Addressing NAS: Carrot versus Stick With all the attention the Neonatal Abstinence Syndrome (NAS) issue has gotten over the past few years, there are lots of opinions on how the issue should be addressed in Tennessee. NAS is a set of symptoms a newborn can exhibit at the time of birth due to their mother’s drug use during pregnancy. Babies are born physically dependent on these drugs. Once they are born their bodies go into physical withdrawal and are given the diagnosis of NAS. Babies have to then be weaned slowly from the drugs to keep them from experiencing painful withdrawal symptoms. In 2013, the State Legislature passed a bill called the “Safe Harbor Act” which states that if a woman enters both treatment and prenatal care prior to her 20 th week of pregnancy that the Department of Children’s Services will not automatically take her baby into custody. This law was designed to encourage (carrot) women to get the medical services and help for their addiction. In this current legislative session, there is a bill being proposed that would charge a mother who’s baby is born with NAS or other medical conditions as a result of their mother’s illegal use of a narcotic drug with an assaultive offense, which is a misdemeanor offense that would have a maximum sentence of one year in jail. If the child dies, the mother can be charged with criminal homicide (stick). In looking at this particular issue, it caused me to pause and ask, “Why have we not given the same attention to women who abuse alcohol or tobacco while pregnant?” In looking at the data, many more newborns are negatively impacted by the maternal use of these substances. An estimated 40,000 newborns each year are affected by Fetal Alcohol Syndrome, with damage ranging from major to subtle. This condition affects more babies than Down Syndrome, Cerebral Palsy, SIDS, Cystic Fibrosis, and Spina Bifida combined. Substance use during pregnancy is not a new issue in our community, but is 100 percent preventable. We have to think carefully about the best approach(s) to address what we see as a threat to the health of our children. None of us want to see babies suffer and have lifelong challenges, but what is the best solution? A lot to ponder.