Characterization of U.S. State Laws Requiring Health Care Provider Reporting of Perinatal Substance Use

Abstract

Background State policies pertaining to health care provider reporting of perinatal substance use have implications for provider screening and referral behavior, patients’ care-seeking and access to prenatal substance use disorder treatment, and pregnancy and birth outcomes. Objectives To characterize specific provisions enacted in state statutes pertaining to mandates that health care providers report perinatal substance use, and to determine the proportion of births occurring in states with such laws. Methods We conducted a systematic content analysis of statutes in all U.S. states that mentioned reporting by health care providers of substance use by pregnant women or infants exposed to substances in utero; inter-rater reliability was high. We calculated the number of states, and proportion of U.S. births occurring in states, with processes for mandatory reporting of perinatal substance use to authorities, and substance use disorder treatment provision for individuals who are reported. Results Twenty states (corresponding to 31% of births) had laws requiring health care providers to report perinatal substance use to child protective authorities, and four states (18% of births) had laws requiring reporting only when a health care provider believed the substance use was associated with child maltreatment. About half of states (13) with any reporting law had a provision promoting substance use disorder treatment in the perinatal period. Conclusions Findings inform the ongoing debate about how health policies may be used to reduce the population burden of perinatal substance use.

Disparities in Chronic Conditions Among Women Hospitalized for Delivery in the United States, 2005–2014

“…16 While substance use screening is recommended for all women during prenatal care, 17 effective provision of this service has been complicated by a recent surge in legislation penalizing pregnant women for disclosing substance use. Punitive legislation has disproportionately impacted women in rural states, 18 where additional barriers to treatment may already exist, including a scarcity of addiction providers willing to treat pregnant women. 19 Our findings support the need for policy- and practice-level interventions to facilitate treatment of substance use disorders among childbearing women, particularly among women residing in rural America.…”

The Impact of the Opioid Epidemic on Children and Adolescents

“…36 In addition, 18 states have enacted policies requiring health care providers to refer pregnant women to SUD treatment and, in some cases, to child protective agencies. 36,65 Final Considerations Navigation across the criminal justice, addiction treatment, and child welfare systems may be particularly challenging to individuals struggling with an OUD. Parents may experience shame from not being able to protect their children from their addiction.…”

Mandatory and permissive reporting laws: obligations, challenges, moral dilemmas, and opportunities

“…17 Some states require or permit providers to report perinatal substance abuse. 18,19 Women who use alcohol or drugs while pregnant may be subject to criminal or civil penalties (eg, incarceration, loss of custody of children, or other penalties).…”

“…Perinatal drug exposure also may result in significant fetal harm, including congenital anomalies, opiate dependence, preterm labor, prematurity, low birth weight, fetal demise, stillbirth, and others . Some states require or permit providers to report perinatal substance abuse . Women who use alcohol or drugs while pregnant may be subject to criminal or civil penalties (eg, incarceration, loss of custody of children, or other penalties).…”