When an anti-choice TikTok user argued against safe and legal abortion by comparing it to prescribing Oxycodone to heroin users, viral TikTok physician Dr. Eric B missed the mark in his pro-choice yet pro-drug war response.
The anti-choice original poster told viewers:
Can I go to your office and be like, “Hey I need some Percocets? […] It’s my body, my choice, and that’s what I want, I need some Percocets.”
And you’re like, “No, I can’t do that, under my medical license I can’t do that.”
But then I tell you, “If you don’t give me Percocets, and I need painkillers, I’m going to go out in the street and shoot up heroin.” So therefore you should feel bad for me and give me Percocets. […]
I’m all for abortion under medically necessary circumstances. But just because women are going to do it anyways and it will be more dangerous, so we should make it legal regardless?
The original poster accidentally made a good case for Safe Supply harm reduction – showing how prescribing without “medical necessity” could save someone from overdose – despite her attempt to make a straw man argument against abortion. Instead of recognizing that similar to abortion, drug use happens regardless of law and can be made a lot safer through regulated monitoring, Dr. Eric is quick to call it a “false equivalency.” Dr. Eric says that while pregnancy is always a medical indication for abortion, he believes the only medical indication for opioids should be the severest of chronic pain found in sickle cell anemia and metastatic cancer, and calls wider prescribing of opioids a violation of the Hippocratic Oath due to the opioid overdose crisis.
Dr. Eric likely doesn’t know this, but prescribing a Safe Supply to illicit substance users is a growing form of treatment outside of the United States. Vancouver permanent supportive housing non-profit PHS now operates Canada’s first take-home safe supply fentanyl program, an expansion of supervised consumption pilots. Aiming to fully supplant rather than add to a user’s illicit drug consumption, PHS charges participants a market rate of $10 per dose. The doctors involved in this program are not violating their Hippocratic oath, they’re meeting patients where they’re at to directly prevent deaths from unknown dosing and contaminants. For these providers, that’s enough of a medical indicator. Safe Supply gives fentanyl users the same right to know what they’re putting in their body, and freedom from poisoning, that alcohol users have had for 90 years.
Since 2012, opioid prescribing has been practically cut in half, and chronic pain patients face insurmountable barriers to maintaining access – which is often decided by an algorithm. The regulatory crackdown efforts had a reverse effect on harm, and illicit drug deaths grow exponentially in the same time period.
The current overdose crisis is not from recklessly prescribed opioids, but rather the rapidly evolving polysubstance cocktail in the illicit street supply incentivized by drug war actions. Teenagers are dying from fentanyl in party drugs, regular methamphetamine users are experiencing opioid overdoses from contaminants, and daily fentanyl users are finding naloxone (Narcan) doesn’t reverse an overdose now that the ‘downer’ supply contains non-opioids like Xylazine and benzodiazepines.
The original user made an accidentally valid point that abortion is safer than pregnancy just as narcotic maintenance is safer than illicit drugs. Bodily autonomy should give everyone the right to know and control what they’re putting or hosting in their body. A doctor fighting to keep these issues separate is slighting the broader fight for reproductive rights, allowing the right to conquer and divide while leaving the most vulnerable community members without rights or protections.
Criminalization of Pregnant Substance Use
The connection between dismantling abortion rights and the drug war has been here long before the fall of Roe. States regularly charge drug users with murder or manslaughter when miscarriages happen, even at stages where the patient had a right to an abortion. In one of countless examples, last year a Comanche Nation citizen who used methamphetamine was found guilty by the State of Oklahoma of “first degree manslaughter” after she experienced a miscarriage while 15-17 weeks pregnant at the age of 19. Oklahoma has charged even charged patients for exposing fetuses to medicinal cannabis during pregnancy.
Methamphetamine use may have been only one of many risk factors an Indigenous teenager in Oklahoma is exposed to that could contribute to a miscarriage; others including access to pre-natal care, nutrition, stress, pre-existing medical conditions, and housing security. It also may have happened with even the most supportive circumstances, as is certainly the case for some of the 26% of pregnancies that result in miscarriage. The cruel absurdity and lack of medical basis in criminally charging someone who experienced a miscarriage appears lost on Oklahoma prosecutors.
These prosecutions are not rare nor exclusive to GOP-controlled states, and lasting harm is done to those targeted even when there was no legal basis for the charges. In 2019, a 25 year old California woman who had a stillbirth was charged with first degree murder due to her methamphetamine use disorder. She spent 16 months in jail, unable to post a $2 million bail, before charges were eventually dropped in 2021. In the same county, a woman who had already been incarcerated for four years on similar charges had her conviction overturned when a judge found no justification in California law earlier this year.
Assumptions many people have about substance use affecting the health of the fetus are not necessarily true. “Crack babies” was a major media panic during the late 80s and early 90s. The dogwhistle focus on crack and not powder cocaine showed the racist intent of the discussion, which was in the context of portraying Black mothers as “welfare queens.” Spawning from a debunked study, columnists asked readers to imagine “four million” developmentally disabled children born from crack cocaine-using mothers who “don’t care about their babies,” growing up to become “super predators.” In the decades that have followed, research has never determined a link between cocaine use during pregnancy and developmental disabilities, let alone “super predator” behavior. The National Institute on Drug Abuse reflects on these fears as “grossly exaggerated” and directs analysis of outcome to the whole context of risk factors, not just assigning blame to a specific drug:
It is difficult to estimate the full extent of the consequences of maternal drug use and to determine the specific hazard of a particular drug to the unborn child. This is because multiple factors—such as the amount and number of all drugs used, including nicotine or alcohol; extent of prenatal care; exposure to violence in the environment; socioeconomic conditions; maternal nutrition; other health conditions; and exposure to sexually transmitted diseases—can all interact to influence maternal and child outcomes.26,29,30
These risk factors and their systematic causes are clearly ignored by prosecutors.
The number of states with laws prosecuting pregnancy drug use as child abuse grew from 12 to 25 between 2000 and 2015. In 23 states, healthcare workers are mandatory child abuse reporters for suspected drug use by pregnant people. Punitive measures against miscarrying will not stop pregnant people with a Substance Use Disorder from using drugs. Neonatal abstinence syndrome, the withdrawals that newborn babies experience following dependence on opioids, is measurably more common in states with punitive laws against pregnant drug use (60 per 10,000) than those without (46 per 10,000). Pregnant people may feel more comfortable engaging with healthcare workers to prevent this syndrome if the threat of incarceration doesn’t lean over them. These laws disincentivize people who use drugs from engaging in pregnancy-related healthcare, making miscarriage, pregnancy complications, and maternal mortality more likely.
Maternal drug use laws are weaponized even when no harm has been done to the fetus and the pregnant person is carrying out the best known practices for drug treatment and prenatal care. In 2013, Wisconsin woman Alicia Beltrane discussed her addiction recovery and participation in a Suboxone treatment program with her doctor while receiving prenatal care.
Suboxone is a medication treatment for Opioid Use Disorder that contains buprenorphine, a mild opioid, combined with naloxone, the medication that reverses overdoses by blocking opioid receptors. Its purpose is to simultaneously reduce cravings and withdrawal symptoms while preventing overdose even if someone were to use illicit opioids.
Despite Suboxone being approved for use during pregnancy, Alicia’s Doctor believed he had a mandatory duty to report this alleged “child abuse.” As a result, Alicia was arrested and denied a public defender, while her fetus was ‘appointed a lawyer’. Mrs. Beltrane was ultimately forced into a 90-day inpatient abstinence program, resulting in her loss of employment and stability.
Court systems typically buy into the disease model of addiction that ostensibly would limit accusations of moral failing. Drug courts typically force possession defendants to attend privately run Twelve Step treatment programs. However, the moment that drug use presents an opportunity for the legal system to step on reproductive rights, the legal system charges it as murder or child abuse. Without federal recognition of reproductive rights, these cases will only get more frequent and damaging. Anyone who understands the importance of abortion rights and bodily autonomy should also recognize how drug laws are are uniquely weaponized against pregnant people. If pre-Dobbs prosecutions can teach us anything, reproductive justice cannot be won if drug users remain criminalized.