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A session featured at the 2023 Society of Family Planning (SFP) Annual Meeting focused on how healthcare professionals can reduce harm for patients in a family planning clinic who use substances. The panel of experts was diverse and featured three physicians, an attorney, and a patient advocate.

Here’s a recap of what three of the experts discussed.

Incorporating Harm Reduction into Practice

One of the three physicians was Dr. Ashley Ebersole, Assistant Professor of Pediatrics in the Division of Adolescent Medicine at the Nationwide Children’s Hospital. In the context of substance use, Dr. Ebersole noted that harm reduction incorporates a spectrum of strategies that includes safer use, managed use, abstinence, meeting people who use drugs “where they’re at,” and addressing conditions of usealong with the use itself.

However, because harm reduction demands that interventions and policies designed to serve people who use drugs reflect specific individual and community needs, there’s no universal definition of or formula for implementing harm reduction.

Dr. Ebersole then stressed the importance of incorporating harm reduction into practice. “There is a lot of trauma associated for both a parent and a child of being separated,” she said. “It is something that can have long-lasting effects on the child to be separated from a parent early in life or at any point in life, and that trauma is associated down the line with mental health disorders. And so from that standpoint, it’s very important to keep families together.”

Given that importance, Dr. Ebersole provided four pillars of harm reduction in a family planning clinic:

1. Overdose prevention through education, naloxone, fentanyl test strips, and safe injection sites
2. Screening and testing for HIV, STIs, hepatitis, and pregnancy
3. Other prevention strategies like syringe access programs, pre-exposure prophylaxis, vaccinations, contraception, and non-stigmatizing language
4. Treatment with medications for substance use disorders, psychosocial support, and injection site care

Legal Strategy Challenging the Test/Report Paradigm

Attorney Mr. Adam Ballout was up next to discuss his work in the prevention space through the Family Intervention Response to Stop Trauma (FIRST) Clinic. This clinic works with pregnant families to inform them about the legal process and to help them determine what resources and help they need. They’ll also connect patients with a parent who has been through this process before so they can help manage their expectations.

Pregnant families are made aware of this clinic through various forms of outreach, including through advocates like Ms. Jennifer Justice who conduct weekly presentations at a local hospital where patients are allowed to deliver in their third trimester if they’re on medically assisted treatment.

Team members will also share information on the clinic with child welfare agencies, local treatment agencies, housing agencies, and local law enforcement agencies. Their goal is to make sure that everyone who comes into contact with the system is aware that these resources exist, especially since they’re fairly new. 

However, many challenges still exist, like the lack of treatment beds that are available long term and the stigma surrounding this patient population.

According to Mr. Ballout, “We’re still up against a very punitive culture in many parts of our state. We see this justified geography where the same mom can walk in and give birth in six different hospitals and have six different outcomes just based on the individual preference about how things are being applied, and so really raising awareness about these discrepancies, how often they occur, and changing this culture from one that’s really punitive to one that’s supportive is really important.”

Experiences of Harm by Reporting

The third and final panelist was Ms. Jennifer Justice, who works at the FIRST Clinic. She was unable to get prenatal care during her fourth pregnancy because she wasn’t stable on a MAT treatment, and so she ended up in an ER room. It was there that an ER doctor took her on as a patient and got her into ARS Ballard, which is a 26-day inpatient program for substance-using pregnant people.

After leaving there and being stabilized on a MAT treatment, she was referred to the FIRST Clinic and was paired with a parent ally. “From the minute I spoke with them, they treated me with such respect and empathy and were just so informed and really protective of me,” said Ms. Justice. “And because of those things, I ended up being really successful and able to parent my three-year-old. He’s never spent a day away from me because of their help.” 

Now as a recovering heroin and meth addict, Ms. Justice works as a parent ally with FIRST Clinic. “I get to be there and help mothers understand the process that they’re about to go through, give them options, which they didn’t have originally, and find those community resources, which is the biggest thing—finding them doctors, treatment, housing, diapers, food, clothing, and all sorts of things,” she said.

When it comes to reducing harm on a larger scale, Ms. Justice encouraged healthcare professionals to learn more about what the policies or laws are, not only on the state level, but also within each individual institution. It’s also important to engage in motivational interviewing courses and become comfortable administering and carrying naloxone.

And in terms of practice-level changes that can be made, Ms. Justice recommends the following:

• Don’t order a urine drug screen on a pregnant patient who has no symptoms of intoxication
• Advocate to change policies that make screening of pregnant women routine
• Document more—not less—when contributing to a report going to the system
• Teach patients and partners how to obtain and administer naloxone

To conclude, Ms. Justice had the following recommendation that summarizes the main message of the entire session: “There needs to be empathy, there needs to be respect, and there needs to be education about the resources.”

References:
Ebersole A, Ballout A, Justice J. “Reducing Harm: Changing Family Planning and Obstetric Paradigms for People Who Use Drugs.” (2023). Society of Family Planning Annual Meeting.