Treatment by any means possible?

A proposed Tennessee law may hurt the drug-addicted pregnant women it's intended to help.

Published February 25, 2009 8:33PM (EST)

At a time when the national news features story upon story of bad behavior rewarded, a local effort to hold someone accountable for their actions should be heartening. Unfortunately, the local effort in question, Tennessee’s proposed Senate Bill 1605, is misguided, won’t work and may make life much worse for the very people it’s intended to help: drug-addicted pregnant women and their children. (Hat tip to the Women’s Health News Blog, which broke this story last week and replicated the full text of the bill.)

SB1605 mandates drug testing for women who fall into any of nine different categories, including obtaining "late" or "incomplete" prenatal care. (Ironically, the "failure" to access care often indicates poverty, and this bill requires women to foot the bill for their tests.) Don’t let the bill’s promise that women who test positive for drugs or alcohol "shall be referred to treatment” fool you into thinking it’s humane or benign: SB 1605 is fundamentally a dragnet with a law-and-order core. It requires the Department of Children’s Services to open a case on women who test positive and mandates that doctors report women patients who don’t want to go into treatment or miss appointments with child welfare officials.

Bills like SB 1605 tend to enjoy plenty of popular support. Lots of people believe that pregnant drug-addicted women should be forced into treatment by any means possible.

But medical professionals -- who, unlike legislators, are actually qualified to set public health policy -- tend to oppose bills like SB 1605 on the grounds that they actually undermine maternal, fetal and child health. An American College of Obstetricians and Gynecologists report released this past December states that OB/GYNs have an ethical obligation to screen their patients regarding drug use and refer them to treatment. At the same time, it reinforces the centrality of respect and trust to the physician-patient relationship. The report names "state laws designed to criminalize drug use during pregnancy" and women’s "fears that they might lose custody of their children" as key deterrents to seeking prenatal care and substance abuse treatment.

SB 1605’s other primary weakness? According to the Tennessee Commission on Children and Youth, the state already lacks adequate facilities for everyone who needs drug treatment. It’s too expensive for low-income women; it’s too hard to access (literally: there’s no budget transportation to treatment centers, and they are often few and far between); and most won’t accept pregnant women or allow parents to bring their kids. Those drug-addicted mothers who allegedly don’t care about their kids? Lots of them actually care quite a bit. Women who want to stop using drugs often cite their children as a prime motivator, and women resist being separated from their children for fear that the state will take them while their mother is in treatment.

Bills like SB 1605 may satisfy the public’s thirst for vengeance or our legislators’ desire to appear heroic, but a truly viable solution to this public health issue is going to require a public health solution -- one that includes adequate resources. If we’re going to address the issue of drug use during pregnancy, let’s do it right.

By Nancy Goldstein

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