Drug Tests and Pregnant Patients: Investigating the Intersections of Law and Health

Dr. Katharine McCabe studies the intersections of law, policy, and reproductive health. She explains: “When we think about these intersections we tend to focus on the hot topic issues we see on the news, like access to abortion, we don’t often think about how child welfare systems or opioid drug policy can affect reproductive well-being.” Her recent work focuses on what happens when therapeutic programs and clinical practices accommodate punitive legal objectives in response to substance use during pregnancy. One of the ways that laws get taken up by health professionals is when providers try to identify pregnant women with substance use issues through drug testing. “In several states, there are laws that equate having used an illicit substance during pregnancy with a form of child abuse or neglect. That exposes already vulnerable women to lots of legal and social risks like the removal of their children or even criminal prosecution in some states.” Providers may have the best of intentions when they drug test their pregnant patients, however, McCabe notes that “when a drug test results in intervention by the state, its therapeutic use is overwritten by its forensic ramifications.” 

Dr. McCabe’s research also documents what happens to pregnant people after they are reported to the state because of their substance use during pregnancy. In Chicago, Illinois, where she conducted her dissertation research, child welfare systems work closely with substance treatment programs to ensure the safety of children born to substance users. Drawing upon interviews from women who were in involuntary substance treatment programs because of perinatal substance use, she found that the gender, race, class, and parenting status of clients shape how these programs are implemented. She states: “the women in these programs thought they were there to receive treatment and get back on their feet, but the focus is really intently on their parenting. Their parental rights become the bargaining chip used to gain compliance in pretty restrictive and disciplinary settings.”

Dr. McCabe is also working on a series of studies examining how the on-going opioid crisis has affected at-risk pregnant and post-partum women and their families.  She is currently conducting interviews in Cincinnati, Ohio, an opioid “hot spot,” to understand the effects of city-wide, universal drug testing of pregnant patients. She asks: “what are the consequences of testing all pregnant patients, during an era when we know that the boundaries between health care delivery systems and other punitive systems, like law enforcement and child welfare services, are so porous?”  The recent coronavirus pandemic has been shown to have a compounding effect on the existing opioid crisis. The next steps of her research will be to examine how COVID-19 has placed new strains on systems that were already struggling to adequately address the opioid crisis and how families have been affected by the confluence of these pandemics.