Home Ask Ms. Harm Reduction Ask Ms. Harm Reduction: She’s Pregnant and on Dope

Ask Ms. Harm Reduction: She’s Pregnant and on Dope

Ms. HR wants the best for you and your bun in the oven. (image via Flickr user trialsanderrors)
Ms. HR wants the best for you and your bun in the oven. Though you probably won’t want to nurse your tot if you’re on methadone after it’s born. (“Nurse the Baby” poster by Erik Hans Krause, via Wikipedia Commons)

All the queries Ms. Harm Reduction answers are actual questions from readers. If you have a quandary related to drugs, sex, work, or any of the other pitfalls and pleasures of life that you need Ms. Harm Reduction’s solution for, please write in at info@titsandsass.com.

Dear Ms. Harm Reduction,
I’m a recovering addict/alcoholic stripper (20 months clean) and I just found out my best friend at work is a pregnant heroin addict. I’m one of the only people who knows she is pregnant, and I’ve been trying to talk her into getting some prenatal care as well as food stamps and WIC because she never seems to have enough to eat. Last week I learned that she doesn’t want to go to the doctor about her pregnancy because she’s a heroin addict. The resident dope dealer/stripper [at work] (also a pretty close friend) confided in me that she is also worried about her. I always thought she was falling asleep at work because she works too much but now I realize she was nodding off, and now I also understand why she never has enough money despite doing well at dancing and why she’s so underweight. Lately, she’s been looking extra pale, dark circles under her eyes, and crying a lot. I’m worried. I know she’s hiding her addiction from me because she knows I’m in recovery and because I’m somewhat of a mentor to her and she doesn’t want to disappoint me. I also understand firsthand the painful shame that often accompanies drug addiction.

I don’t want to embarrass her or make her feel defensive, but I also want to let her know that I do love her regardless and most importantly I would like to give her some information about harm reduction. Is there a way I can go about this that won’t feel invasive? I know a former sex worker who works at a harm reduction center that will give her clean needles. I’ve also been hearing a lot about a bad batch of heroin that’s been going around my city. We’ve had a huge spike in overdoses and I want to make sure she knows it’s out there.

And finally, what the hell is a pregnant drug addict supposed to do? Will she be arrested when her baby tests positive for heroin? Drug addict or not, she needs prenatal care. I can understand the difficult position she is in.

I’m not naive enough to think I can talk her out of her addiction, but I also don’t want her to feel like she needs to hide it from me. I want her to know I’m not judging her and that I’m here to help her if she decides she needs it.


Girl On Opiates is a Great, Amazing Homey


Ms. Harm Reduction won’t patronize you by dismissing the severity of your problem. From the racist crack baby hysteria of the 80s to today’s nutso set-ups which offer to pay drug using ladies to be sterilized, it’s clear that pregnant drug users are one of the most hated and underserved groups in the nation. If a pregnant drug user is also a proud ecdysiast like your friend, well, then, the bullshit she faces piles up even higher because of how folks look at harlots like us. In many states with evil laws around reproductive rights, your friend could even be arrested for potentially harming her fetus. And of course, her custody situation is dicey.

But never fear, Ms. Harm Reduction is here, and there are several steps your best girlfriend can take to help herself and her tadpole out:

1. Get on methadone

I remember when methadone began to be widely available in the 60s. I was already an older gal then—not as far from a spring chicken as I am now, but older than most of the ladies on the stroll. What us dames discovered then was that a methadone clinic could be a knocked-up dopefiend’s best friend.

Methadone and other long-acting opiates used in opiate substitution are far from pie-in-the-sky-perfect treatments. Methadone is actually many times more addictive than heroin—that is to say, methadone withdrawal lasts for months in comparison to the week that cold turkeying off heroin usually takes—and it comes with quite a number of side effects: it dries up a gal’s saliva, wreaking havoc on her pearly whites; it can really pile on the pounds (water weight, mostly); and sometimes it even affects cognition and causes depression. In fact, it’s the reason Ms. Harm Reduction got her falsies early, and she would be doing readers a disservice if she didn’t spill all about the ‘done. But make no mistake about it, ladies and gents, the availability of opiate substitution is a harm reduction must, which offers the best outcome for treatment. As I’ve said, it’s also the best solution available in these old United States for an opiate user with a bun in the oven.

You see, dopesickness wreaks havoc on a pregnant gal’s (or pregnant individual’s) immune system and is no good for a developing fetus. And the slapdash way most of us are forced to obtain our illicit dope supply in the context of criminalization leads to a good amount of time spent dopesick, even if we aren’t trying to quit. So being on methadone maintenance is the easiest way to give that little passenger within a bit of stability.  Most clinics provide one on one counseling and group therapy as part of their program, as well as special groups for their pregnant clients, dealing specifically with the health and safety issues they face. After birth, the young’un can be tapered off the ‘done fairly painlessly, and it has no lasting effect on the infant as it grows.

Many methadone clinics will fast-track pregnant users in ahead of their waiting lists. Clinics tend to charge between 100-300 buckaroos a week, but most low-income government medical insurance programs will cover the treatment. If you’re already encouraging your pal to get on a food stamp program, help her apply for your state’s low income subsidized medical insurance if it has one, or Medicaid or Medicare if it doesn’t. Sometimes just offering to accompany someone to those dreary offices can help them beat the bureaucracy blahs.

The clinic will urine or swab test her every month for drugs, but their confidentiality policies means they’ll at least make a token effort to protect those results. But if the hospital finds drugs in her system when she’s giving birth, she’ll be drug tested every month by the state instead, and your state’s child protection agency is going to get its claws in her custody situation.

Anyway, most dopefiends who get on methadone stop using beyond the occasional chipping, so signing up for a clinic will protect your friend from that bad batch you’re worrying about, too. It will most certainly at least reduce her injection use, which will address your fretting about her clean syringe supply as well. But if we’re talking clean needles, the next step should help with that dratted problem, too:

Yup, that rabbit is dead. (image via Flickr user catjannik)
Yup, that rabbit is dead. (image via Flickr user catjannik)

2. Get a harm reduction organization to lend a helping hand

There are plenty of brave chickadees out there running peer-led harm reduction groups, some of which focus partly or wholly on sex workers, as well as sex workers’ rights organizations with a harm reduction slant, that can help your best girl navigate legal issues and refer her to nonjudgmental prenatal care. Just to give you a quick sampling, there’s the Harm Reduction Action Center in Denver, HIPS in Washington DC, Women with A Vision in New Orleans, Sex Workers Without Borders in Raleigh, North Carolina, Project SAFE in Philly, and Washington Heights CORNER Project in New York, NY. That last one even offers basic gynecological services on site for the ladies or other coochie-owning folks who come in. Most of these places will also be sure to offer the clean works, ties, cookers, and sundry other fixin’s your friend will need to get off safely while she’s doing dope. The two existent health service organizations by and for sex workers would also be a great bet if you happen to live near them: Persist Health Project in New York and St James Infirmary in San Francisco. They may not be able to attend to all her health care needs either, but they’ll be the best source on where to get good care.

Sadly, it’s not as easy to find a harm reduction organization as it is to walk into an AA meeting—as of right now, that goshdarn abstinence model runs the country. But the Harm Reduction Coalition offers a mighty fine comprehensive listing of organizations in every state, plus Puerto Rico, on the Connect Locally page on their site—take a gander there. Even if there are no groups in your area, call the one nearest to you and see if they can’t give you some tips about which health care providers in your state are least likely to give your friend the stink-eye and most likely to give her the compassionate care she needs.

3. Reach out to a support system

Here’s where the other part of your question comes in. Yes, your gal pal needs you now, so you’re right to worry about how best to approach her. But I think it’s pretty simple, really. Just tell her what you told Ms. Harm Reduction: that you love her whether she’s on dope or not and that you just want the best for her and her little sprout. Tell her that you want to help her do whatever she’s looking to do and you’re not trying to force anything on her. Self-determination is an especially important principle of harm reduction—you young folks call it “meeting people where they’re at,”—because so many people and institutions attempt to control us dopefiends’ lives, often violently. Reassuring her that you respect her right to choose will probably help her feel like she can trust you at a point in her life where the poor girl doesn’t know which way’s up. If all of the above seems obvious, it might darn well be, but it can’t be said often enough. She’s lucky to have a friend like you who isn’t jumping to invasive “solutions,” and who doesn’t think that just because she spends quality time with a needle sometimes, she doesn’t deserve to make her own choices.

Recruit your other friends who are in the know to help your bosom buddy out. You mention that your other best girl, your club’s dealer dancer, also has an inkling of your girl’s dilemma. If your preggers friend won’t listen to you about this—as you wrote that she looks up to you as someone who’s kicked and might stay mum so as not to disappoint you—maybe another current dopefiend will have a better chance of reaching her? You say your other friend is also concerned, so let her put that concern to work to aid your enciente buddy. Ms. Harm Reduction would advise you not to pile in on her in a group, though, as no doubt that will cause visions of terrifying “interventions” to come to mind.

Once you manage to blast through your friend’s Great Wall of Denial, don’t just leave it at that. Offer to make some of the calls or do some of the research already mentioned. Ask her if she needs a ride to the harm reduction offices, or to that free healthcare clinic you found that’s friendly to drug users. Heck, treat her to inexpensive luncheons sometimes until she goes on the clinic and stops spending most of her hard earned lucre on bags over food. Or maybe you have some spare vitamin bottles you could give her, since she’s unlikely to buy those on her own? Make sure you don’t run yourself down doing more than you can for her, though—you can’t help any of your gal pals if you pile too much on your pretty self.

All the while, use those shapely ears of yours and keep listening to her. What does she want? Does she want to keep the kiddie or give it up for adoption? What can you do to help her achieve either goal? Goodness knows, she may want an abortion, and that’s her god-given right and may be the best choice for her, too. What does she like about her current situation, and what does she want to change? Are there other reasons for her spates of crying at the club besides this baby scrape? What are they? You might not be able to help her with all or even most of her problems—and god knows, dear, you sound like you have troubles of your own—but at least you can hear what she has to say.

Best of luck with your knotty predicament! Hopefully, some months from now, both your pal and her healthy little nipper will be tapering off of methadone, happy as clams, and all of the suffering she’s going through now will be safely in the past.


  1. I’ve said it once and I’ll say it again – bless you, T&S and Ms. Harm Reduction. There are so few places we can go for helpful, compassionate, and informed advice. If I may, a few more organizations that provide services and support to pregnant women who use drugs:

    – National Advocates for Pregnant Women: legal services for pregnant women nationally, and state-by-state information on laws and policies. http://www.advocatesforpregnantwomen.org/.

    – Young Women United: for women of color in the Albuquerque, NM region. Community support for pregnant women who use drugs, and advocacy for increased access and better pre-natal care and birthing options. http://www.youngwomenunited.org/.

    – Project SAFE: harm reduction direct service providers for women in Philadelphia’s sex trade. Supplies for safer sex and safer injection (syringes, cookers, cottons, etc) can be delivered right to your door! They can also connect women with informed, non-judgmental medical providers. http://www.projectsafephilly.org, or call 1-866-509-SAFE (7233) to set up a delivery.

  2. Ms Goo Gah’s friend’s story really touched me. My daughter was a pregnant heroin addict several years ago and she got on buprenorphine instead of methadone. There were complications with my grand daughter (she had to withdraw-very painful to watch), but she turned out fine. She will be 7 soon.

    Sadly, my daughter was not able to stay clean and is no longer with us. I know you want to help your friend and I hope are able to. As a recovering addict myself (Oct, 2011), I pray that you will not forget that the most important thing you can do is to stay clean yourself.

  3. I just want to say how much I appreciate that this exists. I’m not a drug user myself, but there are so few judgement-free advice columns in the world and the compassion of Ms HR almost brings me to tears. I wish there were more places like this on the internet and in real life. It feels lonely out there when everybody hates you.

  4. This post is so kind and loving…my heart goes out to Goo Gah’s friend.

    It’s really quite incredible how our culture, ostensibly intent on protecting children, has instead a deep, fetishized preoccupation with shaming the very people who create life. When I was pregnant, I couldn’t even enjoy a glass of wine in public without someone offering unsolicited commentary on the damage I was wreaking on my fetus (for the record, my kid is extraordinary in every way and, as far as I can tell, undamaged).

    Is it any wonder folks opt out of prenatal care when they are in special situations? Especially since, in some states, fetuses can be assigned their own lawyer? It’s an exercise in power and control wrapped in the language of concern.

    Sending so much love and support and empathy to this young woman.


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