Mothers in treatment for opioid use disorder shouldn’t also have to fight child protective services

Pregnant people and new mothers who are being treated for opioid addiction often have to fight to keep their children out of the hands of child protective services. But it’s a fight they shouldn’t have to face.

They’re active in treatment. They’re not using illegal drugs. Yet child protective services (CPS) often take their babies away — not because they’re unfit mothers, but because they’re being judged on falsehoods.

For many years, federal law required newborns who were “affected by illegal drugs” to be flagged to CPS. But in the Comprehensive Addiction and Recovery Act of 2016 (CARA), legislators deleted the word “illegal.” This one-word change to federal child welfare policy has resulted in CPS taking away babies from new mothers who are active in treatment and not using illegal drugs.

Many CPS caseworkers, judges, and members of law enforcement believe that people using medications for opioid use disorder are swapping one drug for another. They aren’t. They are choosing the gold standard of treatment for opioid addiction and, in doing so, are making a safe and healthy decision for themselves and their newborns. It’s time national policy reflected that.

Understanding medications for opioid use disorder

Between 2017 and 2020, drug overdose deaths more than doubled among pregnant and postpartum people. But limited resources and stigma prevent pregnant people who are battling substance use from seeking care because when they do start taking medications to assist their recovery, CARA often requires that they be reported to welfare services for child abuse and neglect. It’s a lose-lose scenario for many new mothers and their babies.

But medications used to treat opioid addiction, typically methadone or buprenorphine, are entirely different from opioids themselves when it comes to the health and safety of pregnant people and their babies. According to federal health agencies, these medications are the gold standard for preventing overdoses and treating opioid use disorder. It’s an evidence-based treatment in which the patient’s doctor or medical provider prescribes either methadone or buprenorphine, both of which the Food and Drug Administration has approved as first-line options during pregnancy and breastfeeding. These medications work by preventing withdrawal symptoms and cravings, which reduces the risk of relapse and pregnancy complications for both mother and baby. In fact, these medications are so protective they are associated with positive benefits to children months after birth.

While taking methadone or buprenorphine can carry some risks, such as drowsiness or interactions with other medications, they’re minor compared to the use of street opioids or other non-medical opioids. Opioids like heroin or fentanyl cross the placenta and cause an increased risk of maternal and fetal complications like preterm labor, fetal convulsions, low birth weight, and possible fetal death. In comparison, treatment with buprenorphine or methadone stabilizes the opioid system and prevents the harmful effects of repeated cycles of intoxication and withdrawal.

Failing to distinguish between prescribed, legal medications to treat opioid use disorder and non-medical, illegal opioids can be the difference between a mother keeping her baby — or CPS taking it away.

A new approach for pregnant people and their families

While CARA still remains the law of the land, individual states and hospitals are rethinking the best approach for new mothers and their families. Mass General Brigham in Massachusetts recently announced it will no longer report suspected abuse or neglect to state welfare officials simply because a baby is born exposed to medications used to treat opioid use disorder. Yale New Haven Children’s Hospital and Boston Medical Center have also implemented new drug testing and reporting protocols, and states like New York and Washington now mandate reporting only when withdrawal symptoms or other safety concerns are present.

While actions at the federal level are also beginning to shift with the recently passed SAFE in Recovery Act and further research and reporting from the Biden-Harris administration, there is still much to be done to protect the rights of mothers and ensure they can access anti-addiction medication without the risk of losing their babies to the system.

To do this effectively, these changes must be made at the state and federal levels:

• Rewrite the CARA law, bringing back the word “illegal” so mothers using anti-addiction medications won’t be penalized for seeking treatment and getting help from clinicians.
• Institute dual reporting pathways in hospitals that include toxicology testing, home evaluations, and personal questionnaires to differentiate in utero substance exposure stemming from prescribed medications versus potentially risky drug use.
• Reduce stigma by developing education programs for hospital staff, social services, and law enforcement about the realities and safety of pregnant people using medications to treat opioid use disorder.

Mothers with opioid use disorder deserve better treatment so they can have better outcomes for themselves and their babies. Real change needs to happen from policy, government, and societal levels, but that doesn’t discount the power of individuals when it comes to this issue. If you’re involved in the system — be it health care, social services, law enforcement or legal — take the time to understand the facts so you can truly help the people you’re serving.

Arthur Robin Williams, M.D., is a board-certified addiction psychiatrist and chief medical officer at Ophelia, a company that provides evidence-based opioid addiction treatment. Judith Cole, N.P., is a dual-certified adult gerontology primary care and women’s health nurse practitioner clinician at Ophelia.