Opioid crisis and pregnant people

The US is seeing an enormous use of opioids among a diverse population including pregnant people. In 2000, it was estimated that 1.2/1000 pregnant people abused opioids during their pregnancy as compared to 5.6/1000 in 2009. Now the most recent statistic I have is 1.1% of pregnant people abusing opioids in 2011. The use of opioids in pregnancy is dangerous for a growing fetus and can result in neonatal abstinence syndrome (NAS) which has a constellation of symptoms affecting most bodily systems. The most common symptoms affect the central nervous system and the gastrointestinal system and require about 30 days of hospital stay for treatment after birth.

Currently OBs and midwives use a targeted screening process, they don’t screen all pregnant people- only those with risk factors (unplanned pregnancy, unmarried, unemployed, uninsured, etc) and it requires consent from the person who is pregnant. The screening process may include a questionnaire and/or toxicologic testing (testing a sample to see if the person has been exposed to the drugs in question during their pregnancy).

My question is: with the widespread rise of opioid use, the health implications for a neonate who has been exposed to opioids during pregnancy and the financial burden of caring for these neonates for an extended period of time- should mandatory testing for opioid use be done on all pregnant people?

Please comment with potential pros and cons or other ways we can approach this problem.