Nonpartisan Report on Opioid Prevention & Treatment Includes Important Policy Recommendations for Pregnant Women

Last summer, the Pew Charitable Trust released a comprehensive report that analyzed Wisconsin’s existing substance use disorder (SUD) treatment systems and public policy landscape. The report includes 25 policy recommendations, several of which pertain to providing SUD treatment to pregnant and postpartum women.

Most importantly, the report acknowledges the barriers to pregnant women seeking treatment in Wisconsin that are posed by Wisconsin’s Act 292, which was passed into law in over 20 years ago and is commonly referred to as the “Cocaine Mom” law. This law gives the state almost unprecedented power over pregnant women who use or have admitted to past use of any amount of alcohol or a controlled substance. There is widespread agreement among medical professionals and advocates that the law deprives pregnant women of basic rights and ultimately undermines maternal, fetal, and child health.

Before getting into the specifics of the Pew report, some details about the specific provisions of Act are needed to provide context for why the law serves as a barrier to pregnant women accessing the medical care they need. An excerpt from and article written by WAWH Executive Director, Sara Finger, outlines the most relevant provision:

Under this law, pregnant women who are thought to use alcohol or drugs may be subjected to forced treatment without any proof that it is safe or even helpful for the pregnant woman or her future child. It gets worse. If the woman refuses the forced treatment, a court can then hold her in contempt and incarcerate her in a county jail, where she is likely to be denied access to pretty much everything recommended for pregnant women including healthy foods, and access to prenatal and other health care. The state can also begin proceedings to terminate her parental rights before she even gives birth. And while the state appoints a lawyer to represent fetuses at all stages of such proceedings, the woman has no right to counsel at important preliminary hearings where her rights are at stake.

In 2017, a federal district court initially struck down Act 292 on constitutional grounds, but the case was eventually dismissed by a federal appellate court because the plaintiff eventually left the state.

While the Pew report does not explicitly call for the full repeal of Act 292, it does state that clinicians and patients “report that this policy serves as a barrier to SUD treatment for pregnant women by potentially discouraging individuals from seeking SUD treatment for fear of repercussions” and that “[t]his barrier potentially puts pregnant women and their child at greater risk of harm than they would be if this policy did not exist.”

Pew does generally suggest that the Legislature make changes to state law to make it easier for pregnant women to “seek and receive evidence-based treatment,” which can certainly be interpreted to mean making changes to Act 292. The report says that state agencies work to address misunderstandings about Act 292 among clinicians, social service agencies, and law enforcement. Finally, Pew recommends that the Department of Health Services issue guidelines for health care providers that receive any type of public funding to align with best practices regarding the education, screening, and treatment of childbearing age women regarding SUD’s. 

In addition to recommendations regarding prevention and treatment for pregnant women, the report suggests several policy changes to improve SUD care for postpartum women, including:

• Earlier delivery of postpartum SUD care, ideally before the first regularly scheduled postpartum visit
• Integrating traditional postpartum care and SUD treatment programs, which could be accomplished through co-locating family planning, breastfeeding, psychiatric services, and home visiting programs.
• The Department of Health Services and Legislature should consider incentivizing such policies.

It is encouraging to see these critical issues regarding the intersection of the opioid crisis and women’s health finally being brought to the forefront by respected, nonpartisan organizations like Pew. WAWH is hopeful that this is indicative of a larger shift in the Wisconsin policy landscape regarding substance use disorders that will begin to prioritize patient health, medical evidence, and individual autonomy over the urge to promote the punitive policies that have helped land Wisconsin in its current predicament with opioid addiction.
If you’re interested in learning more about the background of Pew’s Substance Use Disorder Treatment Policy Recommendations for the State of Wisconsin, you can view the full report here.