I gave birth to my elder daughter in Palm Beach County, Florida in 2014. She was delivered by paramedics after a rapid, intense labor led to an unplanned home birth. Afterwards, in the hospital where the paramedics had brought me, my vagina felt like it was frozen in an agonizing, endless scream. The prospect of going to the bathroom was as gruesome as the next Saw sequel. And a new, fragile and vaguely misshapen human was suddenly in the world, and I was the one appointed to making sure nothing bad happened to her. It was terrifying.

    But even with all that, I felt better than I ever had—like my whole being was made of love-glitter. I was cranky, in pain and exhausted, but I just wanted to keep staring at this little person. There’s no replicating the feeling of having just given birth. It’s the best drug in the universe.

    That sedation of sorts is the only explanation I can think of for why I wasn’t totally panicked when a cop walked into my hospital room within hours of my baby’s arrival.

    Consumed by the afterglow of childbirth, I had no idea how much that routine investigation would harm my child and me in the future. But even if I had known, there would have been nothing I could have done to protect us.

     

    When CAPTA Is Used to Target MAT

    Under the Child Abuse Prevention and Treatment Act (CAPTA), in order for states to receive crucial federal funding for their child welfare agencies, they must have specific plans in place to address the needs of infants identified as having been affected by drugs in utero. In many states, that means hospital staff are required to report any infants born to mothers who used substances while pregnant—often, that includes medications used to treat opioid addiction, such as methadone or buprenorphine.

    It doesn’t seem to matter that these drugs are medications prescribed by physicians, nor that it’s widely believed to be safer for pregnant women who are addicted to opioids to transition to opioid agonist therapy than to detox.

    It also doesn’t seem to matter that methadone and buprenorphine are the only medications shown to significantly reduce opioid-related mortality and other complications. Or that neonatal abstinence syndrome (NAS)—withdrawal in infants that can result from a variety of substances taken by the mother during pregnancy, including methadone and buprenorphine—is not linked to long-term adverse health effects, and can be treated safely with minimal discomfort when hospitals use best care practices.

    “Agonist therapy in pregnancy is considered by most to be the standard of care,” says Stephen Straubing, a Florida-based addiction medicine physician and OB/GYN. “Detoxification during pregnancy—while less of a risk to the fetus than previously thought—is associated with a relapse rate in the 80 percent range.”

    Once I was outed to child services as having a substance use disorder, that information became a perpetual black mark on my record.

    Moms like me who engage in methadone or buprenorphine treatment are still regarded with suspicion and treated like child abusers and criminals, even while we actively work toward a life free from illicit drugs using the most effective tools available.

    Addiction treatment providers who receive federal assistance are subject to additional privacy regulations—although such protections are under general threat—beyond HIPAA, which governs confidentiality for most of healthcare.

    “The set of regulations apply to federally assisted substance use disorder programs, which can mean programs that receive federal funding, but also includes nonprofit programs … programs that are authorized to provide MAT or withdrawal management, programs run with state/local money if the state/locality receives federal block grants, [and] programs that accept Medicaid/Medicare/CHIP,” says Jacqueline Seitz, an attorney with Legal Action Center.

    That means methadone and buprenorphine patients should, hypothetically, feel extra secure about not having their treatment history leaked. Patients must give explicit permission to allow their providers to disclose their addiction diagnosis—even to the patient’s own primary care physician.

    But as I discovered just hours after giving birth, moms on methadone are exempt from those protections by way of the CAPTA mandate—in every state that interprets it to include prescription medication (which, of course, includes Florida). Once I was outed to child services as having a substance use disorder, that information became a perpetual black mark on my record.

     

    An Unfounded Child Welfare Investigation

    By the time the officer walked into my room, my daughter was already being monitored for signs of potential opioid withdrawal, because I’d taken prescribed methadone throughout the pregnancy. I was about eight months in remission from a five-year heroin addiction.

    My son—my oldest kid—had been born in 2007, when I was 19 years old. Although I gathered the courage to testify against his abusive biological father shortly after he was born, more than four years of physical and sexual assault led me to develop the post-traumatic stress disorder (PTSD) that I would eventually self-medicate with heroin. With crippling PTSD,  I gave physical custody of my son to my half sister, and eventually to my mom, with whom he has lived a stable and comfortable life since age four.

    He had never been around me while I used drugs. And when the paramedics who delivered my daughter in 2014 asked whether I had other children, I assumed it was to gather my health history. Preoccupied with being in labor, I didn’t take the time to explain to them that my son didn’t live with me.

    So I assume it was one of the paramedics who called the police and reported that I had potentially abused my son by using drugs around him.

    She grilled the doctor about whether my daughter’s emerging withdrawal symptoms were in line with what was expected from appropriate methadone use.

    These kinds of breaches of privacy can undo months—or even years—of recovery work, and undermines the physician-patient relationship, says Dr. Kimberly Sue, medical director of the Harm Reduction Coalition. As an example, she describes the case of one of her patients who was a high-risk polydrug user.

    “Once CPS was involved, it was like ‘us versus them. This social worker unleashed a string of things that could not be undone,” Sue says, referencing the child welfare investigation that followed the report on her patient. “That really harmed her and made her avoid care and made her afraid to engage in care.” Sue notes that though she was very concerned for her patient’s health, she never worried about the children because of their large familial support network.

    The police officer who showed up in my hospital room was accompanied by a child protective investigator (CPI). As soon as the cop learned that my son had been in a different state, under a guardian’s care throughout the past drug use that I had reported to the paramedics, he became instantly bored.

    “Not my jurisdiction,” he grumbled, glancing at the door.

    But the CPI had more questions. She asked about my addiction and treatment history, my methadone dose, and my newborn’s health. When the doctor walked in, she grilled the doctor about whether my daughter’s emerging withdrawal symptoms were in line with what was expected from appropriate methadone use. The doctor said yes.

    That didn’t stop the CPI from opening a child welfare investigation on me.

    My case was closed after a brief, intrusive, but ultimately fruitless investigation. My methadone treatment records—which included counseling notes and random urinalysis results—showed that I was compliant and engaged in my recovery. So the case was deemed unfounded and closed.

     

    The Disastrous Impact of a Past Investigation

    Except that wasn’t the end. Because four years later, I became involved with Florida’s child welfare system again, and I still am. And the information from that unfounded 2014 investigation has influenced my current case to the point of having my two daughters taken from me for what has now been almost a year.

    In early 2018, when an angry in-law placed a call to the Florida child abuse hotline accusing me of using drugs, the Broward County child protective investigator did not make any attempt to speak with me. She didn’t wait for drug test results. When she filed a petition to have my kids taken from me, she cited that 2014 investigation—the one that took place just because I’d followed my doctor’s advice to take methadone.

    “Typically this leads to child apprehension and perpetual surveillance by child welfare authorities of certain people.”

    When I offered the Broward County Sheriff’s office an opportunity to respond by email for this article, Keyla Concepcion, their public information officer, returned a description of their standard investigative procedure, which allows for children to be removed from their parents’ care for 24 hours without a court order “if the information gathered [during an investigation] reveals children are unsafe.” She also noted that, “specifics of each case can be found in orders generated by the court.”

    Court documentation, including transcripts of sworn testimony, confirms that the investigator in my case neglected to make a single attempt to contact me, but did look at my methadone treatment history.

    Throughout the proceedings that followed, my negative drug tests have been mostly ignored, while my addiction history and financial status have been repeatedly showcased as proof of supposed parental negligence.

    Current reporting regulations strip pregnant women of their constitutional right to privacy, says Lynn Paltrow, the executive director of National Advocates for Pregnant Women, a nonprofit advocacy organization that fights for the human and civil rights of pregnant and parenting women. “What’s mandated is surveillance and the collection of information,” she says. “Typically this leads to child welfare interventions that result in child apprehension and perpetual surveillance by child welfare authorities of certain people.”

    She also notes: “The child welfare system is not an equal opportunity system; it’s one that unquestionably targets low-income families, particularly black and brown mothers.”

    Mothers who take these life-saving medications will continue to be targeted until reporting mandates are updated to reflect medical science. I am still fighting to regain custody of my daughters in a frustratingly slow system, one that has been stacked against me from the start.

    I still don’t know whether or not I will lose them forever—and it all stems from telling those paramedics five years ago about my methadone script.



    Photo by Martha Dominguez de Gouveia on Unsplash

    • Elizabeth Brico

      Elizabeth is a journalist from the Pacific Northwest. Her work has appeared in publications including Vox, Tonic/Vice, TalkPoverty, HealthyPlace and The Establishment. She has an MFA in Writing and Poetics from Naropa University. She also writes about trauma, addiction, and recovery on her blog, Betty’s Battleground.

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