If one needs proof that addiction is a disease and not a moral failing, look into the eyes of a woman who knows her behavior is harming her baby but still can’t stop.
With one in three individuals with opioid use disorder passing through the criminal justice system annually, court dockets across the country are overflowing with cases of illegal behavior fueled by addiction. Though such cases wrangle with the complexities of punishing individuals afflicted with what is increasingly seen as a disease that erodes free will, they are the bread and butter of the legal system.
However, the recent Pennsylvania Supreme Court case known as In the Interest of L.J.B. adds another level of intricacy to the court’s decision-making process. The question asked in the case—Does drug use during pregnancy constitute child abuse?—is unpleasant to contemplate, but it is one of absolute importance.
The defendant in the case, a woman referred to as A.A.R., tested positive for illicit opioids, benzodiazepines, and marijuana when she gave birth to her infant, L.J.B., in January 2017. L.J.B. then required 19 days of inpatient treatment for drug withdrawal and was placed in the custody of Children and Youth Services, which alleged that her mother’s drug use during pregnancy was child abuse. On December 28, in a 5-2 decision, Pennsylvania’s Supreme Court ruled in favor of L.J.B.’s mother, stating that Pennsylvania’s child abuse law clearly excludes fetuses in its definition of a child. While the issue may be settled in Pennsylvania, there is little doubt that similar cases will be heard across the country amidst the opioid epidemic.
Pregnant Women with Opioid Addiction—Overlooked and Undertreated
The case of L.J.B. and her mother has drawn national attention to women who simultaneously carry a child and the burden of an addiction—a group that has often been overlooked or ignored in the national discussions about the opioid epidemic. Few individuals in our society bear such a stigma as these women. As an addiction psychiatrist, I’ve heard harsher judgment passed on these patients—even from fellow healthcare workers—than on any others. This stigma permeates our medical and legal systems, creating dire consequences not only for these women, but also for their unborn children.
Pregnancy is unparalleled in its ability to motivate women towards healthier behavior, but approximately four percent of pregnant women still use addictive drugs. When I’m asked to evaluate a woman who is pregnant, I know her disease is severe before I’ve even laid eyes on her. If one needs proof that addiction is a disease and not a moral failing, look into the eyes of a woman who knows her behavior is harming her baby but still can’t stop. There is no better example of the ability of a chemical to overpower the deepest-rooted human instincts.
A recent report released by the CDC revealed that opioid addiction among women in labor quadrupled from 1999 to 2014, signifying the need for immediate action. Opioid addiction during pregnancy can create many problems for mother and child, including preterm labor, neonatal abstinence syndrome, and even fetal death. Tragically, pregnant women with addictions are less likely to receive prenatal care.
Aware of society’s disdain, many don’t want to be stigmatized at the doctor’s office. Some mothers-to-be can’t even find a physician willing to treat them, and others are afraid of being reported to authorities due to laws that have arisen out of prejudice and misinformation…
Find out more about what Dr. Barnett has to say about how harsh laws can harm the mother and child, how we can help pregnant women with their addictions, and more in the original article Pregnant and Scared to Get Treatment: When Conception Meets Addiction at The Fix.