Pregnant woman who took a prescribed opioid for her chronic pain faces a felony charge
Kim Blalock, who says she has chronic back pain, battled excruciating aches during her most recent pregnancy, so she turned to painkillers prescribed by her doctor, hoping for relief.
Instead, the 36-year-old mother of six has endured a distressing ordeal: Her baby tested positive for the opioid, which precipitated an investigation that led an Alabama prosecutor to charge Blalock with prescription fraud in a case her attorneys say is an unprecedented violation of a pregnant woman's privacy and freedoms. Lauderdale County District Attorney Chris Connolly said this is the first time he has prosecuted a pregnant woman refilling her prescription as fraud.
"I'm not a crusader," he told The Washington Post. "I'm not looking to make precedent about this, but the facts are the facts. Our position is that she concealed the material fact from her doctor that she was pregnant in order to continue to get hydrocodone."
This new punitive step in Alabama, the state with the nation's harshest statute against drug use during pregnancy, is part of policies set by dozens of states that researchers say are "divorced from health care."
The case, which was first reported by al.com, comes at a time when officials are wary of pain pills in the wake of a nationwide epidemic of addiction and overdose deaths, leaving chronic pain patients like Blalock at odds with the crackdown on opioid prescribing.
"It really has taken a toll," she wrote in an email. "I didn't get to bond with my baby. I've had severe postpartum depression with this baby."
Blalock, who said she has suffered from arthritis and degenerative disk disease for more than 14 years, said the hydrocodone prescribed by her orthopedist allowed her to function with what "feels like an electric pain" that has plagued her with limited mobility.
"It is worse in the morning or when I'm overdoing it, but it also happens when I'm lying in bed too much," she said.
When she was pregnant with her youngest son this year, she stopped taking the hydrocodone until six weeks before the birth, when she said the pain was unbearable.
"It's not just the pain, which is bad enough. But dealing with chronic pain, I have a lot of anxiety and depression surrounding the pain," she said. "I tried not to take it, but it was getting to the point where I felt like I had no other choice."
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After she gave birth in September, she said she told her obstetrician about the hydrocodone and her newborn was tested, triggering an investigation under a state law authorities use to prosecute parents for exposing children to fumes from home-based meth labs.
Lawmakers later clarified in 2016 that pregnant women taking legally prescribed medications are exempt from the chemical endangerment law following reporting by al.com and ProPublica that revealed officials prosecuted more than 500 women in over a decade under the statute.
Blalock said she showed investigators her pill bottle to prove her medication was prescribed, but the Lauderdale County District Attorney's Office pursued a prescription fraud charge, accusing her of refilling her prescription without informing her doctor she was pregnant.
Blalock's case is the latest in a decades-long trend of states enacting punitive measures against substance use during pregnancy, according to the Guttmacher Institute, an organization focused on reproductive health and rights. Nearly two dozen states and D.C. consider substance use during pregnancy to be child abuse under civil child welfare statutes, according to a state-by-state tracker maintained by the group.
Public health groups, including the American College of Obstetricians and Gynecologists, oppose punishment for drug use while pregnant.
Connolly said he does not wish to "demonize" Blalock, acknowledging she was seeking the medication for her chronic pain. But, he said, he is recommending she participate in a pretrial diversion program in which she could possibly be drug tested and weaned off her medication, alluding to people who have become addicted after long-term use.
"We have an opioid epidemic in not only our state but in the nation," he said. "The idea is there's got to be an alternative to chronic opiate use that can address whatever chronic pain situation this person has or other people. The answer to chronic pain is not to use opiates for the rest of your life."
Blalock's attorneys from the National Advocates for Pregnant Women have represented pregnant women in similar cases across the country, including Chelsea Becker, who was charged by California authorities with murder after she consumed methamphetamine and delivered a stillborn child. The case, which drew widespread attention from civil rights groups and reproductive health advocates, was dismissed in May.
The legal advocacy group says the case against Blalock could possibly set a precedent in Alabama, if she is convicted, for limiting those who are pregnant from refilling prescriptions they would otherwise be allowed to.
"What's particularly troubling is that it is creating a criminal penalty for perceived failure to disclose one's pregnancy - which is private information - even without being asked," Dana Sussman, one of the attorneys representing Blalock, told The Post.
Blalock said she was not asked by her orthopedist if she was pregnant.
Hytham Imseis, an obstetrician on the board of National Advocates for Pregnant Women, said even if Blalock's doctor was aware she was pregnant, that doesn't necessarily mean Blalock's pain should not be treated.
"It was certainly worth being treated when she was not pregnant," he said. "And then when she becomes pregnant, she does not become less worthy of being treated."
"But everyone is fearful of harm to the fetus," Imseis added.
Newborns exposed to opioids in the womb may experience neonatal abstinence syndrome, with symptoms including tremors, trouble feeding and irritability days after birth.
Imseis said studies have shown the diagnosis of the condition is subjective.
While Blalock said her child was born healthy, the prosecution alleges the baby suffered from withdrawal symptoms.
Concerns about addiction have run rampant since the misuse of prescription opioids fueled the deadly opioid epidemic, leading to more than 500,000 deaths in the 21st century. The majority of overdose deaths in recent years have been caused by illegal drugs such as heroin and methamphetamines, increasingly laced with the powerful synthetic opioid fentanyl.
In an effort to address the surge in overdose deaths, officials have clamped down on prescription opioids, leading the Centers for Disease Control and Prevention to release prescribing guidance that was misconstrued by some doctors to cut off prescriptions and leave patients to fend for themselves.
About 20 percent of American adults - 50.2 million people - live with chronic pain, according to the CDC.
Kate Nicholson, the founder and president of the National Pain Advocacy Center, citing a finding that less than 8 percent of people prescribed opioids become addicted, said most chronic pain patients continue taking opioids long-term without abuse.
While people suffering from pain have endured stigmatization and lost access to care, Nicholson said a criminal charge such as this for filling a prescription is uncommon.
"The idea that someone filling a legitimate prescription would be subjected to a felony charge is outrageous," Nicholson said.
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