Keri, now 35 and studying to become an addiction treatment counselor in Illinois, learned she was pregnant in 2016. In those first days and weeks, she was a mess of uncertainty and confusion. She did not know how she was going to care for a child, whether her partner would be supportive, or even where they would live. But one thing she did know was that she did not want to use drugs while she was pregnant or parenting.
The problem was, she was addicted to heroin.
People who use drugs while pregnant and parenting are one of the most stigmatized populations in the United States. There is a pervasive idea that parents—particularly women—have a duty to sacrifice everything for their child, even down to their comfort and enjoyment.
It’s not enough to ensure that a child is well cared for; society expects mothers to also behave in a manner that looks caring. Once someone becomes a mother, she enters into an unspoken agreement to be scrutinized by just about everyone. If illegal drugs are on the scene, she is instantly labeled the Worst Person Ever. And this discrimination is greatly exacerbated for parents of color.
Spectrums of Risk
According to the Centers for Disease Control, “substance abuse” is a risk factor for child maltreatment. There are certainly risks associated with use of illicit drugs, though it’s worth noting that many of those potential dangers stem from the criminalization of drugs, rather than from the drug use in itself.
For example, someone who injects heroin in the home might be at risk of overdose. But this peril is increased both by the secretiveness that illegality demands, making it more likely the person will use alone, and by prohibition’s tendency to incentivize production of more potent drugs—see the widespread presence of fentanyl in US heroin supplies in recent years. Lack of access to the opioid overdose antidote naloxone also compounds the risk.
Regardless of the reasons, the danger of a parent overdosing while alone with a child is real, and cause for concern. Other issues could be that a parent with an active, severe substance use disorder might not have enough money to provide for basic needs like food and appropriate clothing, or might be too intoxicated to notice cues that indicate a child is ill.
But these are only possibilities; drug use takes place on a spectrum. The mere fact that a parent uses a drug does not mean he is not taking good care of his child. And it certainly doesn’t mean he doesn’t love his child.
“Not everyone can remain abstinent throughout their pregnancy or during the time they have children. That’s a reality.”
“Not everyone has access to buprenorphine or methadone, and not everyone can remain abstinent throughout their pregnancy or during the time they have children. That’s a reality; it doesn’t make them bad parents,” says Justine Waldman, medical director of the REACH Project, a harm reduction-oriented equitable health hub in New York State.
“I think what makes them really good parents is making sure—especially with opiates—that there is somebody present who is in a position to watch the children and be capable to care for their needs during the parent’s use. That is the safest method and that’s what we would encourage. So: not using alone, making sure there’s [naloxone] on site, making sure drug use is not occurring in front of or near children, and making sure someone can watch the children if the person using becomes what I would call inebriated.”
Unjustified Child Removals
That is exactly what Suzanne Sellers did. Sellers, who is now the executive director of Families Organizing for Child Welfare Justice, had her first child, a toddler at the time, removed from her care in Illinois in the early ‘90s. A few years later, her second child was removed at birth. She admits to using crack cocaine and alcohol problematically, but adamantly denies abusing either of her children.
“If someone is using drugs and not abusing their child, that is not child abuse.”
“A call was made to the hotline alleging I was neglecting my toddler-aged daughter, saying I was not adequately caring for my daughter because I would take her to the home of family and friends while I would go on drug binges,” she says. “While it was true that I took my daughter to the home of family and friends and I would be away for two to three days at a time, I did so because I wanted my daughter to be properly cared for while I was away. In my mind, that was the most loving, caring thing I could do for her while being an addict.”
Nonetheless, Sellers’ rights to parent her daughter, and later her son, were terminated. She has been sober since 1997, after engaging in drug treatment of her own accord, but custody was never returned. When her rights were permanently terminated in 1999, she had been sober for two years. She now has loving, bonded relationships with her adult children, and fights so that other families don’t also have to endure the trauma of wrongful separation.
“If someone is using drugs and not abusing their child, that is not child abuse,” Sellers insists.
Waldman also talks about the importance of acknowledging the spectrum of drug use. Someone who uses cocaine recreationally on the weekends is probably going to get high when she uses. And during that time, she might be over-excitable, energetic, have difficulty concentrating, or even become paranoid or agitated. These aren’t traits conducive to the most effective parenting; as Waldman notes, it’s a good idea to have someone else there to make sure the child is safe during use, or to do what Sellers did, and drop the child off with another trusted caregiver.
Which is exactly the same thing we’d expect from someone who decides to have a few glasses of whiskey on a Saturday evening.
Immediate Abstinence Isn’t Always the Smart Move
But for someone with opioid use disorder who has developed physical dependency, using opioids stops being about intoxication and becomes a means to feel normal. Without an opioid, someone with dependence will go into withdrawal, which can be incapacitating. With addiction, psychological cravings turn into obsessive thoughts, cycling through the person’s mind, sometimes robbing her of the ability to properly prioritize her basic needs, or those of others.
For some people, maintaining a steady supply of the drug could make them more capable parents than forcing themselves through a cycle of detoxification, life-threatening relapse and intoxication.
“Two glasses of wine, which wouldn’t be illegal for me but might get me slightly inebriated … may put me in a less capable state to care for my children than someone who is injecting themselves not to get sick,” Waldman notes. For people addicted to opioids who do not have the resources or perhaps the desire to access treatment, maintaining a steady supply of the drug could actually make them more capable parents than forcing themselves through a cycle of detoxification, life-threatening relapse and intoxication.
But some people consider it a blasphemy to even suggest that using drugs while pregnant or parenting is anything other than a heinous act of malicious child abuse. This mentality fuels predatory mandated reporter laws all around the country. Mandated reporters are people who work with vulnerable populations—for example, teachers, physicians, and mental health counselors—who are required to report suspected child abuse to their local child welfare authorities.
Exactly what they are required to report varies by state, and as Lisa Sangoi, co-founder of the family advocacy nonprofit Movement For Family Power, observes, child welfare agencies will sometimes mislead mandated reporters about what they are required to disclose.
“In New York City, hospital staff believe they must call in [to an abuse hotline] when a child tests positive for controlled substances,” says Sangoi. “There was a New York supreme court case where they said a mother’s positive cocaine toxicology alone was not enough evidence to make a finding of a child being abused or neglected; this is a longstanding law. Yet OCFS [New York state’s Office of Children and Family Services] wrote a memo which blatantly lies and says medical providers need to call in when a child tests positive.”
When a Drug Dealer Is the Only Source of Treatment
Mandated reporting is not a harmless act. Take Keri, the student in Illinois who learned she was pregnant while addicted to heroin in 2016. She never thought she would be the mom who took drugs while pregnant or parenting.
“I thought being pregnant would give me the power to not use dope,” Keri recalls. “I’d seen friends use when pregnant and I thought I would never do that. I would do whatever I could to stay abstinent.”
“I guess I’m in this alone.”
But when she learned that using illegal drugs was considered child abuse in the state of Illinois, punishable by child removal and even incarceration, she became understandably afraid that she would be punished for seeking care. Nonetheless, she attempted to secure a bed in a local treatment facility. But she was told the wait for an intake assessment would be at least a week, and that she would need to go through an emergency department if she wanted care sooner. When she asked whether that would result in criminal or civil action against her, the intake operator could not give her a response.
“The person on the phone just said ‘I don’t know’—not ‘I don’t know the future, but it will look better if you go through treatment,’” Keri recalls with a short, bitter laugh, remembering just how uninformed and naive she was back then. “So I was just like, I guess I’m in this alone.”
Without access to any formal support for her addiction, but hoping to care for her unborn child as best as she could under the circumstances, she bought several months’ supply of buprenorphine from her dope dealer, and slowly tapered herself off before the last two months of her pregnancy—when the drugs could have caused neonatal abstinence syndrome and might have been detected in her child’s system.
Dr. Mical Raz, a physician and researcher on child abuse policy at the University of Rochester, agrees that stories like Keri’s are, at least in part, the result of mandatory reporting laws. “There’s different ways in which a culture of investigation is harmful to families,” she says. “It discourages people from seeking care and from being open to healthcare providers and seeking the amount of care they need. It is also a response that’s not helpful to families if they are met with investigation instead of services.”
A Nurse’s Dilemma
It’s not just parents who are harmed by these policies. The reporters themselves—who often chose their careers because they want to help families—can be forced to disclose parental drug use, even when they don’t want to or don’t feel the family is at risk.
Tracy Longbrake, a hospice nurse in Maryland, found herself in exactly that position while working in an Oregon-based emergency department. Herself a methadone patient who had once been the subject of brief-but-uncomfortable child welfare investigation, she was shocked when instructed to “trust her gut” about parental drug use.
“The nursing instructor said the CPS workers would believe us over the parents because we’re healthcare professionals,” Longbrake explains. “I felt horrible, I felt I wasn’t qualified to make those decisions … but when I brought that up, the instructor just belittled me and said that if I don’t trust my judgment, I shouldn’t be in this career.”
Longbrake was told by her superiors that she had to make the call or she could lose her job.
It turns out, Longbrake’s judgment didn’t matter all that much. When a mother came in smelling of marijuana, Longbrake was told that as the primary provider who had witnessed the patient, it was her duty to report her to child services—even though Longbrake felt such a call was not warranted.
“This was five years before marijuana became legal,” Longbrake notes. “She was coherent, the baby was appropriately dressed for the weather, the carseat was strapped correctly, she had bottles and everything she needed, she was attentive and concerned for her baby’s well-being.”
But Longbrake was told by her superiors that she had to make the call or she could lose her job. Ultimately, she did make the report, but did her best to explain her perspective. She was never told what happened to that family.
It’s not just mandated reporting that harms families. The judgment and shaming that takes place in everyday interactions can cause palpable harm to parents who use drugs, and deter them from seeking care when they need it.
Mom-Shaming Does Anything But Help
Megan Donovan, a 35-year-old stay-at-home mom in Ohio, has been in pharmacotherapy-based recovery since November 2015. But one of her two children was born before then. She admits that the father’s ability to parent while she was using drugs was crucial to the stability of her daughter’s life, because her use was chaotic and indicative of a use disorder. But shame prevented her from seeking care sooner.
“I used to think that using while pregnant was the worst thing I ever did and that eventually I would kill myself.”
“[Drug use] was treated as a moral failure, and I was shamed for using,” says Donovan. “My shame during that time … definitely caused my cycle of addiction and self-loathing to deepen, I do believe.”
Waldman insists that this kind of mom-shaming is not only unreasonable, but also medically unsound. “It’s been shown that 90 percent of people can’t stop using opioids on their own,” she says. “It’s a ridiculous notion that someone can stop just because they’re pregnant [or parenting]. The reason why is that the brain chemistry, once addiction has set in, makes it so the receptors are ramped up. Once no drug is available and all those triggers are ramped up, it makes it nearly impossible for the brain to not use. I don’t know how many times we need to repeat these statistics to make everyone understand. The data don’t lie.”
“I used to think that using while pregnant was the worst thing I ever did and that eventually I would kill myself because the weight of that guilt would be too great,” says Keri. “I don’t feel that way anymore… It happened, he’s okay, and I am being the best mom I can be now. He’s not damaged by it, he’ll never know—he doesn’t have to know that darkness—and I can prevent him from that if I just keep myself healthy.”
Photo via Max Pixel