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Legal and Medical Experts Discuss Alternative Approaches for Aiding Families Struggling With Substance Abuse

Massachusetts General Hospital is a Harvard teaching hospital in Boston's West End.
Massachusetts General Hospital is a Harvard teaching hospital in Boston's West End. By Naomi S. Castellon-Perez
By Paul E. Alexis and Krishi Kishore, Crimson Staff Writers

Legal and medical experts discussed how to support families struggling with substance abuse in a Tuesday virtual panel jointly hosted by Massachusetts General Hospital's Center for Law, Brain, and Behavior and Harvard Law School's Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics.

Stephanie Tabashneck — a senior fellow in law and applied neuroscience at the centers — moderated the discussion and began her presentation with an anecdote about an expectant mother of three children who suffers from opioid use disorder, anxiety, and depression.

“Julie desires to have a healthy pregnancy but feels ambivalent about going to the hospital for treatment right now and is worried about how her pregnancy will be viewed by [the Department of Children and Families],” Tabashneck said.

Former family court judge Beth A. Crawford, a panelist at the event, noted how those struggling with addiction — like Julie — rarely have the resources to stay the course of their treatment plan.

“Julie was given a service plan to address her opioid use disorder and was given contact information about how to do so,” Crawford said. “Her substance use disorder and her lack of city housing, lack of a telephone just made it really impossible for her to do what she needed to do.”

Crawford said introducing a family drug court would have enabled Julie to be substantially more “successful.”

“Julie would have worked with the program's family social worker to learn skills to safely parent her children and also to understand her children's experience with substance use disorder,” Crawford said. “She would have been in the program for about 18 months before graduating.”

Panelist Davida M. Schiff, director of perinatal and family-based substance use disorder care at MGH, focused on medical care that could support people in early recovery during pregnancy.

Schiff began her presentation by discussing MGH's Harnessing Support for Opioid and Substance Use Disorders in Pregnancy and Early Childhood Clinic, or HOPE Clinic, which provides care for pregnant women with substance use disorders.

The effectiveness of early intervention programs like the HOPE clinic, according to Schiff, are manifold and are directly linked to “improved maternal and neonatal outcomes with lower preterm birth, lower placental abruption and less fetal demise.”

On the role of the law, Schiff commented on the ineffective and detrimental prosecution of pregnant people who struggle with addiction.

“Prosecution of pregnant people with substance use disorder drives them from treatment, and it risks poor outcomes — for both mom and baby,” Schiff said. “Despite almost all professional organizations affirming the need for a public health response, we're seeing actually an increasing number of punitive responses from states [toward] perinatal substance use.”

Schiff also critiqued the “stigmatizing” nature of Massachusetts’s 51A Statute — a law that mandates reporting suspected child abuse.

“It harms the health of pregnant people and their infants because we know that this mandated reporting results in people avoiding the recommended care for them and their baby,” Schiff said.

Crawford emphasized empathy when dealing with parents experiencing substance abuse.

“It was very clear to me that these parents who came into our program with substance use disorder had long trauma histories like Julie did,” she said. “ I just would always say to myself, how lucky I was, I could have very easily been in that same situation. And how would I want to be treated in that situation?”


—Staff writer Paul E. Alexis can be reached at paul.alexis@thecrimson.com
—Staff writer Krishi Kishore can be reached at krishi.kishore@thecrimson.com

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