Treatment options scarce for pregnant women with addictions

New state law exposes gap between intent and real-life execution

This was originally published in The Commercial Appeal on Aug. 7, 2014. The paper, which has changed ownership twice since then, no longer maintains links to older stories.

By Wendi C. Thomas

The first woman in Shelby County charged under a new state law that levies assault charges against women whose newborns test positive for drugs headed to rehab Wednesday.

To the law’s cheerleaders, such as Memphis Republican legislator Mark White, Jamillah Falls’ transfer from jail into a residential program proves the law works as intended.

But critics, such as reproductive rights advocate Allison Glass, maintain that steering addicted mothers first through the criminal justice system and then into rehab ignores the real problem.

“This law did nothing to increase the number of facilities available or to help with access to those facilities,” said Glass, state director of Healthy and Free Tennessee.

The debate exposes a familiar chasm between a law’s stated intent and its real-world execution, a tension heightened by the absence of any precedent. The law, backed by a bipartisan coalition and roundly denounced by most major medical organizations, is the first of its kind in the nation.

If Falls, who also goes by the last name Washington, had sought residential rehab care while she was still pregnant with her daughter Messiah, she would have found few options.

“There’s a difference between what’s shown on the books and what the actual resources are,” Glass said.

Lakeside Behavioral Health System doesn’t accept pregnant women in its rehab programs.

La Paloma Treatment Center will accept on a case-by-case basis pregnant women who have already gone through detox, but only takes private insurance or self-pay. A 30-day residential program costs around $27,000.

The residential center Baby Love has room for 10 pregnant women and/or postpartum women and their infants, regardless of their ability to pay, but only if the mothers also have an addiction and a diagnosis of mental illness.

Saint Francis Hospital will help a woman detox, said hospital CEO

David Archer, but then turns to a list of eight inpatient rehab centers that accept pregnant women, including three in Shelby County and three in Mississippi.

Resources are more scarce in less-populated parts of the state. Tom Castelli, legal director for the ACLU of Tennessee, said he recently talked to a new mother in rural Tennessee who used drugs during her pregnancy.

“She’s been threatened with prosecution, but she can’t find a (residential) treatment program.”

“She’s having to do outpatient therapy 120 miles away” from where she lives, he said.

Falls, 30, is headed to Serenity Recovery Center in Memphis. Her attorney, William Gosnell, said that at some point during her pregnancy, she took suboxone to treat her heroin addiction.

Born July 5, Falls’ daughter Messiah tested positive for heroin and marijuana. Falls faced a sentence of 11 months and 29 days in jail.

What no one disputes is the explosive rise in the number of newborns exposed to drugs, up tenfold in Tennessee from 1999 to 2010. Between Jan. 1 and Aug. 2, the state health department received reports of 556 babies born in Tennessee with neonatal abstinence syndrome. Of those cases, 25 were in Shelby County; more than 300 were in East Tennessee.

“This is not new,” said Dr. Ramasubbareddy Dhanireddy, a professor and chief of the Division of Neonatology at the University of Tennessee Health Science Center, and medical director of the Newborn Center at the Regional Medical Center and the Neonatal Intensive Care Unit at Le Bonheur Children’s Hospital.

“We had heroin in the ’60s and ’70s, we had neonatal abstinence syndrome even in those days, but what is new is how the number of opioid prescriptions in our country has gone up substantially.”

Signs of NAS include hyper-irritability, tremors, high-pitched crying and sometimes seizures, Dhanireddy said, but “not every baby who is exposed to opioids during pregnancy displays signs of neonatal abstinence syndrome.”

Some studies indicate that as many as 90 percent of babies exposed to opioids have some NAS symptoms, Dhanireddy said, but other studies say 45 percent of exposed babies show no signs of withdrawal.

He would offer no opinion as to the wisdom of the law, but Castelli and the ACLU are fighting to overturn it.

“Not every societal problem can be solved or should be solved by the threat of incarceration or the criminal justice system,” he said.

“When you introduce this threat of criminal prosecution, you risk the effect of driving women away from the treatment they need.”