Mothers Who Use Drugs: Closing the Gaps in Harm Reduction Response Amidst the Dual Epidemics of Overdose and Violence in a Canadian Urban Setting

Abstract

Objectives. To identify key gaps in overdose prevention interventions for mothers who use drugs and the paradoxical impact of institutional practices that can increase overdose risk in the context of punitive drug policies and a toxic drug supply. Methods. Semistructured interviews were conducted with 40 women accessing 2 women-only, low-barrier supervised consumption sites in Greater Vancouver, British Columbia, Canada, between 2017 and 2019. Our analysis drew on intersectional understandings of structural, everyday, and symbolic violence. Results. Participants’ substance use and overdose risk (e.g., injecting alone) was shaped by fear of institutional and partner scrutiny and loss (or feared loss) of child custody or reunification. Findings indicate that punitive policies and institutional practices that frame women who use drugs as unfit parents continue to negatively shape the lives of women, most significantly among Indigenous participants. Conclusions. Nonpunitive policies, including access to safe, nontoxic drug supplies, are critical first steps to decreasing women’s overdose risk alongside gender-specific and culturally informed harm-reduction responses, including community-based, peer-led initiatives to maintain parent–child relationships. (Am J Public Health. 2022;112(S2):S191–S198. https://doi.org/10.2105/AJPH.2022.306776 )

Factors related to substance use treatment attendance after peer recovery coach intervention in the emergency department

“…Further, it is important to note that there were low rates of clinical documentation for substance use disorders according to both patient self-report as well as absence from the general medical problem list. Although speculative, the lack of documentation for self-reported substance use may be related to the fast-paced environment and the prioritization of documentation of information that was more directly relevant to the brief intervention, rapport-building, and other medical care ( Boyd et al, 2022 ; Simon et al, 2020 ). A substance use disorder may be especially underreported in electronic health records despite its clinical significance due to the time needed to assess substance use disorder and substance use disorder severity.…”

“…A substance use disorder may be especially underreported in electronic health records despite its clinical significance due to the time needed to assess substance use disorder and substance use disorder severity. There are other major systemic barriers for individuals reporting their substance use such as stigma, medical neglect, treatment that may be punitive (e.g., forced tapering), involvement with the criminal justice system, involvement with child protective services (especially for pregnant women), and impact on insurance rates/coverage ( Boyd et al, 2022 , McNeil et al, 2014 ; McNeil et al, 2016 ; Simon et al, 2020 ; van Olphen et al, 2006 ; van Olphen et al, 2009 ). In the future, it may be useful to determine methods to encourage patient disclosure and to remediate staff documentation, including strategies to reduce staff burden, in order to optimize care and determine whether either drug type or use severity is associated with linkage to treatment ( Curtis et al, 2019 ; Duber et al, 2018 ; Melnick et al, 2022 ; Uong et al, 2022 ; Wamsley et al, 2018 ).…”

‘Planning for a healthy baby and a healthy pregnancy’: A critical analysis of Canadian clinical practice guidelines for the treatment of opioid dependence during pregnancy

“…Greenfield & Grella, 2009;Grella, 2008). In North America and elsewhere, specialised, integrated and comprehensive services for pregnant clients have been established to fill this gap (Ordean et al, 2013), but these services are often under-funded (Lee & Saia, 2019), limiting their comprehensiveness and their availability (Benoit et al, 2014;Boyd et al, 2016Boyd et al, , 2022Tarasoff et al, 2018). Meanwhile, the diagnosis of opioid dependence during pregnancy has increased (Mazure & Fiellin, 2018), as has the number of opioid-related deaths among women 1 (Barbosa-Leiker et al, 2021).…”

“…For a discussion of conflicting clinical research on NAS and current debates about buprenorphine versus methadone, seeWhittaker et al (2019).3 Providing legal protections, so that mothers and those who are pregnant can seek treatment without fear of child custody loss, may be helpful in this regard(Mazure & Fiellin, 2018, p. 10;Boyd et al, 2022).…”

“…3 3 Providing legal protections, so that mothers and those who are pregnant can seek treatment without fear of child custody loss, may be helpful in this regard (Mazure & Fiellin, 2018, p. 10; Boyd et al., 2022). …”