JaymeKay

Generally not. And especially not for pregnant women. A 2013 ACLU report found that Montana jails lack adequate healthcare for women, especially pregnant ones. Our more recent reporting found that the vast majority of jails force people to detox from legal and illegal substances even though doing so is dangerous for a fetus.

More about the justice system interactions here: http://missoulian.com/mothers-to-be-avoid-doctors-hoping-to-keep-drugs-kids/article_69edea02-62b2-59e9-b25e-b2078a4a8f16.html

Some also debate the cost aspect of this. Medication-assisted treatment is cheaper than inpatient therapy and much cheaper than incarceration. It's also more than 3x more likely to lead to longterm recovery than abstinence and counseling. Add in that babies born experiencing withdrawals cost 3x more than an average birth and that the majority of those are paid by Medicaid. There are pretty strong incentives for taxpayers and lawmakers to consider how they should balance cost-saving treatment with the need for criminal punishment.

What leaders in our state think: http://missoulian.com/montana-leaders-fight-drug-crisis-spike-in-foster-care-but/article_487c5371-0113-534a-82d6-2f681a83c3cf.html

It's tough to know. Because hospitals do not universally test the umbilical cord for drug use, we don't really have good data that would allow for an ethnic comparison. We do know the challenges are not limited to Native communities, urban or on reservations. About two-thirds of all child removals by the state involve parental drug use and the majority of those cases involve white families. And we know that Native women can face unique risks for drug use and extra barriers to care. For instance, historical trauma and the multigenerational poverty seen in some Native families can mean some people are more likely to experiences the kinds of terrible things that trigger many drug users to numb their emotions. Limited access to health care also makes it difficult to recover. Some of that is the result of federal policies and Congressional funding decisions that creates a different norm of care for some Native families. It is known that some Native women were sterilized without their consent by federal doctors decades ago, so there is particular mistrust of the health system for some families. Some of the Native women we talked to blamed the Indian Health Service for prescribing painkillers too easily and doing so instead of surgeries they couldn't offer because funding was too short, although that's difficult to track or prove. (A little unrelated, but a guy I interviewed last year needed knee surgery but it wasn't life threatening so he was prescribed painkillers for years until there was the money available to pay for it, a result of Congressional funding decisions. He had worked in construction his whole life and couldn't afford to pay the surgery out of pocket. He had to stop because of the damage to his knees and only years after that was able to get surgery.)

Medicaid expansion and special tribal provisions of the ACA have started to alleviate some of those issues by giving Native families more options for where to access care and how to pay for it. Tribes have increasingly taken on a greater role in delivering health services. For instance, the Confederated Salish and Kootenai Tribes here operates one of the state's few medication-assisted treatment programs, something that is rare in the state as a whole. In Montana, reservations also face the same challenges as other rural communities: isolation from services and job opportunities, hospitals have difficulty recruiting specialists, long drives to basic services, etc.

More here: http://missoulian.com/pregnant-women-on-montana-reservations-find-few-options-for-drug/article_c5f4f34a-bc18-5bed-aceb-b3b7b71a81d0.html

You echoed a lot of the women we talked to. It's definitely a complicated issue that will take commitment from a wide variety of Montanans to address. The biggest thing we heard from women is how important it was to have someone help them connect to all those resources. When they sought help, it was overwhelming to navigate the hospital, treatment, social services, safe housing and all the usual challenges of life and pregnancy on their own. They also said it was critical to know they had somewhere to go for help where they wouldn't face trouble or scorn. There are several pilot projects funded by the Montana Healthcare Foundation that are testing different strategies. Wrapped in Hope in Lake County has helped dozens of women, primarily by serving as navigators through those myriad services from pregnancy through a year after birth. (Relapse risk is higher immediately after birth, so it's critical care doesn't stop when the baby is born.) One hospital, mostly through cultural changes and better connections to community groups, reduced CFS removals by 70 percent and cut the length of NICU stay by more than half for infants who experience withdrawals: http://missoulian.com/kalispell-hospital-shifts-to-care-for-mothers-with-addictions-alongside/article_209d0d52-6215-5656-abd6-283e5b7d2fcc.html

What ideas do you have? Or insights you can share from your experiences?

This is only a sliver of the good work out there. I couldn't find some of the stories I had saved because they're lost in the mess from being in the middle of a move right now, but here are some good ones to get you started.

ARTICLES A pretty thorough analysis of the stats and the policies from Congressional Quarterly. Wonky, of course, but worth the read: http://library.cqpress.com/cqresearcher/document.php?id=cqresrre2016100700

The Washington Post and 60 minutes investigated how “Congress weakened the DEA’s ability to go after drug distributors, even as opioid-related deaths continue to rise” https://www.washingtonpost.com/graphics/2017/investigations/dea-drug-industry-congress/?hpid=hp_hp-banner-main_deanarrative-hed%3Ahomepage%2Fstory&utm_term=.515090aa249c

Seven Days of Heroin by the Cincinatti Enquirer is an in-depth personal look https://www.cincinnati.com/pages/interactives/seven-days-of-heroin-epidemic-cincinnati/

STAT News, an outfit that does excellent reporting on health issues, collected obituaries from around the country to illustrate the epidemic. https://www.statnews.com/feature/opioid-epidemic/obituaries/ This is a pretty good introduction to the brain science behind addiction: https://www.statnews.com/2017/04/19/opioid-addiction-relapse-science/
And other reasons it can be difficult to stop using: https://www.statnews.com/2016/05/25/opioid-addiction-withdrawal-survival/

Eric Eyre of the Charleston Gazette-Mail, whose reporting on the flood of opioids into economically depressed counties won him a Pulitzer. http://www.pulitzer.org/winners/eric-eyre

The LA Times did an excellent investigation into how OxyContin was marketed and how it shaped our current crisis: http://www.latimes.com/projects/oxycontin-part1/

The New Yorker took a more personal look at the family that got rich off that marketing campaign: https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain

At the Palm Beach Post, Pat Beall’s most recent work includes working with a team to track the true number of overdose deaths in their county and why they’re happening. http://www.mypalmbeachpost.com/generationheroin/

BOOKS Drugging the Poor: Legal and Illegal Drugs and Social Inequality by Merrill Singer. This book was recommended to me by several national addiction recovery experts and it’s stellar at looking at the class issues at play. https://www.waveland.com/browse.php?t=135

Dreamland: The True Tale of America’s Opiate Epidemic by Sam Quinones. This book tracks the rise of cheap Mexican heroin and how and why it reaches America. https://www.goodreads.com/book/show/22529381-dreamland

Substance and Shadow: Women and Addiction the United States by Stephen Kandall. Although the book focuses on women, it provides lots of interesting details about drug culture and policy as a whole in America. http://www.hup.harvard.edu/catalog.php?isbn=9780674853614

addicted.pregnant.poor. by Kelly Ray Knight. A great medical ethnography of drug use by women in San Francisco’s daily rent hotels: https://www.dukeupress.edu/addictedpregnantpoor

For many people, science clearly shows it's not simple choice to stop using like we might stop buying black socks instead of white. Drug use can literally rewire the brain and depending on the person might never go back to normal. Medication-assisted treatment is similar to insulin for diabetics. It's a way to manage a longterm health condition and no amount of will can change that biology.

I'd ask them to look at the hard facts showing which types of policies and programs actually help people recover and save the state money. Regardless of what you think addiction is, there is evidence of what works to help people recover, stay out of prison and save taxpayers money. I'd also ask them to listen to the personal stories of these women and try to consider life from their shoes. For most, drug use was not a decision to "have fun," but a coping tool they found to manage with traumas. They were timid to share their experiences because of the stigmas they faced, but ultimately hoped people would take a moment to listen. http://missoulian.com/pregnant-women-who-use-drugs-say-montana-does-little-to/article_16a4f32d-c3f4-5ba1-a4d3-441767f56b4f.html