Every 25 minutes, a drug-addicted baby is born in the U.S.
To try to protect the youngest victims of the nation's opioid epidemic, Tennessee enacted a law that sent new mothers to jail for substance abuse, while other states employ existing child-abuse laws to punish prenatal drug users and remove their children.
But sanctions have backfired, serving only to drive pregnant women away from necessary prenatal care and substance-use treatment, pediatricians say in three new papers.
In one, published this week in Pediatrics, the American Academy of Pediatrics exhorts policymakers to support a public health approach - rather than a criminal justice response - to opioid use in pregnancy.
"I don't think these laws are in the best interests of moms or babies," Dr. Stephen Patrick, lead author of the report in Pediatrics, said in an interview. "Opioid-use disorder is a medical problem and not a moral failing."
Patrick is a professor at Vanderbilt University School of Medicine in Nashville, Tennessee, where he treats infants suffering withdrawal from opioids.
Instead of jail, he called for improved access to long-term contraceptives and substance-treatment programs designed to care for pregnant women.
About 100 substance-using new mothers went to jail in Tennessee between 2014 and 2016 under a fetal-assault law that's no longer in effect, Patrick said.
The law incited so much fear in pregnant addicts that some refused to go to the hospital and gave birth at home, in cars or on the side of the road, he said.
Meanwhile, the number of pregnant women who use opioids and the number of babies born with withdrawal symptoms continues to rise.
Patrick estimated that as many as 440,000 substance-exposed infants are born in the U.S. every year and asserted: "We're not going to arrest 440,000."
Dr. Mary Beth Sutter, a professor at the University of New Mexico in Albuquerque, works with expectant drug addicts in her state, where prosecutors charge pregnant drug users under child-abuse laws, she said in a phone interview.
"Putting women in jail and taking their babies away to try to prevent substance abuse really isn't working," she said. "It does nothing to help these women and children, but it tends to turn them way from care."
Newborns who stay with their mothers require fewer days in the hospital, cutting the cost in half, Sutter writes in a new review in the journal Obstetrics and Gynecology Clinics of North America.
Physicians can better help drug-addicted infants when they know mothers are using illicit substances. But expectant mothers worry so much about being stigmatized, jailed and having their babies taken from them that they frequently fail to disclose drug use, Sutter writes.
Carrying a baby motivates substance users to quit. "If there ever was a time when it's good to help people with substance abuse," Sutter said, "it's pregnancy."
But the demand for substance-treatment programs designed to meet the unique needs of pregnant women and their babies far outstrips their availability. Only 19 states have such programs.
New Mexico has only one in-patient treatment program with just six beds for pregnant and parenting women in the entire state, Sutter said.
Medication-assisted therapy with methadone or buprenorphine has become standard care for pregnant women with opioid-use disorder, Patrick writes. But women who fear losing custody of their babies sometimes avoid treatment so as not to raise suspicion, according to another new report in the Journal of Substance Abuse Treatment.
Psychologist Dennis Hand, a professor of obstetrics and gynecology at Thomas Jefferson University in Philadelphia, examined opioid use in pregnancy throughout the U.S. and found the problem particularly acute in the South.
Southern states have fewer drug-treatment facilities, and more women take benzodiazepines, a class of sedatives and anti-anxiety drugs, along with opioids, Hand found. The combination complicates treatment for mothers and babies.
Southern women also are less likely to have health insurance, and the South has even fewer treatment programs for pregnant women than other areas, Hand said. Tennessee does not cover methadone, and Mississippi has only one methadone clinic, compared to California, which has 138, he said.
The number of infants experiencing opioid withdrawal after birth, or neonatal abstinence syndrome, grew nearly fivefold over the past decade, Patrick writes.
Many of the mothers of newborns that Patrick and Sutter treated had no idea that taking doctor-prescribed pain relievers could lead them and their babies to addiction. Sutter said her patients frequently were prescribed opioids following car accidents, dental surgeries and cesarean sections for previous births.