Opioids, Babies, and Ethics

A new research article flags the problems facing new mothers who have a history of substance abuse.(1) If an infant is exposed to drugs in the womb, especially opioids, the newborn can face withdrawal symptoms on birth, which can require ICU treatment for an extended period of time.(2)

The article notes that use of opioids is often accompanied by psychiatric and mood disorders. Further, the illness of the infant may intensify those disorders for the mother. That can increase risk both to the mother and the infant.

Compared to matched controls, mothers of an infant with NAS were significantly more likely (p<0.01 for all of the following) to have claims for major depression (33 percent vs. 11 percent), postpartum depression (7 percent vs. 0 percent), anxiety (27 percent vs. 1 percent) and adjustment reaction (9 percent vs. 4 percent).(1)

It makes sense. At the very least, the mother may feel guilt over placing the child at risk through her behavior. It can escalate from there.

For society, opioid abuse by pregnant women comes with substantial costs. The ICU isn’t cheap. Then there’s follow-on treatment for impairment of the newborn, and perhaps more intense psychiatric treatment for the mother. Someone pays these costs.

The authors argue for repeated psychiatric screening of the mother during the first year of the newborns life. It’s hard to argue with that, but there’s a cost to that as well.

There are other options, for example:

  • Place the child in a home with adults better able to nurture the child, at least until the mother is clean and stable. Unfortunately, most states don’t allocate the resources need to run successful programs to protect children.
  • If the mother doesn’t want the child, allow her not to have it.

Got any better ideas?

What you can’t do, logically, is to say the current situation is OK and then complain about health insurance premiums and taxes.

 


Sources:

  1. Pediatric Academic Societies. “Mothers of children born with NAS are more likely to experience mental health problems.” ScienceDaily. ScienceDaily, 5 May 2018. <www.sciencedaily.com/releases/2018/05/180505091609.htm>.
  2. https://www.marchofdimes.org/complications/neonatal-abstinence-syndrome-(nas).aspx
  3. Prabhakar Kocherlakota, “Neonatal Abstinence Syndrome,” http://pediatrics.aappublications.org/content/134/2/e547

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