stigma, treatment


For all the pregnant women out there with Opioid Use Disorders (OUD), The American College of Obstetricians and Gynecologists (ACOG) is behind you. A recent tweet by ACOG featured a picture of two doctors and ACOG leaders urging the American Medical Association not to criminalize opioid dependent pregnant women. ACOG describes itself as  “a leading voice in support of policies that help women get the care they need, when they need it.” I followed the lead of a few others and retweeted it with #HelpNotHandcuffs.

There has been a lot of talk lately about how pregnant women with Substance Use Disorders should be treated. Some people believe that when these women take drugs while pregnant, they are endangering the life of their child, therefore it’s child abuse. Others point out that abusing substances is a disorder, and an addiction is a medical problem, and therefore the mothers should not be criminalized but instead should be encouraged to go to treatment. There is strong evidence for this case, because a pregnant woman receiving treatment for drug abuse is much better than a pregnant woman in jail going through withdrawal from drug abuse. Treatment benefits the child, too. It brings up the issue of why we don’t treat addiction for what it is, a medical problem. Instead we stigmatize it and make it criminal. In this country it seems to be easier to throw the woman in jail than to spend the time and money treating her.

Now that doctors and researchers are making the move to stand behind pregnant women battling substance abuse and addiction, policy needs to catch up.

Events, The Expectant Mothers Treatment Program

EMTP Public Presentation!

On Tuesday, June 5th 2018, the Expectant Mothers Program will be making a presentation about our program at the monthly meeting for the Inter-Agency Network of Palm Beach County. The presentation will begin at 8:45am and is open to organizations and the public. Admission is free. Hope to see you there!

The address is:

Children’s Home Society Bldg., ground floor

3333 Forest Hill Blvd.

West Palm Beach, FL 33406

Screen Shot 2018-06-01 at 12.54.19 PM

stigma, The Expectant Mothers Treatment Program, treatment

Stigma & Fear

I was doing more research today for our big presentation on June 5th (more to come!) and I read some disturbing yet accurate articles about the stigma pregnant women (and others) suffering from addiction face. You might first think stigma is something you may have experienced back in high school when. you wore the wrong clothes or said something unexpected in class. Well, you’d be right in that stigma is a lot like judgment, but you’re wrong if you think all that ended in high school.

Today we were talking yet again about how to find our patients for our treatment program, but couldn’t make a decision. How do we reach them? There is no cultural or social gathering place for pregnant women taking drugs. It is judged so harshly by society that support groups or gatherings are almost unheard of. They usually (not always, but often) lack a social circle or group, because they are embarrassed or hiding either the addiction, the pregnancy, or both. They don’t go to the doctor’s office because of the stigma they face from the Ob-Gyn, doctor, or nurses. Or maybe they are more concerned with scoring drugs than attending prenatal visits. They avoid contact with almost everyone, so how do we reach out to this population?

The sad recommendation came up after yet another brainstorming session. We need to be calling emergency rooms and detox centers. Those are really the only two health care related places you might encounter a pregnant addict. This realization brought me up short. How can we as a society have turned our backs on a population so firmly that they have to end up in the hospital for us to notice them? With the opioid epidemic in full swing, these women are facing more backlash than ever. In some states they face jail time if they are caught using while pregnant. They deserve a chance to make more of their life and the life of their child. They deserve the chance to get treatment and feel what it’s like to be a healthy mom holding a healthy baby. The Expectant Mothers Treatment Program wants to help make that happen.

If anyone has any other ideas of organizations to contact or places to check into to find this population, let me know in a comment below. Thanks for your help!

research, treatment

The Harm Reduction Model

Today I was doing some research for the Expectant Mothers Treatment Program (EMTP) when I came across an article about a pilot perinatal addiction clinic called the Perinatal Addiction Treatment Clinic of Hawaii. The more I read about it, the more it sounded like our own EMTP. Just like us, they are based on a harm reduction model, and encompassed perinatal care, transportation, social services, family planning, and addiction medicine, which we also cover in the program. There were a few differences between our treatment programs: their center only accepted pregnant women addicted to methamphetamine (MA) because MA abuse is so prevalent in Hawaii, while we accept pregnant women addicted to any substance. Also, they offer childcare services, which we currently don’t offer, but hope to in the future. Otherwise the structure of each program was pretty much the same-we’re both harm reduction models in slightly different ways.

There are a lot of ways of thinking about the harm reduction strategy. I know some people may read it or hear it and immediately assume it has a negative connotation, that it involves supporting or helping people use illicit drugs. That is not the case. According to, the definition of harm reduction is “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.” 

After reading the rest of the article, I was struck by how much attention the term “harm-reduction” has gotten lately. In the news, cities like Philadelphia already approved safe injection sites in January 2018. After reviewing the harrowing facts about the opioid crisis and reviewing numerous feasibility studies, city officials approved the measure and now face the challenge of how to run them, manage them, and where to build them. “”There are many people who are hesitant to go into treatment, despite their addiction, and we don’t want them to die,” said Dr. Thomas Farley, Philadelphia’s health commissioner and co-chair of the city’s opioid task force. Supervised safe injection sites, he said, save lives by preventing overdose deaths and connecting people with treatment.”

Cities like San Francisco and Seattle have also declared their intention to open safe injection sites, and New York City is right behind them. Mayor Bill DeBlasio recently declared support for the harm reduction plan that has been considered successful in Canada and Europe. According to the New York Times, the plan would be for 4-6 sites to open after a 6-12 month period of outreach to the communities in which they would operate. They would still only operate as a pilot program for the first year. William Neuman of the New York Times outlines the plan for pairing using with treatment: “At the sites, which would be called Overdose Prevention Centers, trained staff would be available to administer medications, such as naloxone, to counteract drug overdoses. Social workers would also be on hand to possibly counsel drug users in the hope that they could be steered into programs intended to help them with their addiction.” New York city is one of the largest cities in the U.S., and saw over 1,000 overdoses last year. I think having social workers, counselors, clinic staff and treatment teams available is absolutely necessary for this exchange to work. We cannot passively sit and watch people engage in illicit drug use. Employees would have to monitor them for overdose and provide information about treatment options. What would be even better is having people on hand to enroll people into treatment programs. The problem is, if they have a “safe place” to use, why bother going to treatment? I’m sure some will see it that way. But I’m hopeful others will be open to trying programs for substance abuse. Many users often wish they had the help to get sober because they don’t think they can do it alone. This is our chance to engage with them.

Also in New York, harm reduction was introduced in yet another formation: a high school recently tried the harm reduction approach while educating kids about drugs. Author Victoria Kim explains, “the curriculum was designed to discourage substance use, but to also acknowledge the possibility that some kids will choose to experiment. Students are taught how to be safe even if they choose to use drugs and alcohol.” Administrators believed the harm reduction approach would work better with young people today, who have access to everything through the internet. In support of their decision they gave this example: “”abstinence-only education may tell young people that they should refrain from using drugs because they could overdose,” explains the Drug Policy Alliance. “Harm reduction drug education explains how to recognize the signs of drug overdose, how to respond and how to get help if they fear that a friend is overdosing.” School officials believe arming kids with knowledge about real circumstances they may face is more logical than simply advising avoidance of drugs altogether. Chances are, with how much of the population uses substances (as of 2016, 28.6 million US citizens aged 12 and older used drugs in the last month, according to, you will at one time or another have an encounter with drugs. It may be passive, like helping someone who takes them or working with people who take them. But for some, it will be active, such as through experimentation. This high school would rather have you know how to stay safe around them or using them than bet on you avoiding them altogether and crossing their fingers.

So it sounds like people are realizing through the opioid crisis that past strategies are no longer effective in keeping people away from drugs, and new ideas and approaches  need to be tested. A principal central to harm reduction is “understanding drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe abuse to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.” So how does the Expectant Mothers Treatment Program fit the harm reduction model? We help pregnant women who are drug users safely use Medication Assisted Treatment, which in our case is a drug called Buprenorphine, to wean themselves off of their drug of choice. So, is Buprenorphine a totally safe substitute medication for mom and baby? No, it has potential health consequences for both, which is what makes it harm reduction. In a perfect world pregnant women wouldn’t have to take a drug like Buprenorphine, but if you are addicted, it is safer for mom and baby to take that than the mother continuing to use drugs or going through symptoms of withdrawal while pregnant, which could cause damage to both mom and baby. Harm reduction isn’t ideal by any means. I would call it compromise in a time where drugs have become so prevalent. Users suffer in many ways when they use drugs-they could lose their social support systems, have relationship difficulties or domestic violence, engage in poor nutrition and health habits, be at risk financially, lose their shelter or ability to work, be forced to cope with mental disorders alone, lose self-esteem and self-worth. If that is the choice, between someone going back to that kind of life or using a harm reduction model, I would side with the strategy that can save lives, not endanger them.



1. Implementation and evaluation of a harm-reduction model for clinical care of substance using pregnant women
By Tricia E Wright, Renee SchuetterEric FombonneJessica Stephenson and William F Haning III
Harm Reduction Journal, 2012. 9-5.




2. What’s Next For ‘Safe Injection’ Sites In Philadelphia? by Elana Gordon for





5. New York High School Tests New Harm Reduction Drug Education Course by Victoria Kim, 4/18/18


6. Harm reduction definition:

Are You Ready For Recovery?

Are you ready for recovery? A lot of times addicts ask themselves something along those lines. The doctors and counselors and case managers are wondering, too. Clinics and programs and treatment centers want to know if you’re ready. But how can you tell?

A study published online in The Journal of Drug Education in February used a nationally representative sample of adult patients to try and figure out what predicted treatment readiness. The participants were involved in a variety of treatment levels, residential to outpatient, mandated and voluntary. They were asked various questions about two main themes, motivation for treatment and resistance to treatment. Then, the researchers compared readiness and other variables to treatment engagement, defined as remaining in treatment for more than 30 days or attending 2 sessions, to measure readiness. So what did they find?

So first of all, yes, some of the individual-level characteristics appeared to be related to patients’ level of engagement. So feeling motivated to go to treatment correlated positively with treatment engagement. That translates to: if you feel ready, you probably are. But since the only person who can figure that out is you, treaters can’t use it to measure treatment readiness. Moreover, when the researchers viewed the study as a whole, it indicated that programs and professionals might be the ones to look to for measures of patient success. The researchers said we shouldn’t put so much stock in “individual-level risk factors” to predict engagement. Instead, look at the relationship between the individual and the program. What exactly does that mean?

““It’s important to begin to think about some of these program-level issues,” Lincoln Sloas, PhD, lead author of the study and assistant professor at Florida Atlantic University’s School of Criminology and Criminal Justice, tells Addiction Professional. “We need to look at how we can tailor programming to the needs of people.””

Researchers gave the example of looking at how an individual interacts with staff and the composition of a program.

Treaters often determine whether or not you’re ready by looking at your individual characteristics, like your age or how often you use, but these are not good indicators of how well you will do in the program. The point is, the program needs to be customized for the individual to ensure the highest level of success. It’s like how some things work for some people but not for others-one swears by AA meetings while another claims they don’t work. You cannot just create a program and put people through it like a machine. People don’t work that way. What works is getting information from your client, getting to know them a little, and creating a unique program of services that fit their individual needs.

At the Expectant Mothers Treatment Program, we pride ourselves on our multi-professional, comprehensive approach. We have over 20 services that we offer to pregnant women battling addiction, and after talking with them every client is given a customized program that we think will best benefit them. It’s more like matching the right programs and services so that they complement each other, each one a puzzle piece part of a bigger picture of success.

I think if treatment centers are seeking successful clients, they should look at the multi-professional approach. We have so many specialists involved in our program, from high risk pregnancy specialists to psychiatrists to nutritionists, each taking care of a different part of the client. If you have the right people on your staff providing their version of care, the client will get the best possible treatment at every level. It doesn’t make sense for one to lead all the others when they all specialize in different things, right?

So what we learned from that study was that at this point, only you can decide if you’re ready for recovery. Once you are, make sure you find the program and staff that best suits your needs-that might mean you interviewing them. Good luck!

Article by Gary A. Enos, Editor on