Kim Blalock had just laid down after a long day’s drive to Kentucky with her husband and three of their six children on Nov. 30, 2020 when her phone started buzzing. It was a call from her 16- and 17-year-old teenage sons back home at the family’s house in Florence, Alabama, who hadn’t wanted to come on their dad’s business trip. When she picked up her phone, she knew immediately that something was wrong. “Mom, what have you done?” one of the boys asked with panic in his voice.
Seven police officers had just burst through their front door, guns drawn, looking for the boys’ mother. Blalock told her sons to pass the phone to the police, but she says officers refused to speak to her. She told her clearly terrified sons to go spend the night at their grandparents. The next day, “I got up at six o'clock in the morning, and made the drive back,” Blalock told me, heading straight for the police station with the intention of turning herself in for whatever crime she had committed.
But even in her wildest dreams, she could never have guessed what the supposed crime would end up being. She was floored when, after arriving at the Florence Police Department, the lead investigator on her case asked her how much heroin she had done. She told the officer she had never used the drug in her life—but she thought she knew what he might be referring to.
Two months earlier, Blalock had given birth to a baby boy. While she was in the hospital, the state’s Department of Human Resources (DHR), the equivalent of child protective services, had stopped by her room because Blalock’s newborn son had tested positive for opiates. But as she explained to DHR, she hadn’t done any illegal drugs—she had a lawful prescription for hydrocodone that she had taken for years to manage degenerative disc disease that had been exacerbated by a botched surgery and a car crash. After Blalock and her son were released from the hospital, a DHR representative visited their home; Blalock showed them her prescription pill bottle and the department closed the family’s case.
Or so she thought.
Less than two months later, the day she received that panicked call from her sons, Blalock learned the local police department had started their own investigation. At the time, she and her husband had been saving up for Christmas presents for their six kids, but decided to save the money instead in case she needed to make bail. “The kids’ Christmas was horrible that year,” Blalock says. “I didn't know if I was going to be arrested.”
In the fallout from the opioid epidemic, law enforcement, local prosecutors and child services agencies are increasingly penalizing parents for using legal substances during their pregnancies. According to the CDC, about 20 percent of American adults—50.2 million people—live with chronic pain. Of those, 22 percent take a prescription opioid to manage their pain. And those patients face stigma fueled by the war on drugs. Since 1973, more than 1,600 women have faced arrest or forced intervention—often related to drug and alcohol use–during their pregnancies in the United States, according to the nonprofit National Advocates for Pregnant Women. Historically, many of those cases were a reaction to the mass hysteria over so-called “crack babies,” but today, that notion has gotten an update thanks to the opioid crisis. Now prosecutors worry about the future of “oxytots,” children exposed to opioids during pregnancy. However, much of that concern is overblown.
As the opioid crisis unfolded so did the rate of babies born to opioid-using parents: the US government reports that between 1999 and 2014 the rate more than quadrupled. The most common fear about opioid use during pregnancy is that the baby will be born dependent on their parent’s medication and go through withdrawal. However, the American College of Obstetricians and Gynecologists explains that neonatal abstinence syndrome is an “expected and treatable condition.” And, further, newborns treated for withdrawal do not develop any differently than other children.
Most of the pregnant people who have been prosecuted are those who used opioids like buprenorphine and methadone to treat substance use disorders. In 2011, a New Jersey woman was placed on the state's child abuse registry for using methadone to treat her opioid use disorder during her pregnancy. In 2013, an Ohio mom was charged with child abuse and neglect for the same reason. And in 2019, a Massachusetts mother was also added to her state's child abuse registry for using buprenorphine.
Blalock, however, might be the first chronic pain patient to be prosecuted for using a medication legally prescribed to her. “If you're pregnant, I don't think you should lay up and hurt. I think you should be able to take a medication as it’s prescribed to you,” Blalock says. But, “even if it is your prescribed medication, they're going to find a way to get you.”
When she learned she was pregnant in early 2020, Blalock decided to stop taking the hydrocodone that had allowed her to manage her chronic back pain for four years. As a 35-year-old mother of six, the prescription had allowed her to keep up with her children even though the pain was often debilitating. Her doctor never talked to her about whether she could continue taking her pills, but Blalock knew that doctors often recommended taking fewer medicines during pregnancy—even Ibuprofen and Tylenol—so she tried not taking the hydrocodone.
In the last six weeks of her pregnancy, though, her pain worsened, spiking to the point that one day Blalock had to visit the emergency room and refill her prescription. She remembers the ER doctor specifically recommending that she use her hydrocodone to manage the pain. “There was this electric current going up my spine to my neck,” she recalls. The pain “would take my breath away.”
On September 29, 2020, Blalock went into labor. When asked at the hospital to list any medications she was taking, she mentioned her hydrocodone prescription. She didn’t think the doctors delivering her son thought much of it then—the OB/GYN even told her to double up on it to manage her pain after the birth—but she later found that the hospital had drug tested her newborn. Drug testing newborns is not routine practice and when done most often targets Black and low income families (Blalock herself is white).
When Blalock arrived at the police station on December 1, the lead investigator told her that they planned to charge her with chemical endangerment of a child, a 2006 Alabama law that punishes parents who expose their children (and unborn fetuses) to controlled substances. Blalock said the police investigator she spoke with did not know that DHR had already closed its investigation.
After Blalock explained to police that she had a legal prescription and was not a heroin user, they let her leave the station. But she worried that the worst was not yet over and went online looking for help. She found National Advocates for Pregnant Women (NAPW), a nonprofit that provides legal defense to pregnant and parenting people. Blalock reached out and NAPW agreed to take on her case. They started by writing a letter to the district attorney and chief of police explaining that Alabama’s chemical endangerment law did not apply to Blalock because of a 2016 amendment that protects pregnant people who use medications prescribed to them.
Her lawyers hoped the case against Blalock would have ended there. But after realizing he couldn’t charge Blalock with chemical endangerment of a child, the Lauderdale County District Attorney Chris Connolly moved instead to charge Blalock with prescription fraud, a felony charge most often used when someone has forged a signature on a prescription, because she had allegedly failing to tell her orthopedist, who prescribed the hydrocodone, that she was pregnant.
When I spoke to Connolly, he told me that he suspected Blalock might be addicted to opiates, and that police had told him her baby had gone through withdrawal. (Blalock says that her son was born healthy.) “I think we now know nationally, it's not a good thing to try to treat a chronic pain situation with the chronic use of opiates, because you end up creating people who are addicted to opiates, and then can't get them, and turn to heroin,” he said. Connolly said he suspected Blalock was addicted to opiates and hoped she could get care via the legal system, ideally through court-supervised drug testing and treatment instead of jail.
Scientists, however, have a very different perspective. The American College of Obstetricians & Gynecologists “opposes any policies or practices that seek to criminalize individuals for conduct alleged to be harmful to their pregnancy.” The fear is that people will stop seeking prenatal or postpartum care if they’re worried their doctors might report them to law enforcement. But even then, Blalock’s medical records didn’t indicate that she had a substance use disorder.
What her medical records did show was that the prescribing doctor didn’t know she was pregnant. While the district attorney saw that as a sign of fraud, Blalock says her pregnant belly clearly showed at her appointments with the practitioner. Her NAPW attorney adds that it isn’t a patient’s job to guess what their doctor doesn’t know. “One of the things that's most concerning about this case is that it sends the message that women can't completely trust their medical providers,” said Emma Roth, Blalock’s NAPW attorney, noting that it could discourage pregnant patients from seeking prenatal care or substance use treatment. “A patient does not have a duty to read their physician’s mind.”
Blalock’s doctor told the DA that he would have weaned Blalock off of her prescription had he known she was pregnant, but addiction specialists warn that even that could have been dangerous. “If you have somebody who's stable, and you change their medication, the best you can hope for is more of the same—that they continue to be stable. But there's a possibility that they will become unstable,” says Mishka Terplan, medical director/senior research scientist at the Friends Research Institute, who is board certified in both obstetrics and gynecology and in addiction medicine. He notes that quickly taking a patient off opioids during pregnancy is inadvisable, partially because “when the pregnant person is in withdrawal, so is the fetus.”
That’s exactly why Blalock was being charged in the first place: opioid use during pregnancy has been connected to certain birth defects, but the most common fear is that the baby will be born dependent on their parents’ medication and go through withdrawal. However, the American College of Obstetricians and Gynecologists explains that neonatal abstinence syndrome is an “expected and treatable condition.”
When working with chronic pain patients, Terplan says, medical guidelines include planning for how to manage pain during pregnancy because untreated pain can lead to worse birth outcomes. “People see the opioid and don’t see anything else,” he said. “The goal is the person and taking care of them.”
Blalock’s lawyers and the district attorney’s office originally tried to settle the case out of court. NAPW sent the DA six letters from medical experts at the University of Alabama at Birmingham in support of Blalock’s case, who echoed Terplan’s concerns and argued the charge should be dropped. The DA made Blalock an offer of deferred prosecution—meaning instead of going to jail she would undergo an assessment and then participate in a random drug testing program. Although she knew that was a far better punishment than going to prison, Blalock worried about how she’d pay for the drug testing, which can cost between $10 to $60 a test in Alabama, multiplied by however many times a week you’re randomly called in to test. She also worried about finding childcare on short notice when she was called in to test.
But then, in November, Alabama Senator Clyde Chambliss, a Republican, sponsored the amendment to Alabama’s chemical endangerment law that should have protected Blalock, published a statement denouncing the local district attorney’s decision to prosecute her. “The circumstances surrounding this case are precisely why we passed this legislation—to protect innocent women from frivolous prosecution and the prohibitive costs, both financially and emotionally, of having to defend themselves against these charges,” he wrote.
That statement as well as long conversations with two of the University of Alabama doctors who’d written letters to his office, seemed to shift the district attorney’s position. After Blalock submitted to a drug test and had a clinical assessment done to prove she did not have a substance use disorder, the DA dropped the charges against her on February 22, 2022. “The drug screen and assessment confirmed what we had contended all along—that Ms. Blalock was not taking any non-prescription drugs, that she does not have a substance use disorder, and that she is not in need of any drug treatment,” her NAPW lawyer Roth told me.
When Blalock and I spoke over the holidays, her now one-and-a-half year old son jabbered away in the background. “He's a healthy, loving, and super smart one year old,” Blalock says, adding that he’d just had a check-up with his pediatrician and was meeting all of his milestones.
But the weight of her case still weighs heavy on her family, especially her older children. She says her teenagers have been bullied at school and “still get scared when we pass a police car on the highway.” After seeing people they know leave mean comments on articles about her case, her family has stopped going to church as often. The postpartum depression that started when her case began, and made it feel impossible to breastfeed her son, is just now starting to lift.
Blalock says she’s relieved to be free of the fear of a felony charge, but she’s “scared another woman in Alabama will be in my situation, and she won't know where to go.” She felt fortunate to have found NAPW online. “Pain doesn't stop just because you're pregnant,” Blalock told me when the charges against her were dropped. “I want other women facing these charges to know that prosecutors can't take control over our bodies just because we're pregnant.”
