The first time I saw a copy of North Carolina bill S297, it was from a prankster friend. I thought I was being punk’d. I thought someone, knowing how crazy it makes me when politicians play doctor, wrote this phony bill and said it was up for consideration in the NC legislature.
When more reputable people sent me similar notices, I found out this bill is for real.
Republican Brent Jackson presented this bill, which reads, “A woman may be prosecuted for assault under G.S. 14-33(a) for the illegal use of a narcotic drug as defined in G.S. 90-87, while pregnant, if her child is born addicted to or harmed by the narcotic drug and the addiction or harm is a result of her illegal use of a narcotic drug taken while pregnant. “
The bill goes on to say that the pregnant woman has a defense to prosecution if she is involved in a treatment program before delivery, stayed in the treatment program after delivery and – get this – completed the program.
This is not a good law.
While it may make politicians and voters feel like they are doing something to stop reckless drug-addicted women from using drugs during pregnancy, it demonstrates a lack of knowledge about what addiction is, how it is treated, and the few treatment options open to opioid-addicted pregnant women.
Here are the ways in which this law is bad, and will worsen the health of addicted women and their babies:
1. Addicted women who become pregnant will shun pre-natal care. They won’t want to take the risk of being sent to jail. While proponents of the bill say it should encourage addicted women to seek help, that’s not realistic. It’s contrary to human nature for a sick person to get medical care if that illness it a crime.
Women with addiction who become pregnant are no different from other women. They want all the best things for their baby, and especially want that baby to be healthy. Most women will have already tried desperately to stop using drugs, and are unable to do so. The inability to stop using is one of the symptoms of the disease of addiction, after all. They are loaded down with shame and guilt over using drugs while pregnant. They feel like bad people, and they feel hopeless. They do what humans do when they feel bad about themselves – they hide. They don’t go to doctors.
Fewer and later prenatal visits directly correlate with worse outcomes. Best results for the mom and babies are seen when addiction is treated as the public health problem that it is.
2. Let’s say the woman IS able to stop using drugs on her own somehow. If the woman is addicted to opioids, her pregnancy can be endangered if she stops suddenly. We know, from years of studies, that opioid withdrawal in pregnancy increases the risk for complications such as pre-term labor, miscarriage, placental abruption, and other conditions. Even if nothing catastrophic happens, the baby is more likely to be born early or have a low birth weight. Even if she’s able to stop without calamity, we know that relapse rates are consistently in the 90% range.
3. If the opioid-addicted pregnant woman came to her OB and asked for help with her addiction, what do you think would happen? I’ve seen such patients shuffled around from place to place with no one willing to take responsibility to treat this high-risk patient. Opioid treatment programs, some teaching hospitals, and one of the state-run inpatient facilities in the state, Walter B Jones in Greenville, NC, are the only places I’ve seen that are willing to take care of these women.
I had one pregnant patient who went to our local hospital emergency department to ask for help with her addiction, as soon as she found out she was pregnant. She talked to the doctor there, who called our local management entity (our equivalent of county mental health system). That LME sent a worker to interview her and the worker recommended she get an appointment with an obstetrician to get help. The ER sent her home with the names of OB’s in the area, which, by the way, she already had. On Monday morning she called them, and was told she could be seen in a few weeks, after she got approved for her pregnancy Medicaid, since she had no insurance at present.
Frustrated, she called that doctor’s office back, and explained that she had an addiction and needed help more quickly. She was directed to go to the emergency department but when she told them she’d already gone there, they recommended she go to a detox.
She went to the local detox unit in our area and they would not admit her because, you guessed it, she was pregnant and they said they weren’t equipped to treat pregnant patients. They recommended she go back to the local emergency department.
She did go to an emergency department, but had the good sense to go to Forsyth Medical Center in Winston-Salem. She was admitted to their detox unit and started on buprenorphine. Workers there arranged for her to be admitted to our opioid treatment program immediately after she was stabilized and discharged from their hospital.
She spent four days trying to negotiate the confusing network of care in our state. Some patients may not be that willing to persist after getting no help from three or four sources.
4. Women may be more likely to consider abortion as an option, even if they would like to have the baby. Think about it – if you commit a crime by becoming pregnant while addicted, what’s the quickest way to remain within the law, prevent arrest with its public humiliation? Get rid of the pregnancy. I suspect it’s easier to get an abortion than to get inpatient drug addiction treatment in this state, but I do not know this for sure.
5. The bill lacks knowledge of addiction as a chronic illness. When farmers become politicians and think they can play doctor, we get these nonsense laws. Since addiction is a chronic illness, the treatment won’t have a “completion.” It makes as much sense as saying a diabetic who gets pregnant won’t be prosecuted for eating sugar if she “completes” the treatment for her diabetes.
It reminds me of my patient in primary care who got angry when I told him he would have to keep taking his blood pressure pills in order for them to work. He thought blood pressure pills should cure the disease. He told me he was taking his business elsewhere, to a better doctor who would prescribe something to cure his hypertension, not just keep taking a pill every day to treat it. He could not grasp the concept of a chronic illness.
6. Second, I hate this term “narcotic.” It’s become more of a legal term than medical. In the doctor world, narcotic means anything that could put someone to sleep. “Narco” in Greek, means sleep, thus the association with sleep and sedation. So I went to GS 90-87 to see what the state’s definition is for this word. Turns out they mean cocaine and opioids.
Sleeping pills and benzodiazepines are not mentioned, and neither is marijuana or methamphetamine. Will these drugs also be illegal in pregnancy?
7. These types of laws attempting to punish “bad” women who use drugs while pregnant are unevenly enforced. You won’t see an affluent opioid-addicted pregnant woman incarcerated under this law, but you may see poor or minority women incarcerated. They have fewer resources to avoid prosecution and less voice to speak out against bad laws like these. One only need look at other states with similar laws to see this is true. Just look at the first person to be jailed in Tennessee after their harsh new law was passed last year.
Plus, these laws are not upheld by higher courts. In Ferguson versus City of Charleston, the Supreme Court held that it was an illegal search when hospital workers sent urine samples for drug tests without consent from the mothers.
If North Carolina passes this bill, we will be the second state, after Tennessee, to pass laws making drug use during pregnancy a crime. Do we really want to model ourselves after Tennessee, with all of their mess?
8. If politicians want to take action to prevent harm to babies, they should focus on nicotine. We know smoking in pregnancy is very harmful to the fetus and newborn, and far more women smoke than use drugs. You can read a summary of current knowledge at this CDC site: http://www.cdc.gov/reproductivehealth/tobaccousepregnancy/
Why does the NC legislature treat smoking during pregnancy as a public health issue? Why not criminalize smoking while pregnant, since we know much more about the harm caused by cigarettes? I could ask the same question about alcohol as well.
Of course I know the answer to my own question. Alcohol and cigarettes are legal, and have much less stigma than other drugs, even though both kill more people per year than all other drugs combined.
Can’t we please let common sense and medical science drive the bus on this issue? Even if you are mad at pregnant women who use drugs and have a desire to punish them, please refrain from doing so, if only for the sake of the babies, who WILL suffer if this law passes.
Policies that inflict criminal penalties on pregnant women with the treatable disease of addiction cause harm to everyone. Hospitals have higher costs when a mom with no prenatal care arrives on their door step ready to deliver, with much higher rates of perinatal complications. Taxpayers end up paying the high costs of incarceration for these women. But most of all, the babies and their moms are harmed.