Treat, don't incarcerate pregnant women with drug problems

June 25, 2005

Recently, an Arkansas woman, Natasha Spainhour of Hot Springs, made headlines when she gave birth to twins who allegedly tested positive for methamphetamine. She was arrested and charged with administering a drug to another. Fortunately, a Garland County prosecutor, Terri Harris, made the decision to drop the charges. She should be praised for following the law and protecting the health interests of both pregnant women and children.

Numerous medical and child welfare groups (e.g., The American Medical Association, The American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American Nurses Association, and the March of Dimes) have all concluded that threatening pregnant women who have drug and alcohol problems with arrest will not help them get well. Rather, it will frighten them away from prenatal care and discourage them from speaking honestly to health care providers who may be able to help. It is not a crime in Arkansas and in 48 other states to continue a pregnancy to term while experiencing a drug problem, drinking alcohol or smoking cigarettes. Addiction is a medical illness and requires confidential medical management and treatment. Pregnancy is a time when women are very motivated to stop using. Women need to feel safe to approach their physicians to get help to quit. Legally available substances, (alcohol and cigarettes), have been found to be more harmful to the developing fetus than illicit substances. Alcohol use by pregnant women is one of the leading preventable causes of birth defects and developmental disabilities. Smoking cigarettes in pregnancy is associated with pregnancy loss, low birth weight, pre-maturity, sudden infant death (SIDS), asthma, recurrent ear infections and attention deficit disorder.

We are proud that our university has an ANGELS program that works with doctors across the state to help identify pregnant women who need help with their addictions to drugs, alcohol and cigarettes. While we can help identify these women we unfortunately have very few places to send them for the kind of treatment that would help them and their families.

Arkansas does have one such program: Arkansas CARES. This comprehensive program allows women to stay connected to their children ( a key factor in family recovery) while treating their addiction to alcohol, illicit substances and nicotine. It also teaches parenting skills, helps children to learn healthy coping skills and treats underlying disorders (e.g. depression and posttraumatic stress disorder). Despite an overwhelming demand for its services, this successful program has recently downsized and closed its North Little Rock site as a result of inadequate funding.

Drug treatment works and is much less expensive than imprisoning new mothers and paying for the expenses of foster care (Ms. Spainhour's twins have been reportedly removed from her custody.) For every $1 spent on treatment, there is a return to society of $7. Yet, instead of increasing funding for such programs the state has made it more likely that women will be arrested or unnecessarily separated from their children.

On March 28 of this year, Arkansas adopted a new civil child welfare law relating to pregnant women. It allows hospital staff to report a newborn that tests positive for certain drugs to the Arkansas State Police Child Abuse Hotline without risking liability for breach of doctor-patient confidentiality. The statute does not mandate such reporting and in this case it led to the baseless arrest of Ms. Spainhour. The new law purports to be one designed to provide services to a newborn child, but provides no additional funding for training hospital staff or child welfare workers about pregnancy and addiction and most importantly provides NO funding for treatment services.

We are living the myth that addiction will stop because of a threat of incarceration. When we get serious about stopping this epidemic, we will build a system based on treatment, not punishment.

Authors of this guest editorial are Linda L. M. Worley, M.D., associate professor, University of Arkansas Medical Sciences College of Medicine, Department of Psychiatry and Obstetrics and Gynecology, and Curtis Lowery, M.D., professor, UAMS College of Medicine, Department of Obstetrics and Gynecology.

The [Arkansas] Sentinel-Record; June 25, 2005 EDT; Editorial Section; Page: 8

This op ed also ran in the Ark. Democrat Gazette on July 3, 2005