Prenatal Use of Medications for Opioid Use Disorder and the Risk of Child Welfare Involvement: Analysis of the State Child Abuse and Neglect Policies Database

Background and Purpose. Medications for opioid use disorder (MOUD), such as methadone and buprenorphine, are an evidence-based treatment recommended for pregnant people seeking care for opioid use disorder. Considerable evidence supports the effectiveness and safety of MOUD for pregnant patients; however, many are hesitant to initiate or continue medication treatment due to concerns pertaining to the potential for Child Protective Services (CPS) involvement before or after birth. The present study explores state-level CPS reporting policies for substance-exposed newborns across the United States, with an emphasis on exemption for legally prescribed medication.

Methods. Data for this study was obtained from the State Child Abuse and Neglect (SCAN) Policies Database, which contains information on child maltreatment definitions and policies from all 50 states, the District of Columbia, and Puerto Rico (current to year 2021). We examined state-level policies related to substance-exposed newborns, including an automatic maltreatment reporting requirement, alternative response options, and exemption for legally prescribed medication. Descriptive statistics were used to categorize patterns of availability of relevant definitions and reporting policies.

Results. In over 40 states, the District of Columbia, and Puerto Rico, child maltreatment definitions included prenatal exposure to drugs or alcohol. Nearly 20 states and the District of Columbia required all substance-exposed newborns to be reported for child maltreatment. In three states, cases involving substance-exposed newborns were ineligible for alternative or differential response (i.e., engaging families in services without a formal CPS investigation). Finally, in over 20 states, the District of Columbia, and Puerto Rico, maltreatment definitions did not include an exemption for newborns testing positive for a controlled substance due to parent’s medical treatment.

Conclusions and Implications. Findings from this study indicate that while prenatal substance use exposure is commonly included in state definitions of child abuse and neglect, nearly half of US states and territories do not include an exemption for legally prescribed medication. Moreover, some state policies appear to demonstrate a punitive approach towards cases involving substance-exposed newborns, requiring an automatic child maltreatment report and a formal investigation. The presence of restrictive policies without a clearly-articulated exemption for newborns testing positive for a controlled substance due to parent’s medical treatment presents challenges for pregnant people with opioid use disorder, who should be offered access to evidence-based medication treatment. Mandated reporting of prenatal MOUD exposure may increase barriers to treatment and cause unnecessary harm to children and their families, with considerable implications for child welfare policy and practice. Limitations related to the SCAN database and implications for future research will be discussed.