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Access to Substance Use Treatment During Pregnancy

For people who use substances, overdose during pregnancy and post-partum is rapidly increasing and is now a leading cause of death, with a particular increase in opioid-related overdose. In a recent post, NIDA director Nora Volkow calls attention to the lack of adequate care among this population. Substance use treatment, including medications, has demonstrated effectiveness in addressing parent and infant health concerns as well as social stressors. However, many individuals encounter challenges accessing need support and treatment. Some providers are less likely to accept patients into treatment if they are pregnant and women of color are less likely to receive medication assisted treatment despite the known benefits. Further, in states with punitive approaches to substance use during pregnancy, pregnant people are less likely to receive medications for opioid use disorders and have less timely, lower quality care when they are able to access treatment for substance use.

In addition to accessing care, during pregnancy individuals using substances face environmental, social, and systemic barriers to seeking care. Notably, for some punitive policies regarding substance use during pregnancy may act as a deterrent for seeking services due to concerns about welfare system involvement. Researchers at Vanderbilt University found that infant foster care placements are increasing by 10,000 infants per year and that over half of these placements are linked to substance use. Further, infants removed due to substance use concerns are less likely to be reunited with their birthing parent in certain states.  Many living in states with punitive policies are even less likely to receive adequate timely support and treatment and more likely to be referred to child welfare services. Facilitating accessibility and establishing creating policies that mitigate barriers to seeking support and treatment are a crucial direction for practice, policy, and research. 

Angelotta, C., Weiss, C. J., Angelotta, J. W., & Friedman, R. A. (2016). A moral or medical problem? The relationship between legal penalties and treatment practices for opioid use disorders in pregnant women. Women’s Health Issues26(6), 595-601.

Patrick, S. W., Frank, R. G., McNeer, E., & Stein, B. D. (2019). Improving the child welfare system to respond to the needs of substance-exposed infants. Hospital pediatrics9(8), 651-654.

Sanmartin, M. X., Ali, M. M., Lynch, S., & Aktas, A. (2020). Association between state-level criminal justice–focused prenatal substance use policies in the US and substance use–related foster care admissions and family reunification. JAMA pediatrics174(8), 782-788.

Volkow N. Pregnant people with substance use disorders need treatment, not criminalization. National Institutes of Health. https://addressing-addiction.org/2023/02/09/pregnant-people-with-substance-use-disorders-need-treatment-not-criminalization/