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Study: Stop mandatory child abuse reporting for infants exposed to addiction medications 

In this photo illustration, bottles of the generic prescription pain medication buprenorphine are seen in a pharmacy on Feb. 4, 2014 in Boca Raton, Fla. The narcotic drug is used to treat opioid use disorder. (Joe Raedle/Getty Images)
In this photo illustration, bottles of the generic prescription pain medication buprenorphine are seen in a pharmacy on Feb. 4, 2014 in Boca Raton, Fla. The narcotic drug is used to treat opioid use disorder. (Joe Raedle/Getty Images)

Massachusetts law says health care providers must contact child protective services any time a newborn has been exposed to opioids, including in-utero exposure to prescription medication used to treat an addiction to opioids. That can punish women in recovery, compelling some to stop treatment, according to a study out of Massachusetts General Hospital.

The researchers have joined a growing list of child welfare experts calling for a change to the mandate.

“It’s time for Massachusetts to stop stigmatizing women with a substance use disorder,” said the study’s senior author, Dr. Davida Schiff. “People are avoiding care because of the risk of mandated reporting.”

The mandate is based on a section of the federal Child Abuse Prevention and Treatment Act. It requires notice to child protective services for infants “born with and identified as being affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure” and tracking of those children.

Massachusetts, unlike most other New England states, has interpreted that language to include two medications used to treat an addiction to opioids, buprenorphine and methadone, because babies may be born dependent on these drugs and need special care during withdrawal.

Other prescribed drugs, such as medications for depression or diabetes, can also cause dependence at birth but are not typically reported, according to the study.

State law says that physical dependence on an addictive drug must be investigated as possible child abuse. But according to Schiff, including treatment medications in that category brings potential consequences that could be much worse for the parent and the child.

“Our current policy and approach, which is leading people to think that it’s better for them to risk overdose and potentially death, is really harmful,” she said.

The state Office of the Child Advocate recommended changes to the drug dependence reporting mandate in a report published two years ago. The result is pending legislation on Beacon Hill that would end automatic reporting of infants born dependent on an addictive substance.

Instead, health care workers would assess the birthing parent. If a clinician is concerned that ongoing drug or alcohol use could put the infant at risk, those cases would be reported to the Department of Children & Families (DCF) and child protective services.

If the parent is considered fit to care for the infant, then information about the birth would be reported to the Department of Public Health. All such cases would be reviewed periodically.

“This change is designed to ensure that only those cases of newborns where there is a child protective factor get reported to DCF,” said Maria Mossaides, director of the Massachusetts Office of the Child Advocate. “Mothers who are using medication that they need to be on don’t need to fear that they would be reported to DCF.”

State child welfare officials said in an email that they support this change. They said they already work with the health department on plans to support families and children dealing with addiction.

The study, although based only on a small group of 26 interviews, still raises questions about the welfare of children born to parents with a history of drug use. Among 25 participants reported to DCF, 12 babies were removed from the mother’s care. Half of the children were removed for short periods of time, but the other half had not been reunited at the time of the study interview.

Schiff said 40% of the women had lost custody of other children during periods of active addiction, which can lead to a longer period of investigation. Some women reported feeling shamed and threatened during the investigation based on their prior drug use.

The proposed change to state law stresses the importance of keeping families together by taking the welfare of both the mother and child into account.

“Sometimes that means providing support to the family so they can overcome an obstacle or get through a particularly difficult period of time,” said Nancy Allen-Scannell, director of the Massachusetts Society for the Prevention of Cruelty to Children. “We don’t want to default to involvement in the child welfare system.”

Allen-Scannell said no one can guarantee that abuse or neglect won’t occur among children that would no longer be automatically referred to DCF, but the periodic reviews of cases not reported would help the state evaluate the change and adjust if needed.

The House and Senate bills, like so many on Beacon Hill, are still in a committee. It’s unclear whether lawmakers will take them up this session.

This article was originally published on WBUR.org.

Copyright 2023 WBUR. To see more, visit WBUR.

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