Maternal Opioid Use and Medicaid: How Social Workers and Policymakers Should Support Mothers and Newborns
By: Courtney Morrison
In 2014, approximately 32,000 babies were born with neonatal abstinence syndrome (NAS), a disease which is categorized by a set of medical problems a baby experiences when withdrawing from exposure to narcotics post birth. Medicaid covers 82% of the costs for all babies born with this syndrome. While support from Medicaid seems significant, the current policies in place punish and stigmatize women, more specifically, low-income women with opioid addictions. To mitigate these experiences, social workers and policymakers need to advocate for policies that offer Medicaid programs for these pregnant women and their children, hold doctors and drug companies accountable for their role in this issue, and protect women who seek treatment. Social workers can further advocate for policy change on a macro level by connecting with local, state, and federal politicians and proposing changes to current policy.
Social workers are important intermediaries whose unique insights into the experiences of expectant mothers make them both apt advocates and invaluable sources for policy makers. Social workers can advocate for policy change by joining committees that advise local and state government in their communities. On an interpersonal level, social workers can work to change the policies within their own clinical settings that may discriminate against or stigmatize clients with Maternal Opioid Use Disorder (MOUD) or NAS. The National Association of Social Workers’ Code of Ethics puts social justice and service to clients as a key aspect of being a social worker making this issue particularly salient for this profession. These advocating steps can be taken by social workers, but also by policymakers who are in a position to make changes that directly impact women and children with NAS and MOUD. Advocating for these changes is the responsibility of all those working within the healthcare system and policymakers can change outdated, grandfathered clauses.
Unfortunately, the current NAS crisis is a function of historical policies that made opioids ubiquitous and accessible for pregnant mothers. Opioid use in pregnant women is a long-standing problem. The maternal opioid and NAS crisis came about through decades of misinformation, stigmatizing laws, and the targeting of low-income individuals. Pregnant women who receive Medicaid are offered opioid prescriptions at higher rates than women who have private insurance. Higher prescribing rates for this group are linked to an increased prevalence of opioid use disorder. Between 1998 and 2011, the number of women with opioid use disorder increased by 127 percent.
Between 1860 and 1910, opioids were available over the counter. In 1986, the World Health Organization (WHO) recommended that physicians only prescribe opioids to patients experiencing cancer-related pain. The media often portrayed pregnant women with substance use disorders as unfit mothers, and in the 1980s and 1990s the term “crack baby” became widespread. This portrayal led to the persecution of pregnant women with opioid use disorder. One example of this is the Minnesota Omnibus Bill of 1989 also known as the “Crack Baby Bill.” The law stated that child abuse and neglect included pre-natal exposure to any controlled substances, putting women further at risk for punishment instead of treatment. Historically, women on Medicaid could be put on mandatory drug withdrawal programs or have benefits revoked if they were found to test positively for drugs.
And today, we are faced with the long-term impacts of maternal opioid use and NAS. Two recent studies funded by the Centers for Disease Control and Prevention have linked opioid use during early pregnancy to congenital malformations. Congenital malformations are a leading cause of infant death in the United States, accounting for 20 percent of all deaths during the first year of life. If babies with NAS do not die from complications within their first year, they often have low birth weights, respiratory illnesses, and long-term cognitive and physical health challenges. When children are born with NAS, they are often taken away from their mothers, and their mother’s identified substance disorder is not treated correctly. Babies on Medicaid born with NAS were found to have longer stays in the NICU than their counterparts on private insurance. NAS and maternal opioid use have long term physical, financial, and societal impacts. While the human toll of the crisis is increasing, there are policies that can improve circumstances for mothers and newborns with NAS.
For instance, policymakers can implement a standardized system of care. Currently, the standard of care varies from doctor to doctor and state to state. One policy suggestion for standardized care is to expand Children’s Special Health Care Service (CSHCS). What CSHCS covers is dependent on the state. In Michigan, CSHCS provides extra coverage such as home-based services and support to children and families born with a wide array of medical illnesses. However, CSHCS does not cover behavioral, emotional, or developmental issues that a child may have due to NAS. This lack of coverage means that a large number of children are left to slip through the cracks of our healthcare system. Michigan and other states should expand their services and cover NAS under CSHCS or NAS. Additionally, since women who give birth are covered by Medicaid for only 60 days after giving birth, we should expand the post-birth coverage that Medicaid provides to a year. This, alongside CSHCS expansion, would address many of the persistent health challenges that both mother and baby endure.
We also need to hold drug companies accountable. Drug companies make billions of dollars from drug sales each year: the global opioids market was valued at $25.4 billion in 2018 and is expected to grow. And because drug companies are first and foremost in business to make money, this can result in companies aiming to profit from both addiction and treatment. For instance, Teva Pharmaceuticals profits from opioid sales yet also profits from the sale of Narcan, the drug given to people who overdose from those opioids. Doctors, social workers, and other medical professionals should advocate for opioid alternatives on behalf of their clients, but policymakers should also consider prohibiting drug companies from making both opioids and Narcan.
Ultimately, social workers and policy makers need to continue to fight against the stigma placed on pregnant women with opioid use disorder and get them the best services possible. Expanding CSHCS, holding drug companies accountable, and advocating on behalf of this vulnerable population are some of the ways that social workers and policymakers can work to get mothers better healthcare services. These better services in turn will help to decrease the rates of MOUD and NAS in the U.S. today.
Photo of a pregnant woman in a sweater by Suhyeon Choi from Wikimedia
Courtney Morrison is a Master of Social Work student at the University of Michigan School of Social Work. She is majoring in interpersonal practice with a concentration in health. In addition, she is a Health Research and Service Administration (HRSA) Scholar focusing on integrated health care and substance use disorders. Her interests include working with families and children, maternal opioid use, and health disparities. She has a bachelors degree in Public Health and a bachelors degree in Psychology with a Journalism minor from University of Michigan-Dearborn.
