits or forego them all together. Tennessee discovered this the hard way, when it passed a law in 2014 making drug use during pregnancy punishable by up to a year in prison. The number of pregnant women seeking treatment for addictions fell drastically because they were too afraid of the legal ramifications. Thankfully, the law expired in 2016, but Tennessee's legislature is now considering passage of a similar bill.

How to Help Pregnant Women with Addictions and Their Children

If our actual desire is to help pregnant women with addictions and their children, there are effective actions we can take. We can start with repealing counterproductive laws, and, as funding is being allocated to counter the opioid epidemic, we can earmark portions of it for these patients and create more treatment options for them. Only 19 states have programs specifically targeting the unique needs of pregnant women, and only 17 provide them with priority access to state-funded addiction treatment programs.

Healthcare providers can help by addressing their own stigma and stepping up to provide treatment to this vulnerable group. These women already face significant barriers to care, so finding a willing and caring healthcare provider shouldn’t be another challenge to overcome. There are also ways to avoid tragic situations like this in the first place. Out of all pregnancies in women with opioid addictions, eighty-six percent are unintended, so ensuring access to affordable and effective family planning services is essential.

For addicted women with unborn children, an invitation into care is far more effective than any legal threat we can muster. Let’s dispense with negative attitudes and legal barriers that keep these patients from seeking treatment. Ensuring that help is available when needed is the way forward, because the only way to aid an unborn child is to help its mother, regardless of how her actions might make us feel. 

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Brian Barnett is an addiction and forensic psychiatrist practicing in Cleveland, Ohio. In addition to caring for patients and conducting research, he writes about addiction and mental illness for the public. His writing primarily addresses barriers to care for individuals seeking treatment, as well as the intersection of mental illness, addiction and the criminal justice system. His articles have appeared in publications such as HuffPost, Stat, Vice and the Washington Post. Follow him on Twitter @BrianBarnettMD.