State Policies That Treat Prenatal Substance Use As Child Abuse Or Neglect Fail To Achieve Their Intended Goals

The US is experiencing a complex substance abuse crisis. Not only has opioid overdose mortality increased sharply, by 400 percent from 1999 to 2017, but opioid use during pregnancy contributed to a 300 percent increase in neonatal abstinence syndrome (NAS)-a postnatal drug withdrawal syndrome in infants that is identified at birth-from 1999 to 2013. States have taken myriad policy approaches to combat the opioid crisis and its consequences, and some states have adopted punitive policies toward prenatal substance use. Using data for the period 2000-14 from the State Inpatient Databases of the Healthcare Cost and Utilization Project, this study examined the effect of state-level policies that treat prenatal substance use as child abuse or neglect on the incidence of NAS, maternal narcotic exposure, and substance use treatment admissions for pregnant women. We employed a difference-indifferences approach to estimate the effect of these policies. We did not find evidence that punitive prenatal substance use policies reduced NAS or maternal narcotic exposure at birth; however, we did find evidence that these policies may deter women from seeking substance use treatment during pregnancy. Policy makers might reconsider the efficacy of punitive policies and investigate increasing access to and reducing the cost of treatment for pregnant and parenting women.