New legislation introduced at start of Substance Misuse Prevention Month

Drug overdose deaths among pregnant and postpartum people increased by 81 percent between 2017 and 2020

Bill Text (PDF)

Washington (October 3, 2023) – During Substance Misuse Prevention Month, Senator Edward J. Markey (D-Mass.), chair of the Senate Health, Education, Labor, and Pensions (HELP) Subcommittee on Primary Health and Retirement Security and a member of the U.S. Commission on Combating Synthetic Opioid Trafficking, along with Representatives Barbara Lee (CA-12) and David Trone (MD-06), introduced the Substance Use Disorder and Family Engagement (SAFE) in Recovery Act to make care accessible for parents living with substance use disorder (SUD) and prevent undue family separation. In addition, the SAFE in Recovery Act would ensure that the best medical practices and comprehensive wraparound services are made available for families impacted by SUD. Representative Kevin Mullin (CA-15) is a cosponsor in the House.

Parents living with substance use disorder (SUD) continue to experience barriers to care, which can have long-term effects on their children’s health and development. Pregnant people are less likely to receive appointments with clinicians providing treatment for opioid use disorder. Current federal law requires health care providers notify Child Protective Services (CPS) if a newborn child is exposed to medications that are effective in reducing SUD symptoms and overdose deaths. As a result, parents—who are in recovery and following doctor’s orders—may be reported to CPS for an extensive investigation, running the risk of placing their newborns and other children into foster care for weeks, months, or even indefinitely.

“We can’t accept a reality where parents are being separated from their children, stigmatized or threatened because they are getting the health care they needed, recommended by a doctor and proven to be safe,” said Senator Markey. “Substance use disorder treatment makes parents and children safer, not less so. The SAFE in Recovery Act provides care that is compassionate for families impacted by substance use disorder. I will keep pushing for a national response to the opioid epidemic that ensures anyone living with substance use disorder can access care.”

“Nobody should be stigmatized for living with substance use disorder. And we certainly should not accept a world in which families are separated while parents and guardians are receiving treatment,” said Representative Lee. “The opioid epidemic is real and its impacting communities across the country. The SAFE in Recovery Act provides essential wraparound care for families and sets a benchmark for a necessary, comprehensive national response to the opioid epidemic. I look forward to working with Senator Markey, and Representative Trone to get this signed into law.”

“Over two million kids in the U.S. have a parent with substance use disorder. As a father of four, I know how hard it is to be a parent, but raising a child while fighting SUD is even more challenging,” said Representative Trone, co-chair of the Bipartisan Mental Health and Substance Use Disorder Task Force. “We must invest in accessible and affordable prevention and treatment for parents and, ultimately, for the sake of their families. The SAFE in Recovery Act will do just that, and I thank Senator Markey and Representative Lee for joining me in this effort.”

A copy of the legislation can be found HERE.

Specifically, the SAFE in Recovery Act would help parents and their children by:

  1. Ensuring care and preventing undue family separation.
    1. Requiring that states do not mandate reporting to CPS when prescription medications is taken in adherence with clinical recommendations (e.g. buprenorphine for opioid use disorder).
    2. Requiring clear, informed consent prior to toxicology testing to detect substance use of pregnant and postpartum people; includes language interpretation services and disability accommodations when necessary.
    3. Protecting individuals’ access to public assistance and preventing family separation determinations based solely on an individual taking prescription medications in accordance with the recommendations of their prescribing practitioner.
  2. Supporting comprehensive wraparound services for families impacted by SUD.
    1. Establishing a Federal Interagency Task Force to Support Families Impacted by SUD to assess government efforts, resources, and services available to support families affected by SUD, and evaluate the utilization of these resources and strategies to improve and streamline comprehensive, wraparound care.
    2. Funding community health centers (CHCs) to close gaps in primary care and require that they provide mental health and SUD services.
    3. Expanding Medicare’s opioid use disorder treatment demonstration program to include provisions to improve outcomes for pregnant and postpartum patients with SUD.
    4. Creating a grant program to provide health, educational, social, and other services to children from families impacted by SUD and enrolled in Early Head Start or Head Start programs.
  3. Ensuring the use of best-available medical practices.
    1. Establishing an NIH Consortium on Pregnancy and Substance Use Disorder Research to understand and mitigate the harms of SUD for pregnant patients and their children.
    2. Requiring a GAO study determining if clinical guidelines are being implemented, identifying the barriers to competent care, and assessing the impact that interactions with CPS have on parents with SUD and their children.

The SAFE in Recovery Act is endorsed by American Society of Addiction Medicine, Enhearten, M.I.R.A.C.L.E. Mamas, Opioid Task Force of Franklin County and the North Quabbin Region (MA), Massachusetts Head Start Association, RH Impact: The Collaborative for Equity & Justice, Jacobs Institute of Women's Health, American Psychological Association Services, Overdose Prevention Initiative, National Health Law Program, Faces & Voices of Recovery, Parabola Center, Maternal Mental Health Leadership Alliance and National Association of Criminal Defense Lawyers.

“The American Society of Addiction Medicine (ASAM) strongly supports reforms that reverse the punitive approach taken to substance use and substance use disorder during and after pregnancy and respond to the shared interests of the parent-newborn dyad by providing ethical, equitable, and accessible, evidence-based care. To that end, ASAM applauds the introduction of the SAFE in Recovery Act, which would improve addiction care for, and help guard against undue family separation of, families impacted by substance use disorder,” said Brian Hurley, MD, MBA, FAPA, DFASAM, President of American Society of Addiction Medicine.

“Head Start programs know that a child’s success in school and life depends not only on the supports and resources available to them, but to their family and community that surround them. The Safe in Recovery Act sponsored by U.S. Senator Ed Markey supports Head Start and Early Head Start programs to continue to support children and families with dignity and compassion in service of school and lifetime success for all vulnerable young children,” said Michelle Haimowitz, Executive Director at Massachusetts Head Start Association.

“Suicide and overdose combined are the leading cause of death for women in the first year following pregnancy. Many pregnant and new mothers are afraid to seek help for substance use disorder, for fear that their children will be taken away from them. The SAFE in Recovery Act focuses on keeping families together, with a focus on the perinatal period, a crucial time frame for essential mother/baby bonding. It gives pregnant and new parents access to recovery and mental health support programs, essential for the health and wellness of all parents. We applaud the Senator’s office for his continued focus on the health and wellness of our nation’s families,” said Jamie Zahlaway Belsito, Founder and Director of Policy and Partnerships at Maternal Mental Health Leadership Alliance.

Senator Markey has been a longtime advocate for communities impacted by the opioid epidemic. Yesterday, Senator Markey partnered with Representative Lee in leading 18 of their colleagues in urging the Biden-Harris administration to develop and publicly announce a national fentanyl harm reduction strategy specifically focused on enhancing public health infrastructure and addressing the collateral consequences that stem from drug arrests and convictions. Last month, he and Representative Trone demanded that the Biden administration track $50 billion in opioid settlement money. In July, Senator Markey applauded the inclusion of his bipartisan and bicameral Department of Defense Overdose Data (DOD) Act as part of the National Defense Authorization Act (NDAA) to record military overdoses, protect service members, and military families living with substance use disorder. In June, Senators Markey and Rick Scott (R-Fla.), along with Senators Marco Rubio (R-Fla.) and Thom Tillis (R-N.C.) and leaders of the House of Representatives’ Bipartisan Mental Health and Substance Use Task Force, announced a bipartisan resolution to designate June 6th as Naloxone Awareness Day. In March, he and his colleagues introduced their bipartisan, bicameral Modernizing Opioid Treatment Access Act, legislation that would improve access to methadone, a substance use disorder medication treatment, by modernizing outdated rules. In December, Senator Markey secured provisions of his bipartisan Opioid Treatment Access Act (OTAA)—legislation that reduces wait times for patients qualifying for methadone medication treatment and expands access to methadone clinics—into the end-of-year omnibus spending package.