American Society of Addiction Medicine, Public Policy Statement on Substance Use and Substance Use Disorder Among Pregnant and Postpartum People (Oct. 2, 2022).
Quote
- “Equating a positive toxicology test with child abuse or neglect is scientifically inaccurate and inappropriate.”
- “Patients have the right of refusal and refusing a toxicology test should neither be seen as indication of use nor detract from clinical care.”
- “Child protection system agencies should not use evidence of substance use to implement sanctions on parents, especially child removal.”
- “Toxicology testing during the perinatal period should be standardized in hospital policies, be used only when clinical indications suggest it is necessary, be part of a clear plan outlined by the clinician (e.g., how will the result change clinical care?), and—outside of emergency situations—obtained with informed, written consent”
Article primary conclusion
The American Society of Addiction Medicine (ASAM) issued this public policy statement to provide evidence-informed recommendations regarding substance use and substance use disorder (SUD) during pregnancy and the postpartum period. ASAM recommends replacing punitive responses to substance use with ethical, equitable, accessible, evidence-based care that supports both parent and newborn.
The statement supports universal screening using validated instruments, access to evidence-based treatment including methadone and buprenorphine for opioid use disorder, harm reduction services, trauma-informed care, postpartum health coverage, and policies that promote family preservation. It states that toxicology testing should be performed only when clinically indicated, with informed written consent, and that patients should be informed of the potential legal and social consequences of testing. ASAM further states that clinicians should not interpret a positive toxicology test as determinative of a substance use disorder and that “equating a positive toxicology test with child abuse or neglect is scientifically inaccurate and inappropriate.”
The statement also recommends eliminating policies that discourage pregnant and postpartum people from seeking care, including mandatory reporting practices based solely on substance use, and cautions against automatic child protection system involvement or family separation in the absence of evidence of abuse, neglect, or danger to a child.
Article context
This statement is influential because it represents the formal position of a major professional society and synthesizes a large body of evidence into policy recommendations. Unlike primary research, however, it does not generate new data or independently test hypotheses. Instead, it reflects the judgment of addiction medicine experts regarding how existing evidence should inform clinical practice, health policy, and systems of care. Because it addresses issues that frequently arise in healthcare, child welfare, and legal settings, including toxicology testing, informed consent, family separation, child protection system involvement, medications for opioid use disorder, and racial inequities, it provides important insight into contemporary standards of care and professional norms within addiction medicine. At the same time, readers should recognize that its recommendations reflect expert interpretation of the available evidence rather than new empirical findings.
Editor's note
This statement reflects a significant shift in addiction medicine away from viewing perinatal substance use primarily as an individual clinical problem and toward understanding it as a matter of health policy, family integrity, racial equity, and reproductive justice. Unlike earlier professional guidance focused largely on diagnosis and treatment, ASAM explicitly addresses toxicology testing, child protection involvement, family separation, criminalization, incarceration, and structural inequities as factors that influence health outcomes for pregnant and postpartum people.