There has been growing attention on the effect of substance use, including opioid use disorder, on pregnant and birthing people and their infants. Although effective medication treatment for opioid use disorder is the standard of care, racial disparities are evident in access during pregnancy. Structural racism affects treatment access and approaches to reporting to child welfare services. Black people and their newborns are more likely to be drug tested in medical settings, and Black newborns are more likely to be reported to child welfare services. Child welfare models often focus on substance use as being the dominant issue that drives risk for abuse or neglect of a child, and current reporting practices, which vary by state, contribute to these disparities. This commentary proposes an alternate way of thinking about family-based support. We suggest changes to law, institutional policy, clinical care, and ideology. Specifically, we propose realigning around shared goals of supporting the birthing person–infant dyad and recognizing that substance use is not synonymous with abuse or neglect; creating an anonymous notification process outside of the child welfare system to meet federal data-collection requirements; limiting perinatal drug testing and requiring written, informed consent for parental and neonatal testing; and developing integrated care teams and hospital settings and policies that support dyadic care.

人们越来越关注物质使用（包括阿片类药物使用障碍）对孕妇和分娩者及其婴儿的影响。尽管对阿片类药物使用障碍进行有效的药物治疗是护理标准，但在怀孕期间的使用方面存在明显的种族差异。结构性种族主义影响治疗的可及性和向儿童福利服务报告的方法。黑人及其新生儿更有可能在医疗环境中接受药物测试，黑人新生儿更有可能被报告给儿童福利服务机构。儿童福利模型通常将药物使用视为导致虐待或忽视儿童风险的主要问题，而当前的报告做法因州而异，导致了这些差异。本评论提出了另一种思考基于家庭的支持的方式。我们建议对法律、机构政策、临床护理和意识形态进行修改。具体来说，我们建议围绕支持分娩的人-婴儿二元组的共同目标进行重新调整，并认识到物质使用并不是虐待或忽视的代名词；在儿童福利系统之外创建匿名通知流程，以满足联邦数据收集要求；限制围产期药物检测并要求父母和新生儿检测的书面知情同意；开发支持二元护理的综合护理团队和医院环境和政策。在儿童福利系统之外创建匿名通知流程，以满足联邦数据收集要求；限制围产期药物检测并要求父母和新生儿检测的书面知情同意；开发支持二元护理的综合护理团队和医院环境和政策。在儿童福利系统之外创建匿名通知流程，以满足联邦数据收集要求；限制围产期药物检测并要求父母和新生儿检测的书面知情同意；开发支持二元护理的综合护理团队和医院环境和政策。