{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:19:56Z","timestamp":1777940396498,"version":"3.51.4"},"reference-count":45,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2019,8,1]],"date-time":"2019-08-01T00:00:00Z","timestamp":1564617600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Policy, Politics, &amp; Nursing Practice"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:p>Opioid use during pregnancy is on the rise in the United States. Neonatal abstinence syndrome (NAS), also known as newborn drug withdrawal, is a public health epidemic. Between 2004 and 2014, Tennessee experienced a fivefold increase in NAS hospitalizations, from 1.5 to 8.0 per 1,000 live births. Soaring increases in the number of newborns with NAS nationwide have caught the attention of many federal and state lawmakers, especially given the unknown burdens associated with medical and social services needed by those affected over time. Tennessee opioid-related regulations and laws enacted between 2000 and 2018 were systematically reviewed and analyzed to identify each law's purpose; effects on families and individuals; pros and cons in terms of social, practical, and legal factors; and implications for nursing practice. Our findings were that Tennessee's laws are intended to decrease the number of opioids prescribed, ensure access to continued prenatal care and substance abuse management for mothers with substance use disorders, and reduce the ease of obtaining opioids. We also found that Tennessee lawmakers have enacted laws and regulations aimed at decreasing the abuse of opioids, but not reducing the incidence of NAS. As new laws are considered, it is critical that health care providers and lawmakers work together to ensure that the developed and enacted laws strike a balance between safely managing the care of both pregnant women and their newborns without producing negative outcomes.<\/jats:p>","DOI":"10.1177\/1527154419864540","type":"journal-article","created":{"date-parts":[[2019,8,7]],"date-time":"2019-08-07T12:37:44Z","timestamp":1565181464000},"page":"153-162","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Implications of Tennessee's Opioid Legislation for Neonatal Abstinence Syndrome"],"prefix":"10.1177","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0418-7648","authenticated-orcid":false,"given":"Jennifer N.","family":"Shearer","sequence":"first","affiliation":[{"name":"College of Nursing University of Tennessee, Knoxville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul Campbell","family":"Erwin","sequence":"additional","affiliation":[{"name":"School of Public Health, The University of Alabama at Birmingham, AL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon K.","family":"Davis","sequence":"additional","affiliation":[{"name":"College of Nursing University of Tennessee, Knoxville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel G.","family":"Anderson","sequence":"additional","affiliation":[{"name":"College of Nursing University of Tennessee, Knoxville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2960-7896","authenticated-orcid":false,"given":"Lisa C.","family":"Lindley","sequence":"additional","affiliation":[{"name":"College of Nursing University of Tennessee, Knoxville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2019,8,7]]},"reference":[{"key":"bibr1-1527154419864540","unstructured":"American College of Obstetricians and Gynecologists. (2017).\n                      ACOG committee opinion: Opioid use and opioid use during pregnancy\n                      . Retrieved from https:\/\/www.acog.org\/Clinical-Guidance-and-Publications\/Committee-Opinions\/Committee-on-Obstetric-Practice\/Opioid-Use-and-Opioid-Use-Disorder-in-Pregnancy?IsMobileSet=false."},{"key":"bibr2-1527154419864540","unstructured":"Bauer, A. & Li, Y. (2013).\n                      Neonatal abstinence syndrome and maternal substance abuse in Tennessee: 1999-2011\n                      . Retrieved from https:\/\/www.tn.gov\/content\/dam\/tn\/health\/documents\/nas\/Neonatal_Abstinence_Syndrome_and_Maternal_Substance_Abuse_in_Tennessee_1999-2011.pdf."},{"key":"bibr3-1527154419864540","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.03.015"},{"key":"bibr4-1527154419864540","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2016.2150"},{"key":"bibr5-1527154419864540","unstructured":"Burke, S. (2016, April 1). Doctors applaud the end of Tennessee's fetal assault law.\n                      Boston Globe\n                      . Retrieved from https:\/\/www.bostonglobe.com\/news\/nation\/2016\/04\/01\/doctors-applaud-end-tennessee-fetal-assault-law\/0NjT1R1LZmVCWQvQIOHSYI\/story.html."},{"key":"bibr7-1527154419864540","unstructured":"Centers for Disease Control and Prevention. (2018).\n                      U.S. opioid prescribing rate maps\n                      . Retrieved from https:\/\/www.cdc.gov\/drugoverdose\/maps\/rxrate-maps.html."},{"key":"bibr8-1527154419864540","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2017.0122"},{"key":"bibr9-1527154419864540","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-0562"},{"key":"bibr10-1527154419864540","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2014.03.1296"},{"key":"bibr12-1527154419864540","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-3212"},{"key":"bibr13-1527154419864540","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1005359"},{"key":"bibr14-1527154419864540","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6531a2"},{"key":"bibr15-1527154419864540","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001446"},{"key":"bibr16-1527154419864540","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000991"},{"key":"bibr17-1527154419864540","first-page":"61","volume-title":"Neonatal abstinence syndrome: Federal prevention role and related data","author":"Lee K.","year":"2015"},{"key":"bibr18-1527154419864540","doi-asserted-by":"publisher","DOI":"10.1891\/0730-0832.35.5.277"},{"key":"bibr19-1527154419864540","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2014.10.006"},{"key":"bibr20-1527154419864540","unstructured":"McMillan, B. (2015, March 21). Intractable Pain Act unanimously repealed.\n                      Herald-Citizen\n                      . Retrieved from http:\/\/herald-citizen.com\/stories\/intractable-pain-act-unanimously-repealed,4542."},{"key":"bibr21-1527154419864540","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1600879"},{"key":"bibr22-1527154419864540","unstructured":"Melton, C. & Pellegrin, M. (2018). The opioid epidemic in TN (1 of 3): Key policy milestones and indicators of progress. Retrieved https:\/\/www.sycamoreinstitutetn.org\/2017\/08\/03\/opioid-epidemic-tn-milestones-progress\/."},{"key":"bibr23-1527154419864540","unstructured":"Miller, A. M., McDonald, M. & Warren, M. D. (2018). Neonatal abstinence syndrome surveillance annual report 2017. Retrieved from https:\/\/www.tn.gov\/content\/dam\/tn\/health\/documents\/nas\/NAS%20Annual%20Report%202017%20FINAL.pdf."},{"key":"bibr24-1527154419864540","unstructured":"Miller, A. M. & Warren, M. D. (2014). Neonatal abstinence syndrome surveillance annual report 2014. Retrieved from https:\/\/preprod.tn.gov\/content\/dam\/tn\/health\/documents\/nas\/NAS_Annual_report_2014_FINAL.pdf."},{"key":"bibr25-1527154419864540","unstructured":"Nelson, K. L. (2017, July 26). Knoxville doctor could change how pregnant women overcome opioid addictions.\n                      Knoxnews.com\n                      . Retrieved from www.knoxnews.com\/story\/news\/health\/2017\/07\/26\/knox-doctors-research-prompting-protocol-change-detoxing-pregnant-women\/511594001."},{"key":"bibr26-1527154419864540","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2015.36"},{"key":"bibr27-1527154419864540","unstructured":"Public Chapter Number 327, SB 1869, 102nd General Assembly. (2001). Retrieved from http:\/\/sharetngov.s3.amazonaws.com\/sos\/acts\/102\/pub\/pc0327.pdf."},{"key":"bibr28-1527154419864540","unstructured":"Public Chapter Number 398, SB 459, 108th General Assembly. (2013). Retrieved from https:\/\/publications.tnsosfiles.com\/acts\/108\/pub\/pc0398.pdf."},{"key":"bibr29-1527154419864540","unstructured":"Public Chapter Number 430, SB 0676, 108th General Assembly. (2013). Retrieved from https:\/\/publications.tnsosfiles.com\/acts\/108\/pub\/pc0430.pdf."},{"key":"bibr30-1527154419864540","unstructured":"Public Chapter Number 820, SB 1391, 108th General Assembly. (2014). Retrieved from https:\/\/publications.tnsosfiles.com\/acts\/108\/pub\/pc0820.pdf."},{"key":"bibr31-1527154419864540","unstructured":"Public Chapter Number 840, SB 2534, 102nd General Assembly. (2002). Retrieved from http:\/\/sharetngov.s3.amazonaws.com\/sos\/acts\/102\/pub\/pc0840.pdf."},{"key":"bibr32-1527154419864540","unstructured":"Public Chapter Number 880, SB 2552, 107th General Assembly. (2012). Retrieved from https:\/\/publications.tnsosfiles.com\/acts\/107\/pub\/pc0880.pdf."},{"key":"bibr33-1527154419864540","unstructured":"Public Chapter Number 1002, SB 2552, 109th General Assembly. (2016). Retrieved from https:\/\/publications.tnsosfiles.com\/acts\/109\/pub\/pc1002.pdf."},{"key":"bibr34-1527154419864540","unstructured":"Public Chapter Number 1011, SB 2547, 108th General Assembly. (2014). Retrieved from https:\/\/publications.tnsosfiles.com\/acts\/108\/pub\/pc1011.pdf."},{"key":"bibr35-1527154419864540","unstructured":"Salter, M. L., Ridley, N. & Cummings, B. A. B. (2015).\n                      Implementation of Chapter 820: Opportunities to address pregnancy, drug use, and law\n                      [White Paper]. Retrieved from https:\/\/taadas.s3.amazonaws.com\/files\/849386597375813462-white-paper-2-2-16.pdf."},{"key":"bibr36-1527154419864540","unstructured":"Substance Abuse and Mental Health Services Administration. (2012).\n                      Treatment episode data set-admissions\n                      . Retrieved from https:\/\/www.datafiles.samhsa.gov\/study-series\/treatment-episode-data-set-admissions-teds-nid13518."},{"key":"bibr37-1527154419864540","first-page":"251","volume-title":"Essentials of health policy and law","author":"Teitelbaum J. B.","year":"2017"},{"key":"bibr38-1527154419864540","doi-asserted-by":"publisher","DOI":"10.1136\/ewjm.173.5.306"},{"key":"bibr39-1527154419864540","unstructured":"Tennessee Department of Mental Health and Substance Abuse Services. (2014).\n                      Prescription for success: Statewide strategies to prevent and treat the prescription drug abuse epidemic\n                      . Retrieved from https:\/\/www.tn.gov\/content\/dam\/tn\/mentalhealth\/documents\/Prescription_for_Success_Executive_Summary.pdf."},{"key":"bibr40-1527154419864540","unstructured":"Tennessee Department of Mental Health and Substance Abuse Services. (2016).\n                      Tennessee epidemiological profile of alcohol and drug misuse and abuse\n                      . Retrieved from https:\/\/www.tn.gov\/content\/dam\/tn\/mentalhealth\/documents\/Tennessee_Epidemiological_Profile_of_Alcohol_and_Drug_Misuse_and_Abuse.pdf."},{"key":"bibr100-1527154419864540","unstructured":"Tennessee Division of Health Care Finance & Administration. (2017). Neonatal abstinence syndrome among TennCare enrollees-2015 data. Retrieved from https:\/\/www.tn.gov\/content\/dam\/tn\/tenncare\/documents\/TennCareNASData2015.pdf."},{"key":"bibr41-1527154419864540","unstructured":"Tennessee Department of Health. (2017). Controlled substance monitoring database: 2017 report to the 110th Tennessee General Assembly. Retrieved from www.tn.gov\/content\/dam\/tn\/health\/healthprofboards\/csmd\/2017_Comprehensive_CSMD_Annual_Report.pdf."},{"key":"bibr42-1527154419864540","unstructured":"Tennessee Department of Health. (2018). Controlled substance monitoring database: 2018 report to the 110th Tennessee General Assembly. Retrieved from https:\/\/www.tn.gov\/content\/dam\/tn\/health\/healthprofboards\/csmd\/2018%20Comprehensive%20CSMD%20Annual%20Report.pdf."},{"key":"bibr43-1527154419864540","unstructured":"Tennessee Division of Health Care Finance & Administration. (2016).\n                      Neonatal abstinence syndrome among TennCare enrollees-2014 data (Provisional data)\n                      . Retrieved from https:\/\/www.tn.gov\/content\/dam\/tn\/tenncare\/documents\/TennCareNASData2014.pdf."},{"key":"bibr44-1527154419864540","doi-asserted-by":"publisher","DOI":"10.1177\/0091450918790790"},{"issue":"5","key":"bibr45-1527154419864540","first-page":"125","volume":"64","author":"Warren M. D.","year":"2015","journal-title":"Morbidity and Mortality Weekly Report"},{"key":"bibr46-1527154419864540","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2017-3520"}],"container-title":["Policy, Politics, &amp; Nursing Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1527154419864540","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1527154419864540","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1527154419864540","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T05:48:20Z","timestamp":1777700900000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1527154419864540"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8]]},"references-count":45,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2019,8]]}},"alternative-id":["10.1177\/1527154419864540"],"URL":"https:\/\/doi.org\/10.1177\/1527154419864540","relation":{},"ISSN":["1527-1544","1552-7468"],"issn-type":[{"value":"1527-1544","type":"print"},{"value":"1552-7468","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8]]}}}