Case Study: Obey Law on Criminal Reporting for a Pregnant Mother Addicted to Heroin?

Case Description: 

You are the obstetrician of a 27-year old single woman referred to you late in her first trimester after positive pregnancy test. She admits to a history of heroin addiction, with several unsuccessful attempts “get off it” in community-based programs, as well as to current using. Although buying and using heroin is illegal, she has no criminal record. The heroin use poses developmental risks to the fetus as well as the risk of fetal addiction.

She claims she will “do anything now to help my baby.” She says she previously believed she was infertile and considers the pregnancy a gift from God. She insists that “all I want in life is to be a good Mom.”

You live in a state that defines drug abuse while pregnant as criminal child endangerment with mandatory reporting and mandatory treatment. As you interpret the law, your patient clearly falls under its purview. You know if you follow the law on mandated reporting, she will be prioritized for immediate access to an inpatient drug treatment program that provides medically-supported heroin withdrawal for mother and fetus. But she may also get a criminal record. Or she may be flagged to child protective services in advance of treatment, treatment outcome, or pregnancy outcome—increasing the risk that after birth her baby will be taken from her regardless of treatment outcome.

You believe she is strongly motivated to try to become drug-free for the sake of her fetus, and with proper medical and social support, could be successful without coercion.

What should you do?

See full discussion of case here