Addiction medicine fellow at Massachusetts General Hospital in Boston.
Medical epidemiologist for the Great Plains Area Indian Health Service intermittently from 2004 through 2019.
AMA J Ethics. 2020 Oct 1;22(10):E862-867. doi: 10.1001/amajethics.2020.862.
Individuals with substance use disorders (SUDs) are at markedly elevated risk of involvement in the criminal legal system. Over the past 30 years, substance use during pregnancy has been criminalized through laws on the federal, state, and tribal level. American Indian (AI) individuals are disproportionately affected by these laws due to their race, socioeconomic status, and limited access to SUD treatment. This article aims to educate readers on laws criminalizing substance use during pregnancy and on how AI individuals are disproportionately affected by these laws. It also discusses how these laws conflict with the ethical principles of autonomy, nonmaleficence, and justice. Finally, this article recommends that clinicians advocate for the decriminalization of SUDs during pregnancy and for improvement in access to comprehensive, evidence-based SUDs care.
患有物质使用障碍（SUD）的个体明显有较高的卷入刑事法律系统的风险。在过去的 30 年中，通过联邦、州和部落层面的法律，怀孕期间的物质使用已被定为犯罪。由于种族、社会经济地位和有限的物质使用障碍治疗机会，美洲印第安人（AI）个体受到这些法律的不成比例的影响。本文旨在教育读者了解将怀孕期间物质使用定为犯罪的法律，以及 AI 个体如何不成比例地受到这些法律的影响。它还讨论了这些法律如何与自主、不伤害和公正的伦理原则相冲突。最后，本文建议临床医生倡导怀孕期间物质使用障碍的非刑事化，并改善获得全面、基于证据的物质使用障碍治疗的机会。
