When Medication Becomes a Hammer

I learned something new today…sort of.

In part, CAPTA, the Child Abuse Prevention and Treatment Act, “provides federal funding and guidance to States in support of prevention, assessment, investigation, prosecution, and treatment activities and also provides grants to public agencies and nonprofit organizations, including Indian Tribes and Tribal organizations, for demonstration programs and projects” (childwelfare capta).

Additionally, it “defines child abuse and neglect as, at minimum:

“Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or
“An act or failure to act which presents an imminent risk of serious harm.

“This definition of child abuse and neglect refers to parents and other caregivers. A ‘child’ under this definition means a person who is younger than age 18 or who is not an emancipated minor” (HHS).

But, according to the US Department of Health and Human Services, “Your state or territory may also define child abuse and neglect in their laws” (HHS).

I’m not a lawyer, and I don’t play one on TV, so smarter people than I have figured this out. For example, Wisconsin, where I live, has added quite a bit to CAPTA’s minimal definition:

“Abuse” means any of the following:

Physical injury inflicted on a child by other than accidental means
When used in referring to an unborn child, serious physical harm inflicted on the unborn child and the risk of serious physical harm to the child when born caused by a habitual lack of self-control of the expectant mother of the unborn child in the use of alcoholic beverages, controlled substances, or controlled substance analogs, exhibited to a severe degree
Manufacturing methamphetamine in violation of § 961.41(1)(e) under any of the following circumstances:
- With a child physically present during the manufacture
- In a child’s home, on the premises of a child’s home, or in a motor vehicle located on the premises of a child’s home
- Under any circumstances in which a reasonable person should have known that the manufacture would be seen, smelled, or heard by a child

Neglect Citation: Ann. Stat. § 48.02

“Neglect” means failure, refusal, or inability on the part of a caregiver, for reasons other than poverty, to provide necessary care, food, clothing, medical or dental care, or shelter so as to seriously endanger the physical health of the child.”

And it goes on to define Sexual Abuse/Exploitation and Emotional Abuse (childwelfare wisconsin). So, yeah, the minimal definition from CAPTA is covered.

Now, here’s where things get really tricky: according to a CNN article in April 2024, “At the federal level, child abuse prevention laws passed in 1974 mandated that child welfare agencies receive notification when an infant was born affected by ‘illegal drugs.’ The Comprehensive Addiction and Recovery Act, known as CARA, removed the word ‘illegal’ from the law in 2016 to mandate notification of authorities anytime a newborn is affected by ‘drugs,’ legal or illegal” (CNN).

And this led to my learning moment: when I see “drugs” that imply both legal and illegal, I think alcohol! I was so excited that CARA and CAPTA were now considering ALCOHOL as a drug that can lead to child abuse and neglect. In my mind, this meant that if there was evidence that a neonate was affected by illegal drugs as well as ALCOHOL and now, increasingly, cannabis as a LEGAL drug, notification of authorities was mandated. But it doesn’t.

Next time I’ll discuss how mandatory “reporting” likely helps no one, but right now I want to discuss “legal” and “illegal” drugs. According to the CNN article, “This one-word change is why the law now applies to medication-assisted treatments, such as (…) methadone (…). Theoretically, it could apply to any medication that a pregnant person is taking that affects the infant, including anti-seizure medications and anti-depressants” (CNN).

According to the American Academy of Pediatrics, one out of seven pregnant people drink alcohol during pregnancy despite our knowing that alcohol is a teratogen, meaning it’s “known to cause abnormalities in a fetus after prenatal exposure” and that Fetal Alcohol Spectrum Disorders, caused only by prenatal exposure to alcohol (PAE), are 100% preventable (healthy).

Further, pregnant people are self-reporting use of cannabis 2 to 5% of the time (NCBI), but test results indicate that the real ratio is anywhere from 30 to 60% (science).

Sure, drugs are drugs, alcohol and cannabis included, but none of that matters if we’re testing for the wrong substances! If OB/GYNs in delivery think “medication for addiction treatment” or “benzodiazepines” when they realize that they have to test for ALL drugs, both legal and illegal, but pregnant person X is using alcohol and/or cannabis, the help available to baby and mom is nil.

Resources

https://www.childwelfare.gov/resources/about-capta-legislative-history/

https://www.childwelfare.gov/resources/definitions-child-abuse-and-neglect-wisconsin/

https://www.cnn.com/2024/04/11/health/substance-use-pregnancy-policy-change/index.html

https://www.healthychildren.org/English/health-issues/conditions/chronic/Pages/Fetal-Alcohol-Spectrum-Disorders-FAQs-of-Parents-and-Families.aspx

https://www.hhs.gov/answers/programs-for-families-and-children/what-is-child-abuse/index.html#:~:text=%22Any%20recent%20act%20or%20failure,imminent%20risk%20of%20serious%20harm.%22

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021337/

https://www.sciencedirect.com/science/article/pii/S089085672300045X#:~:text=Under%2D%20and%20overreporting%20could%20be,eg%2C%20amphetamine%5D%20instead)