Pubdate: Tue, 13 Nov 2001 Source: New York Times Drug Policy Forum Website: http://forums.nytimes.com/comment/index-national.html Note: This, and the series of forums, is being archived at MAP as an exception to our web only source posting policies. Cited: The National Advocates for Pregnant Women (NAPW) http://www.advocatesforpregnantwomen.org/ Note: This is a follow up to Lynn Paltrow's visit to the DrugSense Chat Room. Transcript at http://www.mapinc.org/drugnews/v01.n1904.a01.html Also: Sunday, Nov 18, at 8:00 p.m. Eastern, 5 p.m. Pacific visit with Chris Conrad in the Drugsense Chat Room at http://www.drugsense.org/chat And: on Monday, Nov. 19, 2001 8 p.m. Eastern, 5 p.m. Pacfic visit with Ethan Nadelmann in the NY Times Drug Policy Forum http://forums.nytimes.com/comment/index-national.html TRANSCRIPT: LYNN PALTROW'S VISIT TO THE NYTIMES DRUG POLICY FORUM Lynn Paltrow Hi this is Lynn Paltrow, ready to take questions. I'm Executive Director of the The National Advocates for Pregnant Women (NAPW). NAPW is a non-profit organization dedicated to securing the human and civil rights, health and welfare of pregnant and parenting women, and furthering the interests of their families. NAPW seeks to ensure that women do not lose their constitutional and human rights as a result of pregnancy, that addiction and other health and welfare problems they face during pregnancy are addressed as health issues, not as crimes; that families are not needlessly separated, based on medical misinformation; and that pregnant and parenting women have access to a full range of reproductive health services, as well as non-punitive drug treatment services. Celaya Hi Lynn, Perhaps you can shed more light on an issue we were discussing today. Do you have any data on how pre-natal marijuana use affects the fetus/newborn? Dean Becker Hi Lynn, so good of you to join us. What would you say is the most common situation that pregnant women find themselves embroiled in about their drug use and how does that scenario develop, from snitches, nurses or police? Tbarrus Hi Lynn, Will you please comment on the "health issues" faced by the pregnant woman and her fetus with regard to the following CNS active drugs used by the pregnant woman during pregnancy tobacco coca alcohol opium coffee cannabis Which drug, when used, causes the most harms to the pregnant woman? Which drug, when used, causes the most harms to the fetus? Tom Barrus, Pharmacist Lynn Paltrow I am not an expert on this, but understand that there is not a whole lot out there supporting claims that it is particularly harmful. Two drugs for which there is the most evidence of harm and potential harm are cigarettes and alcohol. I know that one author -- Bonnie I. Robin-Vergeer, The Problem of the Drug-Exposed Newborn A Return to Principled Intervention, 42 Stan. L. Rev. 745, 771-76 (1990) who argues for universal testing and reporting to the child welfare system any newborn that tests positive for an illegal drug -- excludes from her recommendation reports for marijuana because of lack of evidence regarding marijuana use and interference with parenting ability. Lynn Paltrow I am not a health care professional -- but do have some information from the legal and advocacy work that I have done. As my previous answer indicates -- I believe there is the most evidence of harm for alcohol and cigarettes -- but the potentially harmful effects of these drugs -- like all drugs are mediated by such things as nutrition, prior health conditions, prenatal care and other factors. One of the most significant factors in pregnancy outcome appears to be poverty. Trippin Hi Lynn You told me the other night that Coindon was behind the spearhead to suppress women's rights, do you have enough support to use against him to stop his discriminatory effort? Celaya Lynn Aren't there some cultures that believe that marijuana is a useful drug to use to alleviate labor pains? Lynn Paltrow You asked Aren't there some cultures that believe that marijuana is a helpful drug to use during conception? Certainly there are some among our own culture who may believe this. I am however not familiar with that particular belief. I have however heard an increasing number of women say that marijuana use helped them get through severe morning sickness, and know of one Ph.D. candidate who is researching that issue right now. Lynn Paltrow On the earlier question about relative harm from various legal and illegal drugs, the writer might be interested in a report from the Committee to Study the Prevention of Low Birthweight that found numerous behaviors and risk factors besides the use of illegal substances that increase the chances of bearing a low birthweight infant, considered to be the greatest single determinant of infant mortality in the United States. See Committee to Study the Prevention of Low Birthweight, Division of Health Promotion and Disease Prevention, Institute of Medicine, Preventing Low Birthweight - Summary 1 (1986) at 1-7. Among the many behavioral and environmental factors that contribute to low birth weight are smoking cigarettes, poor nutritional status, exposure to occupational hazards and living at a high altitude. Tbarrus Lynn, Is it a "health issue" or a "crime" for a pregnant woman to use the hard drug alcohol to a level that she gives birth to a baby forever maimed and physically deformed with Fetal Alcohol Syndrome due to the alcohol drug use of its mother? Is it a "health issue" or a "crime" for a pregnant woman to use the hard drug tobacco to a level that she kills her fetus, resulting in miscarriage, due to the tobacco drug use of the mother? Lynn Paltrow Q What would you say is the most common situation that pregnant women find themselves embroiled in about their drug use and how does that scenario develop, from snitches, nurses or police? A. Our efforts to document arrests of pregnant women seem to indicate that women who use cocaine are most likely to be arrested. We don't always know how the woman's drug use came to police attention, but it does appear that in most cases it involves health care workers who violate a variety of ethical and legal prohibitions against disclosing highly sensitive patient health information. Lynn Paltrow You ask Is it a "health issue" or a "crime" for a pregnant woman to -- drink alcohol or smoke to a degree that it harms a fetus. As our mission statement indicates we believe that it is a grave mistake -- whether thinking about children's health or women's rights -- to treat anything a woman does to her own body as if it were a crime against someone else. Even where there is better evidence that a drug or behavior may cause harm -- you have to ask what would the use be of treating the woman as a criminal? Every leading medical group in the country to take a position on this issue opposes criminalization. Why? For one reason because it is likely to deter women from getting health care they need -- making health matters worse. Lynn Paltrow As tbarrus was intimating, I haven't seen any information that any recreational drug, legal or illegal, is more harmful that alcohol or tobacco. Is there any action to make prenatal use of these substances illegal? If not, then any prosecution for use of other substances is bigotry, hypocrisy or simply a prohibitionist ploy. Lynn Paltrow Q Aren't there some cultures that believe that marijuana is a useful drug to use to alleviate labor pains? A. Oh is that what you meant to ask? I have heard of that and know of a case where a woman who was in labor but not dilated enough to be accepted in the hospital yet was advised by a neighbor who happened to be a nurse that smoking marijuana would not hurt the pregnancy and would help ease her labor pains. When she tested positive for the drug at the point of delivery, the state took her baby away! Trippin Lynn Please let your supporters know that this marijuana law reformer (and many more) are supporting them in your fight with the machine. It's a senseless evil thing that is being forced upon the people of this nation. Celaya Lynn Every leading medical group in the country to take a position on this issue opposes criminalization. So. Another confirmation that the government, and especially law enforcement is way out of bounds in sticking its nose into what recreational substances people use. Do you see the end of prohibition as the best way to end the specific problem you are dealing with? Lynn Paltrow In fact no state legislature has passed a law to make it a crime to be pregnant and engage or not engage in any behavior. One state though, by judicial fiat, reinterpreted the state's child abuse law, holding that a child includes a viable fetus. As a result the statute now effectively reads that any harm or risk of harm to a viable fetus would constitute child abuse. This would have to include alcohol and cigarettes. In fact a state agency published a brochure stating "Not only is it dangerous for pregnant women to smoke, drink, use other drugs or engage in other activities that risk harming their babies, but it's also a crime in South Carolina." The Attorney General, Charles Condon insists however -- in certain contexts only, that the decision only applies to illegal drugs. Lynn Paltrow Before going to the next question though -- several states as a matter of Civil child welfare laws do include alcohol use during pregnancy -- or an FAS diagnosis as a possible basis for investigating a family or removing a child from the parent's custody. Dean Becker Lynn, how many women are subject to this type of inquisition each year and how many are found guilty, lose parental rights, go to jail? Lynn Paltrow Certainly our current drug policy is irrational. In South Carolina a pregnant woman suffered a stillbirth and also had a positive drug test for cocaine. She was charged and convicted of homicide by child abuse and sentenced to 12 years in jail. In fact there was absolutely no evidence that cocaine caused the stillbirth -- rather the state found witnesses to say that since they couldn't determine any reason for the stillbirth -- it must have been cocaine. This conclusion without performing a host of tests to rule out other possible causes. (Anywhere from 20-70% of stillbirths are from undetermined causes) If this woman had gone out and deliberately obtained a 3rd trimester abortion -- she could only have gotten 3 years in jail. The state is willing to pay something like 24,000$ a year to imprison her -- but would never dream of even paying a fraction of that amount to provide meaningful drug treatment much less income support. As is true of other punitive drug policies -- those involving pregnant women do not in fact further any legitimate health or public welfare goals. They do however work well as political tools. Lynn Paltrow As colleagues of mine -- like Sheila Murphy have pointed out -- focusing attention on so called crack mothers and welfare queens is a terrific strategy for other political purposes. So, for example, if your goal is to end AFDC -- income support programs for poor families, you make it appear that your hard earned tax dollars are just going to a bunch of selfish drug using women. Similarly , if your goal is to overturn Roe v. Wade -- the supreme court's decision recognizing a right to decide to have an abortion - -- then you go after a drug using pregnant woman as a "child" abuser to get a court to declare that fetuses are really persons under the law. If your political goal is to control low income families and families of color -- use drug use -- any evidence of it -- no matter how functional and loving the family might be -- to take the kids away. Lynn Paltrow Few people realize that for women in the US, achieving the status of full citizen is an unfinished project. Although many gains have been made -- the constitution's protection do not fully extend to women who are pregnant. A few examples: · While it is generally recognized that people have a right to bodily integrity and the right to procreate, women face an array of restrictions on their reproductive decision-making, from restriction on access to abortion services, to restrictions on alternative birthing practices to a wide variety of health and welfare polices that devalue and undermine motherhood for low income and women of color. Although it is generally accepted that adults can decide what medical treatment they will or will not have - once a woman becomes pregnant others may be able to make that decision for her. Angela Carder was forced, against her will, to undergo surgery because it was believed it would help her fetus; in fact, it failed to save the fetus and contributed to her death. Pregnant women may be punished for informed refusal of HIV treatment and are often denied recommended forms of drug treatment. And, while many states now permit adults to determine whether and what treatment they will accept if they become critically ill or incompetent, some states exclude pregnant women from this right of self-determination. · Employers in some high-paying industrial jobs have told fertile women that they need not apply, claiming that these were fetal protection polices. Other employers have simply told women holding minimum wage jobs that they would lose their jobs if they became pregnant. So while some courts are declaring fetal personhood -- women are not yet fully persons under the law. Neitzen James Lynn I have various opportunities to interact with CPS workers in my county. Can you provide some good 'entry level' studies or other resources about the 'crack baby' myth? What is currently known about the long-term prognosis for cocaine-exposed newborn? Last I heard, they'd found nothing that could be separated from the effects of poverty itself. Keep up the good fight Lynn! Lynn Paltrow Thank you all for your questions and participation. I have to go -- but there is a lot of useful information on our web site www.advocatesforpregnantwomen.org Thank you to DB for organizing this and helping me through my first on line web forums. Lynn Lynn Paltrow Can't resist one more answer -- though you can find this on our web site. We would be happy to send fact sheets and other material to help educate CPS and other workers. For now --- Research has found that crack-exposed children are not doomed to suffer permanent mental or physical impairment, and that whatever effects may result from the use of this drug are greatly overshadowed by poverty and its many concomitants - poorer nutrition, inadequate housing, health care and stimulation once the child is born. See Deborah A. Frank, MD et. al., Growth, Development, and Behavior in Early Childhood Following Prenatal Cocaine Exposure A Systematic Review, 285 JAMA 1613 (Mar. 28, 2001); Wendy Chavkin, MD, MPH, Cocaine and Pregnancy - Time to Look at the Evidence, 285 JAMA 1626 (Mar. 28, 2001); Hallam Hurt, M.D. et al., Problem-Solving Ability of Inner-City Children With and Without In Utero Cocaine Exposure, 20 DEV. & BEH. PEDIATRICS 418 (Dec. 1999). Alan Mozes, Poverty Has Greater Impact Than Cocaine on Young Brain, Reuters Health, Dec. 6, 1999. See also Linda C. Mayes et al., The Problem of Prenatal Cocaine Exposure A Rush to Judgment, 267 JAMA 406 (1992). As yet other researchers explain The "crack baby" on which drug policy is increasingly based does not exist. Crack babies are like Max Headroom and reincarnations of Elvis - a media creation. Cocaine does not produce physical dependence, and babies exposed to it prenatally do not exhibit symptoms of drug withdrawal. Other symptoms of drug dependence - such as "craving" and "compulsion"-cannot be detected in babies. In fact, without knowing that cocaine was used by their mothers, clinicians could not distinguish so-called crack-addicted babies from babies born to comparable mothers who had never used cocaine or crack. JOHN P. MORGAN & LYNN ZIMMER, The Social Pharmacology of Smokeable Cocaine Not All It's Cracked Up to Be, in CRACK IN AMERICA DEMON DRUGS AND SOCIAL JUSTICE 131, 152 (Craig Reinarman & Harry G. Levine eds., 1997). Trippin bye Lynn.....thank you Dean Becker The greatest evil of drug prohibition is the collusion of our government. Lynn, you are astounding. I so much appreciate you taking the time to visit with us. When you encounter a new problem or solution dealing with your advocacy for pregnant women, please drop back to these screens and update us. Thank You! Donald Way Thanks for coming Lynn, you're a great guest! Neitzen James Wow, thanks Lynn. That was excellent! Tbarrus Thank you Lynn for participating in the NYT's Drug Policy Forum tonight! - --- MAP posted-by: Richard Lake