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Tone of Tennessee Discussion of Pregnant Drug-Using Women Changes Dramatically

Could Tennessee move, within a period of just a couple of years, from a state roundly criticized for a punitive approach to pregnant women addicted to drugs to one that puts significant money behind getting these women into effective treatment?

The executive director of a state association of substance use treatment and prevention professionals believes advocates have momentum for encouraging a significant state budget infusion for treatment, with discussions ongoing in the weeks following the July sunset of the state's 2014 amendment to the fetal assault law (Public Acts Chapter 820). The measure had subjected to prosecution those women who used an illegal drug while pregnant and whose babies were born with Neonatal Abstinence Syndrome (NAS).

Mary-Linden Salter, executive director of the Tennessee Association for Alcohol, Drug & other Addiction Services (TAADAS), tells Addiction Professional that she credits the treatment community for a pivotal advocacy role that led earlier this year to a legislative vote killing a measure that would have extended the fetal assault law beyond its July 1 sunset date.

“Not every provider in Tennessee serves women, and not all of those who do serve pregnant women,” says Salter. “Folks stepped up—even those with no dog in the fight.”

Salter adds that the debate around the law “put a face on the addiction treatment community. It led them to be more advocacy-oriented in general.” With that, she believes, could come additional funding support for treatment for pregnant women and others in need, in the fiscal 2018 budget process that will unfold in the legislature next year.

Pointing out contradictions

TAADAS last December issued a white paper that made the case for the sunsetting of the law and the establishment of more treatment-focused options for women at risk of losing their children. The white paper pointed out that women in Tennessee were being penalized for not being able to access treatment during pregnancy, in a state with a shortage of treatment slots during a blossoming opioid crisis.

The report also pointed out some contradictions related to legislators' effort to reduce NAS births via the 2014 bill. For example, it stated that the most evidence-based treatment for pregnant drug-using women, medication-assisted treatment such as methadone or buprenorphine, actually leads to similar rates of NAS births.

Also, the white paper stated that treatment of other chronic diseases, such as hypertension and diabetes, also requires careful adaptation during pregnancy, adding, “Many of these conditions pose a higher risk to a developing fetus than do opioids.”

The white paper stated, “TAADAS does not endorse criminal penalties for pregnant drug-using women because our data shows that criminal sanctions drive women away from care.”

Salter says that by the time the state legislature convened earlier this year, around 50 organizations in the state were on record in opposition to the law's continuation. These ranged from addiction treatment groups to drug court organizations to a leading right-to-life organization, which was concerned about the potential for increases in abortion as women sought to avoid arrest and prosecution.

Several women, including one who Salter says gave birth on the side of a road in order to avoid testing at a hospital (the woman is now in recovery and works at an addiction treatment program), testified before the committee that was considering a measure to extend the law beyond July 1. A deadlocked committee vote maintained the July 1 sunset date.

Nearly two months after the law's expirastion, Salter says advocates remain vigilant amid concerns that the measure could be reintroduced for consideration next year.

In the meantime, discussion has turned to efforts to meet the need for additional treatment that came to light during debate over the law. Salter says the fiscal 2018 budget allocation that is being discussed would be broad-based, but would benefit pregnant women greatly because rules governing state and block grant funding for treatment require priority consideration for pregnant and postpartum women.

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