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Implementation of State Laws Giving Pregnant People Priority Access to Drug Treatment Programs in the Context of Coexisting Punitive Laws

Published:October 19, 2022DOI:https://doi.org/10.1016/j.whi.2022.09.001

      Abstract

      Background

      In response to increased prenatal drug use since the 2000s, states have adopted treatment-oriented laws giving pregnant and postpartum people priority access to public drug treatment programs as well as multiple punitive policy responses. No prior studies have systematically characterized these state statutes or examined implementation of state priority access laws in the context of co-existing punitive laws.

      Methods

      We conducted legal mapping to examine state priority access laws and their overlap with state laws deeming prenatal drug use to be child maltreatment, mandating reporting of prenatal drug use to child protective services, or criminalizing prenatal drug use. We also conducted interviews with 51 state leaders with expertise on their states’ prenatal drug use laws to understand how priority access laws were implemented.

      Results

      Thirty-three states and the District of Columbia have a priority access law, and more than 80% of these jurisdictions also have one of the punitive prenatal drug use laws described. Leaders reported major barriers to implementing state priority access laws, including the lack of drug treatment programs, stigma, and conflicts with punitive prenatal drug use laws.

      Conclusions

      Our results suggest that state laws granting pregnant and postpartum people priority access to drug treatment programs are likely insufficient to significantly increase access to evidence-based drug treatment. Punitive state prenatal drug use laws may counteract priority access laws by impeding treatment seeking. Findings highlight the need to allocate additional resources to drug treatment for pregnant and postpartum people.
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      Biography

      Sarah A. White, MSPH, conducts research on public policies related to mental health and substance use disorders within the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health.

      Biography

      Alexander McCourt, JD, PhD, examines firearm policy, opioid policy, and other areas affected by the relationships between law and the public's health within the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health.

      Biography

      Sachini Bandara, PhD, studies how public health policies can improve wellbeing for people who use drugs, have mental illness, or are involved in the carceral system within the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health.

      Biography

      Daisy J. Goodman, CND, MPH, CNM, is a practicing nurse midwife, caring for women whose pregnancies are complicated by drug and alcohol use. She directs women's health services in Dartmouth-Hitchcock's perinatal addiction treatment program and works in their Department of Obstetrics and Gynecology.

      Biography

      Esita Patel, PhD, RN, conducts real-world and timely health policy evaluation, with a special interest in issues at the intersection of health policy and the health workforce within the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health.

      Biography

      Emma E. McGinty, PhD, conducts mixed-methods research on mental health and substance use disorder policy by integrating approaches from public policy and implementation science in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health.