With surprising speed, prescription opioids have become our greatest challenge in drug policy — not to mention an issue in the presidential election. An estimated 10 million Americans take prescription opioid medications for nonmedical reasons. Deaths from prescription opioid medications have quadrupled since 1999. Both Hillary Clinton and Donald Trump have felt compelled to make the issue part of their campaigns.

Prescription opioid misuse among pregnant women poses especially difficult issues given the complex medical challenges of addiction treatment and pain management during pregnancy, the possibility of harm to the developing fetus, and the unique legal and ethical sensitivities arising in any potentially coercive intervention involving pregnant women. The prevalence of such disorders among pregnant women appears to have also increased by roughly a factor of four since 1999.

The plight of pregnant women struggling with addiction elicits widespread compassion and, sometimes, support for policies such as expanded access to addiction treatment. Yet the sight of pregnant women misusing intoxicating substances and media reports of newborns experiencing symptoms of acute opioid withdrawal elicit harsher reactions, too. And those reactions may increase support for policies such as criminal charges or child abuse referrals. Health experts worry that such policies drive may drive pregnant women away from health care providers or lead them to conceal their drug use from their doctors.

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