Addressing Prenatal Opiate Use

The story in Sunday’s NYT by Abby Goodman and Katie Zezima on newborn babies in Maine suffering from opiate withdrawal since their mothers were addicted to OxyContin makes for excellent reading. But nothing in the piece particularly suggested an appropriate policy rememdy. Fortunately, Harold Pollack has some experience with this issue and some good ideas:

I’ve done a fair amount of research on substance use among pregnant and parenting women. Eleven years ago, at Mark Kleiman’s behest, I wrote a piece for the Drug Policy Analysis Bulletin, was called “when pregnant women use crack.” I argued then that the “crack baby” problem was often a pediatric problem masquerading as an obstetric one. I’d stand by this basic perspective.

People are often most disturbed by the direct biological impacts of a specific substance, especially because these impacts are often poorly-understood at the period when prenatal substance use first attracts public attention. Most of the time, the chief threats to maternal and infant well-being do not arise from the immediate teratogenic properties of a drug on the developing fetus. With the ironic and crucial exception of alcohol, the direct biological impacts of intoxicating substances are readily overstated.

Most pregnant women who use illicit drugs will have basically healthy babies. When they don’t, the underlying biological mechanism is often something other than the illicit drug, but something that becomes much more difficult to properly address when illicit drug use is in the mix. They may have infections that affect birth outcomes. They are likely to be smoking and drinking. They may have depression or other mental health concerns. They may have poor nutrition and poor general health. Some of these women will be exposed to domestic violence or various challenges that come with being pregnant and not having much money. They may delay prenatal care because they are ambivalent about the pregnancy. They may be afraid or ashamed to access medical resources when they have a drug problem.

The upshot of all of this is that while obviously being addicted to opiates while pregnant is far from an ideal situation, it’s one where the range of possible outcomes is actually quite wide. The essential thing is to avoid adopting an approach that’s so punitive toward the women in question that it leads them to avoid seeking the substantial public health resources that are available to manage the situation. Effective engagement with people living at the margins of society is difficult, but possible, and it makes a big difference: “the real challenge is to develop and field good interventions to help pregnant women with drug problems both before and after their children are born.”