CE24-012 - ASSESSING THE IMPLEMENTATION AND OUTCOMES OF STATE PRENATAL DRUG USE LAWS

Prenatal drug use has increased nearly five-fold over the past two decades and is associated with elevated risk
of drug overdose, maternal morbidity and mortality, adverse birth outcomes, and family separation through
foster care. States have enacted several types of laws in response to the rising rates of prenatal drug use: 1)
child maltreatment laws deeming prenatal drug use child maltreatment; 2) mandatory reporting laws requiring
providers to report prenatal drug use to child protective services; 3) testing laws mandating that providers drug
test pregnant patients or newborns, and/or giving providers legal protection to drug test pregnant patients
without consent; 4) criminalization laws criminalizing prenatal drug use; and 5) priority access laws giving
pregnant people priority access to drug treatment. Evidence on these laws’ effects on overdose, treatment
engagement and health care use among pregnant and postpartum people and their infants is limited. Critically,
evidence on whether and how the effects of these laws differ by race or ethnicity are also lacking. Meanwhile,
in 2018, Congress passed the Family First Prevention Services Act (FFPSA), dramatically overhauling state
child welfare system financing. FFPSA newly allows the use of federal funds to provide services to parents at
risk of losing custody of their children, including paying for SUD treatment services. All five types of prenatal
drug laws involve the child welfare system, but no research to date has examined how implementation of
FFPSA-driven changes to the child welfare system may vary across states with different prenatal drug law
contexts. We fill these critical research gaps through the proposed mixed-method, concurrent-embedded study
using an innovative adaptation of difference-in-differences methods. We will examine the effects of state
prenatal drug use laws on drug screening and substance use disorder diagnosis (Aim 1) and health care use
and nonfatal overdose (Aim 2). We will examine 16 state policy changes during the study period and estimate
racial disparities in policy impact using 50-state administrative Medicaid claims for 2015-2022. We will integrate
findings from Aims 1 and 2 with a qualitative analysis characterizing how states have implemented FFPSA
across heterogeneous prenatal drug law contexts (Aim 3). The proposed study is the first to use 50 state
Medicaid data and robust causal inference methods to evaluate state laws’ effects on substance use-related
outcomes (Aims 1 & 2) and to conduct a novel exploration of a new federal law, FFPSA, which has far-
reaching implications for state child welfare systems’ interaction with parents with substance use. Findings will
inform other researchers, health system leaders, and policymakers dedicated to improving the health and well-
being of families affected by substance use.

Grant Number: 5R01CE003689-02
NIH Institute/Center: ALLCDC
Principal Investigator: Sachini Bandara