Overamped: Harm Reduction for the Modern World

Harm Reduction and Pregnancy

By now we all know that there are only a few months left of physical MRR so I am going to use the last few issues to talk about some things that I’ve always wanted to address in this column but haven’t gotten around to yet. This month, it’s harm reduction and pregnancy. In my prior life, I was an abortion counselor, so this issue is really an amalgamation of my true loves. I’ve talked to plenty of women who are pregnant and who use substances throughout my time on this planet, and I’ve heard many unsolicited opinions about what these people should do with their bodies. I consider this platform to be conducive to this conversation (monologue) because I don’t have to listen to any shithead’s opinion and there’s no comments section, so I can say whatever I want and just get to assume that everyone agrees with me. I’ll miss this.

As far as stigma goes, it can’t get much worse than a pregnant woman using drugs. This should go without saying, but if you’re pregnant, regardless of whether or not you’re using substances, you get to decide what you want to do. You have options. Unfortunately, some of you have a lot less options than others, and that’s bullshit but here we are. Below are a few resources about options that I’ve always found helpful. If all else fails, please email me and I can help you figure out what the laws are in your area.

The first is called Women on Waves. For the past ten years, this organization has sailed to countries where abortion is illegal or inaccessible, picks people up on their boat, takes them out to international waters, and gives them the abortion pill. It’s completely legal. They’ve been to Ireland, Mexico, Guatemala, and Morocco. They also fly abortion drones now, which have successfully delivered early abortion pills to women in Ireland and Poland. It’s not the most practical option because chances are they aren’t going to be anywhere near you need them, but it’s still a genius idea.

If you need help figuring out what you want to do or what’s possible for you to do, call Planned Parenthood (1-800-230-PLAN). If you want unbiased referrals, information, or if you need help paying for an abortion, call the National Abortion Federation at 1-800-772-9100 or go the the NNAF website at https://abortionfunds.org/need-abortion/. If you’re not sure what you want to do and don’t want to talk to anyone, try the Pregnancy Options Workbook. It’s a little old, but I think it stands the test of time: https://www.pregnancyoptions.info/pregnant.htm.

Whatever you do, don’t make the mistake of going to a crisis pregnancy center. These are anti-choice centers run by religious zealots who won’t give a shit if you live or die after you’re not pregnant anymore. You can often spot them because they offer “free ultrasounds”. Here’s a pretty good article on how to recognize a crisis pregnancy center: https://womenhelp.org/en/page/939/how-to-spot-a-crisis-pregnancy-center-before-you-walk-in-the-door

Before I get into tips to help you stay staff during your pregnancy, I want to get something straight. The effects of substance use during pregnancy are way inflated in our society. The stigma is nearly impenetrable, and by demonizing pregnant women we are giving men/the government more authority over our bodies and our lives, so please be conscious of that fact when you call people “crack babies” or when you call moms “junkies” or even just assuming that mothers who use during pregnancy are necessarily parents. It’s not as simple as that.

In fact, this overblown fixation on women’s’ womb’s has created a culture where it’s acceptable for lawmakers to sentence women to jail for using substances while pregnant. In 2017, a federal court ruled in favor of a Wisconsin woman who sued the state after she was thrown in jail for using methamphetamine while pregnant. Prosecutors used a 1997 state law that says an expectant mother can be held in custody if she demonstrates a lack of self control over substance use which “presents a substantial risk to the health of the unborn child.” But in 2017, the US Supreme Court overturned that ruling, and re-authorized the state of Wisconsin to apply this law.

In 2017, Amnesty International came out with a report which found that in 38 states, women can be charged with “fetal assault”, in which the embryo or fetus is considered the victim of a crime. In some instances, the fetus can be granted legal representation, whatever the fuck that means. In 23 of those 28 states, the laws apply from the moment of fertilization. In some states, you can be arrested for giving birth to a child who has been exposed to substances.

So women who are using before they even know they are pregnant are not shielded from prosecution. Before you go and get all judgey like, “how can someone not know they’re pregnant?” trust me, it happens all the time. I’ve talked to hundreds of women from various levels of education, socio-economic statuses, races, ethnicities, dietary habits, marital status, number of prior pregnancies, and even women that were on birth control who didn’t discover they were pregnant until it was too late for them to get an abortion in their state. There are many, many valid reasons why women both young and old don’t realize they’re pregnant until their second or third trimester so just hold your judgement on that one.

The authors of the Amnesty International report state, “We found stark evidence of discrimination in the implementation of pregnancy criminalization laws, which tend to be disproportionately enforced against low-income women and women of color. These women are often already facing multiple levels of discrimination and do not have the resources to navigate the court system or child protection services. For this reason, women who have historically faced discrimination are at heightened risk of prosecution when they become pregnant. Drug testing is applied selectively, often based on discretionary risk’ factors such as low income. Some doctors admitted that their decisions about who to test were based on their own biases.” The effects of laws like these are obvious. As with all other laws that punish users, prohibition makes it way less likely that pregnant people are going to seek out appropriate healthcare.

Most women who become pregnant are able to stop using substances. It’s safe to say that the overwhelming majority of women want a healthy pregnancy and want to stop using while pregnant. Fear of having to go to prison, no less fear of having to give birth in prison is and should be a terrifying prospect to any rational human. Most major medical organizations agree and have denounced laws like these for jeopardizing the health of women, mothers, and newborns.

Joelle Puccio, is a traveling NICU Nurse and a Board Member at both the People’s Harm Reduction Alliance & National Perinatal Association. Joelle does a lot of really incredible work around harm reduction and pregnancy. In an interview with the Harm Reduction Coalition, she says:

“Illicit drugs are not as bad for babies as we’ve been led to believe. I’m not saying that every pregnant person should go out and start a habit, in fact I would advise any pregnant person not to use recreationally at all, including caffeine and cannabis. What I am saying is that there is simply no evidence to support the harms that our society blames on perinatal substance use. In scientific research, perinatal substance use is associated with negative outcomes. It is important to note that associations are not a cause and effect relationship…The way our society responds to perinatal substance use is BY FAR more harmful than any substance effects. In order to create useful knowledge and policies about the actual effects of perinatal substance use, we need to radically change the way we treat women and other people who can become pregnant.”

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Here’s some things to expect and tips for keeping safe if you find yourself or someone you love using while pregnant.

Prenatal Care

Prenatal care is really important for the health of both you and your pregnancy. Babies born to mothers who don’t get early prenatal care are much more likely to have a low-birth weight and are 5x more likely to die than babies born to mothers who received early care. It is important to find a doctor that you trust but I know that’s easier said than done. It’s especially difficult to know what to expect when in some states and countries you can walk into an ER while pregnant and high and they’ll get you on methadone, get you financial support, and provide prenatal treatment that day, meanwhile in other states and countries if you can expect to be arrested.

Drug Screening and Department of Children and Families

US hospitals are mandated to report pregnant patients who show traces of opioids, cocaine, meth or alcohol via a urine test. This doesn’t mean the child will necessarily be taken away from the mother, but it does mean a social worker will follow up to evaluate the safety of the situation during pregnancy and after the baby is born. It means that the situation will be evaluated for safety. Usually, social workers advocate to keep women with their babies whenever possible.

Narcan

Narcan is completely safe for people who are not pregnant, but due to ethical issues around conducting research on pregnant women, there are no adequate studies that prove whether or not Narcan could cause harm to a fetus. Theoretically, miscarriage, early birth, or serious withdrawal symptoms in babies may occur if Narcan is given to a person who is pregnant, but again, that has yet to be proven. Keep in mind that if a pregnant person fatally overdoses, the fetus is going with them. If you think that someone is overdosing, it is better for their health if you give them naloxone 100% of the time, regardless of whether or not they may be pregnant.

Hepatitis C and Pregnancy

The risk of passing Hepatitis C (HCV) from parent to child is low, approximately 5%. Babies who do contract HCV perinatally will often clear the virus on their own. Experts think that about 40% of children will fully recover by the age 2 without medical intervention. If needed, a baby may receive HCV treatment if they haven’t cleared it on their own after 2 years.

Opioid Use and Pregnancy

Pregnancy changes your body, and may also change the way drugs work in your body. Your metabolism may change and your body will be generating more blood. Drugs may be more or less effective than they were before you were pregnant. No matter the situation, it is always safer for you to smoke, sniff, or booty bump your shit instead of injecting, and that’s especially true if you’re pregnant.

Despite popular belief, quitting cold turkey is not what’s best for your zygote. Withdrawing while pregnant can be very dangerous and carries higher risk of miscarriage, preterm birth, and fetal death. It’s safer for the fetus if you taper down slowly, preferably with the help of a medical professional, or start substitution therapy.

Buprenorphine and methadone are okay alternatives to opioids and safe to take during pregnancy while under medical supervision. Both Methadone and Buprenorphine can cause Neonatal Opioid Withdrawal (NOW), which is a temporary, treatable, and is not life-threatening condition if you have appropriate medical care. There are ups and downs to both treatments so you and your doctor must decide which is best for you. Methadone requires daily trips to the clinic which can be good because you have constant access to medical care, however, most methadone clinics won’t let you bring your kids, so if you are already a mom, you’ll need to make sure you have childcare lined up every single day. Transport can get expensive depending on where you are.

Buprenorphine (Suboxone and Subutex) is a pill or sublingual that you can pick up in weekly or monthly increments from a pharmacy, so no need for daily visits. Subs also carry the risk of NOW in newborn babies. Buprenorphine is the active ingredient in both Suboxone and Subutex, however, if you are pregnant, your doctor will prescribe you Subutex because it does not contain Narcan in it for the reasons mentioned above.

The best time to switch to methadone or Subutex is in the second trimester. Breastfeeding is safe when you are on opioid replacement therapy, and may help to treat NOW in your infant. It’s much less safe to breastfeed while using street drugs because you don’t know what you’re taking. Be extra aware of your lower tolerance, if you pick up again your overdose risk will be much greater!

Stimulants and Pregnancy

Cocaine (crack or powder), Meth in any form, adderall, ritalin, vyvanse, etc. Again, best to smoke, snort, or booty bump. If you are shooting up and you need to break down any solid substance, you can use citric or ascorbic acid. Don’t use lemon juice because it can cause infections. You also may want to use a finer filter than cotton, especially with pills, because if you inject any impurities or any small pieces of the pill you can get a really bad infection. Visit a local syringe exchange and get a wheel filter or a sterifilter.

Sleep is important during pregnancy, so make sure to take it as easy as possible. Try not to go on any long runs and make sure you are eating and drinking water. Stimulants can lessen the flow of blood to the placenta. There is some evidence that cocaine use during pregnancy can cause the placenta to separate from the uterine wall, which can limit oxygen and nutrients from reaching the fetus and can cause heavy bleeding for the pregnant person. Stimulants can cause high blood pressure, one of the leading causes of maternal death around the world. Stims have also been suggested to cause premature rupture of placenta (PPROM) which can cause infection, premature birth and other terrible shit.

Taking too much of a stimulant can cause an overdose. Stimulant overdose may look like heart attack, aneurysm, stroke, or panic attack. Withdrawal is not as risky as withdrawing from opioids or alcohol during pregnancy, physically speaking. However stimulant withdrawal can cause severe depression, agitation, cravings, etc. In terms of replacement therapy, there’s not many providers out there who are going to prescribe you anything so your best bet is social support. There is statistical evidence to show that therapy and group therapy can help.

If you’re smoking crack, always use some clean chore boy or a screen, and make sure to protect your mouth by using a rubber spark plug cover or some other piece of flexible PVC which you can get at the hardware store. Try to only use your own pipe so you don’t contract HCV or any other viruses.

In terms of breastfeeding, you may not produce as much milk as you normally would because stimulants can decrease your ability to produce milk. If you are using stimulants intermittently while pregnant, wait 24 hours after using to breastfeed your baby again. If you are using throughout your pregnancy, talk to a doctor you trust about switching to formula.

Alcohol and Pregnancy

Like opioids, alcohol is a central nervous system depressant. Withdrawal from alcohol during pregnancy or any other time can be extremely dangerous. While you may feel like you are dying when withdrawing from opioids, you won’t. Alcohol withdrawal is the one and only kind of withdrawal that can kill you. You can always taper down by yourself, but it’s much safer if you do it with the help of a physician. Remember to try not to mix alcohol with any other substances.

Drinking alcohol during pregnancy increases the chances of miscarriage or stillbirth. can cause Fetal Alcohol Spectrum Disorder (FADS). Babies born with FADS may have low birth weights, smaller head size, and organ and facial abnormalities. They may also develop learning disabilities and reasoning may be impaired as they grow up.

There are some medications that can help you quit drinking. It’s unclear how safe any of these meds are to pregnant people, but they are all thought to be safer than alcohol itself. Antabuse is a drug that is created to treat alcoholism by making you feel like total shit if you drink while on you’re taking it. Naltrexone (vivitrol) is used to treat alcohol addiction in addition to opioid addiction, though the benefits are modest. Naltrexone can help treat cravings. It works similarly to antabuse. Basically if you’re on either medication and you take a drink, you’ll get an instant hangover.

There’s a lot of groups that offer support for alcoholism. AA is an obvious one, but there are also other groups that don’t use the 12 step model or include any religious aspect. Try checking out a SMART recovery or Moderation Management group. Individual therapy works too.

Breastfeeding while using alcohol is not safe for the baby, since alcohol gets passed through breastmilk. Formula is safer for people who are frequent drinkers, and “pumping and dumping” is safer for moms who drink occasionally. Your body filters alcohol out of milk like it does with blood, so when you no longer feel the effects of alcohol, your milk is safe to give to your baby. I would give it several hours though. The recommendation is to wait 2-4 hours for each drink you have.

You can find more harm reduction tips for pregnancy by visiting the National Advocates for Perinatal Care and Harm Reduction Facebook: facebook.com/groups/AdvocatesPerinatalCareHarmReduction. Thanks to Joelle and the rest of them for providing a lot of the tips you saw in this issue. Keep hydrated and stay safe (but have fun) until next time. Do @me at dearauntiehazel@gmail.com.