During my graduate social work internship at a syringe access program I saw many things that shocked me at the time. I witnessed multiple overdose emergencies, for example, thankfully none of them fatal because we had naloxone on hand. However, it was still traumatic for everyone involved to see someone on the brink of death. I was especially struck when this happened to someone close to my age.
Charlotte* is one of the young women I’ll always remember.
I first met her when she came into the agency to access medical care for a minor ailment. The next time I saw her was quite different—she barely stumbled inside before collapsing in the throes of a heroin overdose. The staff administered naloxone and she became alert as the paramedics whisked her away. She didn’t come back for weeks and I assumed that she associated the agency with the unpleasant experience of being hospitalized. I was relieved when she returned after about a month. She’d wanted to stop back in for a while, she told me with a shy smile, but had been preoccupied—she’d recently discovered that she was pregnant.
A typical response to someone happily sharing such news is an offering of congratulations. I was outwardly speechless, however, while internally my mind raced: In Charlotte’s chaotic life, could pregnancy possibly be a positive thing? How was her drug use already impacting her own health and the health of the pregnancy? What kind of life could she provide for a baby?
Looking Charlotte in the eye, I realized that my private reaction wasn’t remotely helpful. Instead of falling back on my problematic biases, I could choose to treat Charlotte as I would my sister or a friend and as I would want to be treated myself when sharing similar news—with basic kindness. Instead of questioning or lecturing, we discussed her goals and referrals to supportive resources.
As Charlotte began to formulate a plan about how to best take care of herself during her pregnancy, she admitted that fear of being recognized as a drug user made her very reluctant to seek prenatal care and mentioned feeling grateful for the opportunity to speak openly about her situation without facing condemnation as an evil person and a bad mother. In contrast with the specter of that selfish, reckless monster, she—like any expectant parent— was far from perfect but clearly wanted the best for her baby.
Charlotte helped me see that conscientious advocates and service providers must aim to do better. It is an abomination to public health when biased attitudes and policies create more risks and further marginalize pregnant and parenting people who use drugs. The National Perinatal Association’s Workgroup on Perinatal Substance Use just released a new position statement that captures an alternative, harm reduction-based approach beautifully. They’ve created a series of complementary infographics and social media posts to help share the message.
Driven by similar goals, together with allies including Elephant Circle, COLOR, CannAbility Foundation, Harm Reduction Action Center and others, the Drug Policy Alliance’s Colorado office co-founded the Colorado Coalition to Protect Children and Family Rights. Our mission, based on ten simple principles, is to advocate for humane, public health-oriented policies for families affected by substance use. Our principles are focused on but not unique to Colorado, so we hope they are a rallying cry to others doing similar work elsewhere.
At the end of the day, existing and proposed “child welfare” policies are oxymoronic and unjust when they shame people and undermine family ties based on faulty assumptions and misinformation about drugs and drug use. Even pregnant and parenting folks who never use drugs problematically or who are doing well in treatment face continued misinformation and stigma.
Those of us who genuinely care about child welfare must start by openly acknowledging and boldly asserting the fact that using drugs and caring for a family are not necessarily mutually exclusive.
Harm reduction gives us the best framework to support and empower people like Charlotte—people like our sisters, friends, neighbors, colleagues and even ourselves—who may use drugs or even struggle with problematic substance use while simultaneously striving to provide the very best for their children and families.
*Name has been changed.
Amanda Bent is a policy coordinator for the Drug Policy Alliance, based in Colorado.