This first in a series of articles on state policies that support or inhibit postpartum women’s (PPWs’) access to long-term recovery from opioid-use disorders (OUDs) reviews current federal and state policies on mandatory reporting by health care professionals of a patient's substance use during pregnancy and their implications.
In addition, this article provides resources to guide grantees of the federal Bureau of Justice Assistance’s (BJA’s) Comprehensive Opioid, Stimulant, and Substance Abuse Program (COSSAP) in understanding and responding to their respective states’ policies on this issue. Subsequent articles will describe approaches to integrate treatment for substance-use disorders (SUDs) into obstetrics and gynecology (OB/GYN) care and strategies for obtaining financial support for long-term recovery programs. The focus of the current article is on policies that mandate the reporting by health-care providers of any suspected alcohol or drug use by PPWs under their care. States differ in their policies on mandatory reporting requirements, types of participating state agencies, and consequences for women who use substances during pregnancy. Depending on the state policy, mandatory reporting can be either a facilitator of or a barrier to providing appropriate SUD treatment for women. This article reviews the provisions of the federal Child Abuse Prevention and Treatment Act (CAPTA), which was enacted in 1974 as a state grant funding mechanism for supporting the prevention, assessment, and treatment of child abuse and neglect, including substance use by PPWs. In 2016 the Comprehensive Addiction and Recovery Act (CARA) amended the provisions in CAPTA regarding mandatory reporting requirements of providers of pregnancy and infant care. It established standards of care and treatment for PPW, including the development of a safety plan for infants and caregivers. A table shows policies on substance use during pregnancy for each state.