Top Federal Health Official Says Drug Criminalization Is Contributing To Stigma And Overdoses During And After Pregnancy

A top federal drug official is blasting the criminalization of drug use by pregnant people and new parents, arguing that the resulting stigmatization is harming families and contributing to the overdose crisis.

National Institute on Drug Abuse (NIDA) Director Nora Volkow become a vocal critic of drug criminalization in the past several years, noting racial disparities in enforcement and the ineffectiveness of treating addiction as criminal, rather than public health, matter.

In a recent op-ed published by STAT, Volkow focused on the consequences of criminalizing pregnant women over substance misuse disorders. She said that this population needs “support, not criminalization.”

There’s been a demonstrable increase in overdose deaths among people during and immediately after pregnancy, and it’s now the leading cause of death during or shortly after pregnancy, ranking higher than “excessive bleeding, cardiovascular conditions, or other well-known complications of pregnancy,” Volkow said.

“These stunning data highlight just how important it is to ensure access to substance use disorder treatment for pregnant and postpartum people, including the need to eliminate barriers that interfere with this treatment,” she wrote.

“People seeking treatment for addictions face additional obstacles, especially if they have children. Only a small minority of treatment facilities provide child care, creating yet another obstacle on top of securing transportation, housing, food, and other necessities, all of which can be more difficult for people who are also supporting children. The barriers get even higher for pregnant people.”

“Fear of criminal punishment deters many pregnant people from seeking help for drug or alcohol problems,” the director added. “Many U.S. states have punitive policies in place related to substance use in pregnancy, which may include regarding it as potential child abuse, or grounds for commitment or being charged with a criminal act. Penalties for substance use in pregnancy can include fines, loss of custody, involuntary commitment, or incarceration.”

Volkow wrote that “punitive policies cause pregnant people to fear disclosing their substance use to their health care providers or to avoid seeking treatment for a substance use disorder,” and they “may also cause them to avoid or delay getting obstetric care.”

“Decades of research show that addiction is a chronic but treatable condition that drives people to use substances even if it harms their health, careers, and relationships. Punitive policies are not effective at addressing substance use disorder and, if anything, only exacerbate its societal risk factors, including worsening of racial health disparities. Punitive approaches also lead to more negative outcomes for parents and their children…

Having a substance use disorder during pregnancy is not itself child abuse or neglect. Pregnant people with substance use disorders should be encouraged to get the care and support they need—and be able to access it—without fear of going to jail or losing their children. Anything short of that is harmful to individuals living with these disorders and to the health of their future babies. It is also detrimental to their families and communities, and contributes to the high rates of deaths from drug overdose in our country.”

Relatedly, an Alabama bill that moved through a Senate committee last year would have required women “of childbearing age” to present proof that they’re not pregnant in order to purchase medical cannabis products—a proposal that faced sharp resistance from drug policy and civil rights activists.

For her part, Volkow has been an outspoken advocate against criminalization, repeatedly encouraging an alternative approach to drug use that removes stigma and provides people with the treatment resources they need to recover.

Drug criminalization has “created a structurally racist system” in which Black people are treated “worse” than others, the official said in an interview late last year.

She also talked about the relationship between racial prejudice and drug criminalization in 2021, saying the U.S. is “currently reckoning with a long history of discriminatory and racist policies, many of which still continue today.”

Last year, Volkow said in a blog post that there’s an urgent need to reshape addiction treatment, specifically by putting more resources towards identifying “pre-addiction” to get people help before the disease.

In a separate essay in 2021, the health official reiterated that the current federal drug policy leads to disproportionate enforcement against communities of color and can actually increase the risk of overdose deaths. She stopped short of explicitly endorsing decriminalization, but signaled that it was time for that kind of an approach to effectively combat addiction and overdoses.

Volkow also discussed survey data last year and said that people are going to keep using psychedelics like psilocybin—especially as the reform movement expands and there’s increased attention being drawn to the potential therapeutic benefits—and so researchers and regulators will need to keep up.

The director separately participated in a panel hosted by a prohibitionist group and sponsored by D.A.R.E.—and she reiterated that data shows youth marijuana use has remained stable “despite the legalization in many states.”

She said the same at a Senate hearing last year, much to the surprise of a GOP senator who said he expected otherwise based on alcohol-related trends.

Also last year, Volkow also said that she’s yet to see evidence that occasional marijuana use by adults is harmful.