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The state should stop penalizing mothers for taking prescription medications

When Worcester resident Keri McCallum delivered her first child seven years ago, she was actively using drugs, and the Department of Children and Families removed her daughter. When McCallum got pregnant a second time three years later, she was ready to get sober. She started taking buprenorphine, a prescription medication commonly used to treat substance use disorder. When her son was born, she was seven months sober.

Because McCallum was using buprenorphine, which state law classifies as an addictive drug, her son’s birth triggered a mandatory report by the hospital to DCF. “My whole pregnancy, despite being sober, I was in fear that they were going to remove him from my custody,” McCallum said.

DCF let McCallum keep custody of her son, and the buprenorphine helped her turn her life around. But McCallum, who cofounded Miracle Mamas, which supports mothers in recovery, says she considered going off the medication during pregnancy to avoid a DCF report.

It is absurd for a mother to be reported to child welfare authorities for taking medication prescribed by her doctor. It harms the mother and baby because it creates a perverse incentive for the mother to go off medication while pregnant — which can lead to relapse, overdose, and worse health outcomes for mom and child.

Yet that happens because of a state law requiring hospitals to report to DCF when there is “reasonable cause to believe that a child is suffering physical or emotional injury resulting from … physical dependence upon an addictive drug at birth.” The law is interpreted differently by different hospitals, but one interpretation requires a report whenever a newborn tests positive for an addictive drug — whether illicit heroin or prescription buprenorphine.

That outcome isn’t good for parents, children, or physicians. As Massachusetts Medical Society President Dr. Hugh Taylor said, “Doctors are delighted to have patients get into care to treat this disorder and are unhappy they then are being asked to report them in ways that can be problematic and worrisome for the moms.”

As scientific knowledge of substance use disorder and treatment expands, the law must keep up. A bill, sponsored by Senator Ed Markey, in Congress would, among other provisions, prohibit states from mandating reporting to child welfare agencies when prescription medication is taken under doctor’s orders.

A bill pending on Beacon Hill would eliminate the state requirement for mandatory reporting of substance-exposed newborns while instructing the Department of Public Health to develop guidelines around when health care providers should report. This common-sense update, coupled with strong evidence-based guidelines, would remove needless reporting while ensuring that reports are filed when a parent’s drug use actually does threaten the child.

Physicians would retain discretion to report cases when a parent is using substances, legal or illegal, in a way that threatens their child’s well-being. Uncontrolled illegal drug use by a parent can jeopardize child welfare and should be investigated. If a provider is uncertain, they should err on the side of reporting and let DCF be the judge. But providers should have discretion not to report parents using drugs in a way that does not endanger their child — like a mother using buprenorphine to treat addiction.

Medically, Taylor said a newborn can experience withdrawal symptoms if a mother is on prescription opioids. But those symptoms are treatable, and he worries a baby is in more danger if a mother stops taking medication and relapses.

In Massachusetts, the House voted to eliminate mandatory reporting as part of a broader bill on substance use disorder. Lawmakers should send legislation containing that policy change to the governor.

The state DPH maintained in a statement to the Globe editorial board that drug use is not predictive of parenting ability. The agency is receiving technical assistance from the National Center on Substance Abuse and Child Welfare to better engage pregnant women who use drugs with treatment and write new reporting guidelines. Passing legislation could bolster these efforts.

Several Massachusetts hospitals already reinterpreted the law. Mass General Brigham announced a policy in April establishing that substance use alone would no longer trigger a report to DCF without reason to believe a newborn was at risk of physical or emotional injury. Dr. Sarah Wakeman, medical director for substance use disorder at Mass General Brigham, said hospital officials concluded that exposure to an addictive drug alone does not constitute a risk of injury and providers need to consider circumstances around the exposure.

“A toxicology test is not a parenting test is not a child abuse test,” Wakeman said. “To get away from the idea that substance exposure is the same as abuse and neglect, we focus on how do we make an assessment around child safely.”

Boston Medical Center revised its policy in 2021 to no longer report a birthing parent taking medication for substance use disorder absent concerns about a parent’s ability to care for their child. Reporting dropped by 45 percent, according to BMC, and a study found no significant changes in length of hospital stay or how many parents maintained custody.

The American Society of Addiction Medicine and American College of Obstetricians and Gynecologists both recommend using toxicology tests to connect parents with substance use treatment and eliminating punitive mandated reporting policies.

While federal law requires states to report data about substance-exposed newborns, states like New Hampshire and Connecticut have adopted approaches where anonymized data is used for federal reporting, and families are only referred to child welfare when a provider identifies concern for a child’s well-being.

Limiting needless reports would save parents the trauma of an investigation without necessarily affecting outcomes. In fiscal 2022, there were 1,654 DCF reports of substance-exposed newborns. Of those, DCF deemed 834 children subject to neglect. Ideally, a policy shift would eliminate reports that would eventually be screened out.

The child welfare system should be used when a child is in danger — not when a mother is following a doctor’s orders and seeking to get her disease under control before her child is born.

Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.

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