The War on Drugs and Women’s Rights

President Obama announced last month that his administration will be taking steps to combat opioid abuse in the United States, including increasing the number of doctors who can prescribe buprenorphine, a medication used to treat opioid dependence, and crafting a national strategy to combat this issue in the coming year. This comes at a time when nationwide rates for prescription drug abuse have skyrocketed over the past decade enough for the Center for Disease Control and Prevention to recognize it a national epidemic. Opioids like hydrocodone and oxycodone now lead in deaths across the nation. Not surprisingly, approximately 55 percent of federal prisoners are serving time for drug related charges and the United States is now number 2 in the world for the highest rate of incarcerated women, most of whom are serving sentences related to drug offences. While the war on drugs has been slowly fraying at the seams since the term was coined, our country’s renewed spirit of revolution has finally brought the issue to the forefront again. It also doesn’t hurt that nearly 90 percent of heroin users in the last decade were white, resulting in more privileged individuals taking up a cause once dismissed as only effecting minority races and the poor.

One of the most vulnerable populations effected by this epidemic is pregnant women, particularly women of color where the intersection of the war on drugs, women’s rights, and racism collide. This past October, I had the privilege of attending the 2015 Symposium on Neonatal Abstinence Syndrome (NAS), sponsored by the National Perinatal Association and National Advocates for Pregnant Women. This meeting of providers, community members, and medical staff centered on the legal and medical implications for women who use substances or are in substance abuse treatment while pregnant. Coming from New York State where I work at a medication-assisted treatment (MAT) office, I could never imagine the things going on in states like Tennessee. Laws such as the Keeping Children and Families Safe Act are often manipulated to create statewide legislation that punishes women for their substance use disorder and essentially criminalizes pregnancy.

As a result of this legislation:

• The threat of being arrested if a child is found positive for substances like methadone or heroin prevent women from seeking prenatal care and fosters a culture of mistrust between a woman and her doctors;
• Medical providers are asked to police women’s bodies and a urine toxicology is used as the deciding factor for whether or not a women is able to parent her child;
• Mothers are not allowed to spend adequate time with their children after birth and are prohibited from breastfeeding;
• More children are placed in foster care;
• Politicians and policy makers are encouraged to craft legislation that is reflective of stigma and not science;
• In some extreme cases, women may decide to abort wanted pregnancies for fear of criminal charges should their baby test positive for illicit substances.

Despite what some may think, the problem is not that babies go home with their mothers who are in recovery, the problem is that there are not enough empathetic supports in place to help these women. Threatening someone with a report to CPS or jail-time does not create an effective therapeutic relationship. We need to work with mothers and pregnant people in a trauma-informed way, not in a manner that could further victimize them. It’s often true that parents in this situation need help balancing the care of a newborn with maintaining their sobriety; however, taking away a parent’s child increases the risk of relapsing. This is especially true for women who have just given birth.

Instead of putting it on Child Protective Services to intervene, intensive preventative and educational services should be offered to drug dependent women by an agency that is aware of the specific medical and trauma needs of this population. Women with a history of drug abuse need an advocate in their corner who can educate and support them through the beginning of their parenthood. Providing this service would eliminate the need for CPS involvement unless child abuse, neglect, or maltreatment is explicitly suspected. Being born to a mother who is in drug treatment or using drugs should not be an indicator of child abuse and policies that criminalize pregnant women with a substance use disorder do nothing to help mother or baby. They do not provide treatment or support and use subjective opinions to guide them. All they seek to do is punish a mother for her disease, instead of looking at the issue as a systemic problem often initiated by a legal drug prescription. As social workers fighting for justice, it is our obligation to work against these inaccurate and biased laws. We need to advocate for policies that are inclusive and reflect the lived experiences of mothers. We need more medication-assisted treatment (MAT) programs and the adaptation of more harm-reduction models of care. Finally, we need to advocate for the creation of more interdisciplinary centers to treat and support pregnant mothers in addictions recovery, such as the UNC Horizons program and Lily’s Place.

Now that this issue is finally getting more attention, we need to be careful about what is done to fix it. Will policies be crafted in an inclusive, intersectional way or will the conversation go quiet once the privileged classes are no longer effected by the issue? Our role as social workers is to make sure all voices are heard and policies are relevant to all people. Substance abuse does not respect boundaries. It effects all genders, races, ages, and socioeconomic statuses and policies crafted to treat this epidemic must be inclusive of all. As Dr. Hendree Jones said at the 2015 NAS Symposium, “The opposite of substance abuse is connection.” It is our responsibility to stand by these mothers as allies and advocates and see these changes through.

Elizabeth Borngraber is a graduate student in the University at Buffalo School of Social Work in New York state whose studies and interests are focused around women’s health and rights, healthcare access, and policy.