Some states and hospital systems have updated their drug testing policies for pregnant women and newborns to higher support substance use disorder treatment and recovery for patients and to deal with racial disparities in testing and reporting.
According to federal lawHealth professionals must notify child protection authorities if an infant is affected by the mother's substance use, including alcohol consumption. However, the federal rules apply – which were Updated 2016 in response to the opioid epidemic – emphasize that independent substance use disorder doesn’t constitute child abuse and requires states to develop their very own “Safe Care Plans” to advertise the long-term health of the newborn and the mother.
But federal law doesn’t define “affected,” and testing and reporting policies vary from state to state and even hospital to hospital. As the opioid crisis continues, among the nation's major hospital systems and a handful of states have taken or are considering taking less punitive measures so long as the infant will not be in immediate danger.
One impetus for change is research showing that black women are pregnant they usually tend to be drug tested and long-standing disparities in the best way Black and Indigenous families live treated by child welfare institutions. Mental illness and substance use have also occurred Main causes the reason for maternal deaths, in response to the federal Centers for Disease Control and Prevention.
“Data on bias in reporting on child well-being related to substance use by pregnant/birthing people has existed for decades,” Sarah Roberts, a legal epidemiologist and professor on the University of California, San Francisco, wrote in an email to Stateline. Roberts Sense Testing policies across the country.
What has modified, Roberts said, is a growing awareness of the harms related to over-testing and over-reporting to child protective authorities.
Only two states, Minnesota and North Dakota, have laws requiring drug testing of pregnant patients in certain circumstances, reminiscent of complications during childbirth that indicate possible drug or alcohol use, they are saying an evaluation by If/When/How, a reproductive justice nonprofit. And only 4 states (Louisiana, Minnesota, North Dakota and Wisconsin) require drug testing of newborns under certain circumstances.
But hospitals and doctors are sometimes confused about their very own states' laws, Joelle Puccio said. Director of Education on the Academy of Perinatal Harm Reduction, which provides information for pregnant women and drug-using parents.
“What is actually happening is more and more punitive, more surveillance than required by law, and it is increasingly affecting Indigenous, Black and other families of color,” said Puccio, who has worked as a registered nurse in perinatal and perinatal surgery for twenty years within the intensive care unit working for newborns.
Mass General Brigham in Boston, one in all the country's most respected hospital systems, announced changes to its perinatal reporting policies in April as a part of a broader effort to eliminate practices that might “unintentionally perpetuate structural racism.”
Provided that the infant will not be in imminent danger, the hospital will only conduct toxicology tests with the written consent of the pregnant patient and can report positive results to child protection authorities provided that doctors determine that the infant is suffering or in imminent danger. Mass General Brigham may also move away from considering a baby's exposure to drugs or alcohol — including the mother's medication treatment for opioid use disorder — as an automatic reason for reporting abuse or neglect. This is meant to counteract the stigma that pregnant patients often face during treatment with such medications and which causes them to fear health care.
“The biggest deterrent for people seeking care was the concern that if they received buprenorphine or methadone, a life-saving treatment for opioid use disorder, they would have an open case with the Department of Children and Families,” said Dr. Davida Schiff, director of perinatal and familial substance use disorder care at Mass General Brigham. “We know that buprenorphine and methadone reduce the risk of overdose.”
Dr. Allison Bryant Mantha, a gynecologist and deputy chief health equity officer at Mass General Brigham, said a priority of the policy change is to cut back the scope for bias.
“When you give people a lot of leeway, sometimes prejudice creeps in,” she said. “Sometimes minimizing variability leads to equity.”
legislation was introduced within the Massachusetts Senate to guard parents from scrutiny by child protective services or criminal prosecution if their infant was exposed to a substance in utero.
Other states have already approved such policies. Since 2019, Connecticut has directed health care providers to maintain parents' identities private when reporting a positive test to child protective authorities and as a substitute provide supportive services. This 12 months, New Mexico A law was also passed that not considers substance use disorders to be abuse or neglect.
And in 2020 Colorado has updated its definition of kid abuse and neglect to exclude cases by which a newborn tests positive for substance or alcohol exposure and the mother is on medication.
But hospital staff still express confusion about state laws, said Britt Westmoreland, a doula and addiction recovery specialist on the University of Colorado College of Nursing.
“I have had hospitals whose policies were more punitive than state law,” Westmoreland said, “and I addressed that head-on by educating them about state law.”
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