Background

The use of illegal substances by pregnant women is a major public health problem in the United States. Efforts to protect the unborn child have included the screening for illegal substance use by pregnant women and reporting positive findings to law enforcement. Rather than promoting prenatal care and treatment, the threat that their use of illegal substances can be disclosed to law enforcement would discourage some pregnant women from seeking prenatal care and treatment of their substance use disorder and negatively impact the confidential psychiatrist-patient relationship.

Introduction

All states have mandatory report statutes that require professionals to report suspicions of child abuse and neglect. When pregnant women use illegal substances, the need to protect an unborn child must be balanced with their right to treatment confidentiality, their need for prenatal care, and their need for treatment of substance use disorders.

Policy Statement

The American Academy of Addiction Psychiatry (AAAP) supports the voluntary screening and testing of pregnant women for substance use disorders and mental illness for the purpose of providing prenatal care and treatment services to the mother and unborn child. AAAP is opposed to legislation or policies that require mandatory reporting of illegal substance use by pregnant women.

Psychiatrists have an obligation to maintain confidentiality that includes information gathered during the assessment and treatment of substance use disorders. When the use of illegal substances by pregnant women and/or mental illness are identified, psychiatrists should provide voluntary treatment services to the full extent possible.

AAAP supports increased funding for education, outreach, prevention, social services, improved access to drug treatment services, and prenatal care, for pregnant women. AAAP also supports funding of research and the development and implementation of effective models for comprehensive treatment of pregnant women with substance use disorders.