Prescribed and Penalized: The Detrimental Impact of Mandated Reporting for Prenatal Utilization of Medication for Opioid Use Disorder

Erin C Work^{1

2

3}, Serra Muftu⁴, Kathryn Dee L MacMillan^{5

6}, Jessica R Gray^{7

8}, Nicole Bell⁹, Mishka Terplan¹⁰, Hendree E Jones¹¹, Julia Reddy¹², Timothy E Wilens¹³, Shelly F Greenfield^{14

15}, Judith Bernstein¹⁶, Davida M Schiff⁴

Affiliations

¹ Division of General Academic Pediatrics, MassGeneral for Children, 125 Nashua St Suite 860, Boston, MA, 02114, USA. erincwork@ucla.edu.
² Department of Community Health Sciences, UCLA Fielding School of Public Health, 650 Charles E. Young Dr. S., Los Angeles, CA, 90095, USA. erincwork@ucla.edu.
³ Department of Social Welfare, UCLA Luskin School of Public Affairs, 337 Charles E. Young Dr. E., Los Angeles, CA, 90095, USA. erincwork@ucla.edu.
⁴ Division of General Academic Pediatrics, MassGeneral for Children, 125 Nashua St Suite 860, Boston, MA, 02114, USA.
⁵ Division of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, 02114, USA.
⁶ Division of Pediatric Hospital Medicine, MassGeneral Hospital for Children, 55 Fruit St, Boston, MA, 02114, USA.
⁷ Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.
⁸ Division of Pediatrics, MassGeneral for Children, Boston, USA.
⁹ Living in Freedom Together-LIFT Inc, Worcester, MA, USA.
¹⁰ Friends Research Institute, 1040 Park Ave, Suite 103, Baltimore, MD, 21202, USA.
¹¹ UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, 410 North Greensboro St., Carrboro, NC, USA.
¹² Gillings School of Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
¹³ Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
¹⁴ Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, 115 Mill St, Belmont, MA, 02478, USA.
¹⁵ Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
¹⁶ Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.

PMID: 37253899
PMCID: PMC10229393
DOI: 10.1007/s10995-023-03672-x

Prescribed and Penalized: The Detrimental Impact of Mandated Reporting for Prenatal Utilization of Medication for Opioid Use Disorder

Erin C Work et al. Matern Child Health J. 2023 Dec.

. 2023 Dec;27(Suppl 1):104-112.

doi: 10.1007/s10995-023-03672-x. Epub 2023 May 31.

Authors

Affiliations

¹ Division of General Academic Pediatrics, MassGeneral for Children, 125 Nashua St Suite 860, Boston, MA, 02114, USA. erincwork@ucla.edu.
² Department of Community Health Sciences, UCLA Fielding School of Public Health, 650 Charles E. Young Dr. S., Los Angeles, CA, 90095, USA. erincwork@ucla.edu.
³ Department of Social Welfare, UCLA Luskin School of Public Affairs, 337 Charles E. Young Dr. E., Los Angeles, CA, 90095, USA. erincwork@ucla.edu.
⁴ Division of General Academic Pediatrics, MassGeneral for Children, 125 Nashua St Suite 860, Boston, MA, 02114, USA.
⁵ Division of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, 02114, USA.
⁶ Division of Pediatric Hospital Medicine, MassGeneral Hospital for Children, 55 Fruit St, Boston, MA, 02114, USA.
⁷ Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.
⁸ Division of Pediatrics, MassGeneral for Children, Boston, USA.
⁹ Living in Freedom Together-LIFT Inc, Worcester, MA, USA.
¹⁰ Friends Research Institute, 1040 Park Ave, Suite 103, Baltimore, MD, 21202, USA.
¹¹ UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, 410 North Greensboro St., Carrboro, NC, USA.
¹² Gillings School of Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
¹³ Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
¹⁴ Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, 115 Mill St, Belmont, MA, 02478, USA.
¹⁵ Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
¹⁶ Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.

PMID: 37253899
PMCID: PMC10229393
DOI: 10.1007/s10995-023-03672-x

Abstract

Objectives: Some states, including Massachusetts, require automatic filing of child abuse and neglect for substance-exposed newborns, including infants exposed in-utero to clinician-prescribed medications to treat opioid use disorder (MOUD). The aim of this article is to explore effects of these mandated reporting policies on pregnant and postpartum people receiving MOUD.

Methods: We used modified grounded research theory, literature findings, and constant comparative methods to extract, analyze and contextualize perinatal experiences with child protection systems (CPS) and explore the impact of the Massachusetts mandated reporting policy on healthcare experiences and OUD treatment decisions. We drew from 26 semi-structured interviews originally conducted within a parent study of perinatal MOUD use in pregnancy and the postpartum period.

Results: Three themes unique to CPS reporting policies and involvement emerged. First, mothers who received MOUD during pregnancy identified mandated reporting for prenatally prescribed medication utilization as unjust and stigmatizing. Second, the stress caused by an impending CPS filing at delivery and the realities of CPS surveillance and involvement after filing were both perceived as harmful to family health and wellbeing. Finally, pregnant and postpartum individuals with OUD felt pressure to make medical decisions in a complex environment in which medical recommendations and the requirements of CPS agencies often compete.

Conclusions for practice: Uncoupling of OUD treatment decisions in the perinatal period from mandated CPS reporting at time of delivery is essential. The primary focus for families affected by OUD must shift from surveillance and stigma to evidence-based treatment and access to supportive services and resources.

Keywords: Child protection systems; Mandated reporting; Medications to treat opioid use disorder; Perinatal opioid use disorder; Substance-exposed newborns.

Plain language summary

What is already known on this subject? Child protection systems (CPS) reporting is associated with barriers to prenatal care and family resources and services. Some state policies in the United States mandate reporting to CPS for prenatal substance exposure, including prescribed medications for opioid use disorder.What this study adds? This study centers the experiences of pregnant and postpartum people with opioid use disorder with mandated reporting policies for prenatal substance exposure, describes the harms to families associated with these policies, and makes recommendations for policy change. Findings emphasize the need to uncouple medical decisions from CPS reporting and involvement.

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Conflict of interest statement

Dr. Wilens acts as co-editor for Elsevier Psychiatrics Clinics, Psychology of North American (ADHD), and Neurotherapeutics; has received royalties from Ironshore, Guilford Press, and Cambridge University Press; and provides consulting for Gavin Foundation, Bay Cove Human Services, US National Football League (ERM Associates), US Minor/Major League Baseball, and White Rhino/3D. The authors report no other conflicts of interest.

References

1. Broadhurst K, Mason C. Child removal as the gateway to further adversity: Birth mother accounts of the immediate and enduring collateral consequences of child removal. Qualitative Social Work. 2019;19(1):15–37. doi: 10.1177/1473325019893412. - DOI
1. CAPTA Reauthorization Act of 2010, S.3817, 111th Congress (2010).
1. Cleveland LM, McGlothen-Bell K, Scott LA, Recto P. A life-course theory exploration of opioid-related maternal mortality in the United States. Addiction (Abingdon, England) 2020;115(11):2079–2088. doi: 10.1111/add.15054. - DOI - PMC - PubMed
1. Committee Opinion NO. 711: Opioid use and opioid use disorder in pregnancy. Obstetrics and Gynecology. 2017;130(2):e81–e94. doi: 10.1097/aog.0000000000002235. - DOI - PubMed
1. Comprehensive addiction and recovery act of 2016, 114th Congress (2016).

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Prescribed and Penalized: The Detrimental Impact of Mandated Reporting for Prenatal Utilization of Medication for Opioid Use Disorder

Affiliations

Prescribed and Penalized: The Detrimental Impact of Mandated Reporting for Prenatal Utilization of Medication for Opioid Use Disorder

Authors

Affiliations

Abstract

Plain language summary

Conflict of interest statement

References

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical