The Biden administration shared the actions it is taking to prevent overdose deaths, reduce stigma, and expand access to treatment among pregnant women with substance use disorder (SUD) in a report issued by the White House’s Office of National Drug Control Policy (ONDCP) on Friday.

The report noted the importance of increased education and data transparency, as well as drug treatment court programs funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Department of Justice, explaining that overdose is the leading cause of pregnancy-related deaths in the year following delivery of a baby in states like Ohio and Tennessee.

“As a physician, I have seen firsthand how treatment for people with substance use disorder, including pregnant women, can improve health outcomes and save lives,” said Rahul Gupta, MD, MPH, MBA, director of the ONDCP, in a White House press release.

Yet, across the country, gaps in access to care persist, he added. “This report lays out what we must do to ensure people who need help can get it, including pregnant women.”

Medications for SUD have been found to reduce the risk of relapse and death in pregnant and postpartum women. While these medications may cause drug withdrawals in newborns, they have been shown to improve pregnancy outcomes overall, including reducing the chances of premature birth, according to a White House fact sheet.

The guiding principles behind the report include recognizing that every individual has the right to effective treatment, and that denial of such care is a violation of civil rights; acknowledging that having a SUD while pregnant is not de facto child abuse or neglect; and that criminalizing pregnant women with SUD only drives women away from care.

“Pregnant women using substances or having SUD, should be encouraged to access support and care systems, and barriers to access should be addressed, mitigated, and eliminated where possible,” the report stated. Coordination across public health, criminal justice, treatment, and early childhood systems is critical to improving outcomes and reducing disparities.

One key focus of the report is on education, including developing training and technical assistance to inform the use of SUD medications for recipients of the Department of Justice’s Office of Juvenile Programs Family Treatment Court Program and SAMHSA’s drug treatment court programs.

The report also calls for educating women’s health primary care providers throughout the Veterans Health Administration about SUD. Information gleaned from training programs at four pilot sites this winter will help shape national guidance for SUD care for female veterans across the country, the ONDCP noted.

Other key actions in the report included:

• Expanding access to medications for SUD for pregnant women and women of reproductive age in Tribal nations and Tribal communities
• Publicly reporting data on access to SUD treatment for pregnant and postpartum women, and tracking the number of obstetricians and midwives who are waivered buprenorphine prescribers
• Incentivizing partnerships between hospitals and community-based organizations that use evidence-based approaches to support individuals with SUD through perinatal and postnatal periods through HHS grants
• Hiring a “dedicated Associate Administrator for Women’s Services” at SAMHSA to spearhead efforts to improve outcomes during pregnancy and the postpartum period
• Creating “national certification standards” for peer recovery support specialists

The ONDCP also stressed the need to reduce the incidence of neonatal abstinence syndrome, a drug withdrawal syndrome that occurs shortly after birth among newborns, and to improve maternal mental health for women with SUDs who are pregnant, postpartum, or breast-feeding.

The report provided some context for the reasons behind the gaps in access to care, namely “systemic and cultural barriers,” including stigma. Studies have shown that non-white race, living in a rural area, and not speaking English were all independently associated with a lower likelihood of receiving medications for SUD in pregnancy.

Finally, the report emphasized the link between substance use and placement in foster care. A majority of infant foster care placements involved parental substance use, reflecting “missed opportunities” to prevent unnecessary family separation by bringing pregnant women and new mothers into treatment.