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Examining Prenatal Substance Use Policies and Their Impact on Pregnant Women's Likelihood of Getting Treatment

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State policies that rely only on treatment programs or on criminal penalties to help get pregnant women who use drugs into rehabilitation aren't as effective as those that use multiple approaches, according to new research from the School of Public Health.

The study, published in the journal Addictive Behaviors, explored state-level, prenatal substance-use policies and how they impacted the likelihood that pregnant women were admitted for substance abuse treatment. They found that states with a combination of treatment and support, clinician-reporting requirements and criminal justice measures were most successful at getting women into treatment.

Health economist Mir M. Ali, doctoral candidate Priscilla Novak and associate professor Jie Chen, all in the Department of Health Services Administration, worked with colleagues at the University of Minnesota and RTI International to examine how different state policies affect how many pregnant women receive treatment for substance use.

The researchers used a dataset of millions of admissions to substance treatment centers nationwide between 2002 and 2014 to compare pregnant women’s treatment admissions between states with different policies: criminal penalties, physician reporting requirements or treatment programs, or some combination of the three. Other states had no policies.

The study found that states with only criminal measures (like Alabama) or only treatment and support services (like Pennsylvania and Ohio) had the fewest pregnant women admitted into treatment.

But it was the states that incorporated several approaches — some mix of treatment services, physician reporting measures and criminal policies — that saw the highest admissions. Both Maryland and Virginia have policies covering all three components.

“This [multifaceted] approach may facilitate more open communication around substance use and dependence between women and their healthcare providers,” Novak said. “It may be that in states where there is criminalization but not treatment, women are more likely to withhold substance use information from their provider.”

On their own, criminal measures can discourage women from seeking medical help, and women in at least 45 states have faced criminal charges for drug use during pregnancy, ProPublica reports.

But when coupled with other policies, criminality can ensure doctors refer women to services and enable the state to require pregnant women with substance use disorder to enter treatment, Novak said.

The issue of drug and alcohol use among pregnant women is an important one: women who use substances during pregnancy are in danger of extended hospitalization, illness, violence and death, and their newborns often experience poor birth outcomes, chronic health conditions and neonatal withdrawal syndrome.

The study’s findings highlight the role of state policy in health outcomes for women and their children and have significant implications for lawmakers and officials looking to craft public policies that safeguard health.

“For states that currently have no policy, the evidence would suggest that a comprehensive policy is superior in terms of getting substance using women into treatment,” Novak said.

Ali, Novak and Chen authored the study alongside Katy B. Kozhimannil from the University of Minnesota and William N. Dowd from RTI International. The study, ‘Substance use disorder treatment admissions and state-level prenatal substance use policies: Evidence from a national treatment database,’ was published in the journal Addictive Behaviors.

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