When my first slew of drug tests returned negative, the opposition began slinging whatever they could think of in my direction, hoping something would stick.
I am living in two worlds. One is a world populated by doctors and advocates, run on the tenets of research and science and reason. It is a world in which addiction is treated with medicine, and where there’s no question that people who use drugs deserve to be safe and free of avoidable infections and diseases. In this world, nobody hesitates to administer naloxone if the occasion calls for it. In this world, people are not afraid to touch the bodies of drug users, and we all understand that if you can self-administer naloxone, you don’t need naloxone. I experience this world through phone lines, e-mails, and social media. I write about this world; this world is my template for how all worlds should be.
Addiction as Moral Failure
Then there is the world where my life takes place. In this world, having an addiction is a moral failure. Drug use is met with punishment. Judges replace doctors and toxicologists, making medical decisions and determining the results of drug tests with reckless abandon. In this world, abstinence is the only route to health. In this world, a hit of pot is just as chaotic as compulsive, daily injections of heroin. In this world, there is no sterile equipment; in this world, everyone is sick. Here, you can be sentenced to death just for being the friend of someone who overdoses. This is the world I touch with my fingers and teeth—the world where I walk, and eat, and breathe. This is the world where I live.
I became involved with the Florida Department of Children and Families in April 2018. I was never charged with a crime or afforded the presumption of innocence, evidentiary standards, or jury decision that would have accompanied a criminal charge. Instead, one judge—virtually accountable to no one and equipped with full immunity—deemed my husband and me guilty of some nebulous pre-crime like the woeful characters in Philip K. Dick’s short-story-turned-film “Minority Report.” Apparently, I am guilty of the possibility of neglecting or otherwise harming my children in the future because I have a diagnosed substance use disorder.
Since that decision, I have been forced to obey the mandates set forth by my county’s child welfare authorities in an attempt to win back custody of my girls. So far, not a single mandate has been evidence-based.
I love writing about harm reduction, evidence-based addiction care, and trauma-informed mental health practices. I enjoy staying informed about best practices in addiction medicine. I am proud that I get to help demystify and destigmatize addiction and mental illness, and I am honored to have the opportunity to speak with the researchers who have dedicated themselves to driving us out of the dark ages of addiction medicine. But now that I am living in those dark ages myself, I can’t shake a sense of bitterness: I write about a better world, but it’s one that I only get to view from afar.
Substance Use Disorder Treatment and Geography
In 2017, I wrote an article for OZY about the general disparities between addiction care in red states and blue states. I was living in Seattle, Washington, at the time but I’d had some experience trying to get help for addiction in Florida—so I knew how backward providers could be. For example, when I gave birth to my daughter in Palm Beach while on prescribed methadone, hospital staff refused to let me breastfeed her. She was treated for Neonatal Abstinence Syndrome (NAS) and pediatric staff claimed that enough methadone would be passed through my breast milk to potentially harm her. In reality, numerous studies have found the exact opposite to be true and breastfeeding is now recognized as one of the most effective balms for NAS, due to the maternal contact and general health benefits of breast milk. The amount of methadone passed through breast milk is too negligible to help or harm.
As I wrote in the OZY article, Democratic-ruled states are more likely to offer Medicaid coverage for methadone and buprenorphine, while Republican states are less likely to even offer the medications themselves, much less cover them. People in red states also face harsher penalties for drug crimes and are less likely to be allowed to continue a methadone or buprenorphine prescription while incarcerated. (Though this is a nationwide issue, blue states are leading the reform.) But writing the story from Seattle meant writing from a place of comfort: I was living among the reformers—walking within the pages of history that will be attributed to the good guys. I was able to take my buprenorphine every day because my state insurance covered it. I was surrounded by intelligent, informed people with whom I could speak honestly about my decision to engage in non-abstinence-based recovery. When I wrote about the issues in the system, I wrote from a place of distance. Of privilege.
I did not appreciate how lucky I was until I dove headlong into the true trenches of the Drug War.
In Recovery and Losing Custody
In Broward County, Florida, my children were removed from me because of unsubstantiated accusations of drug use. When my first slew of drug tests returned negative, the opposition began slinging whatever they could think of in my direction, hoping something would stick. Most of it revolved around the fact that I was poor—but ignorance about mental illness and addiction reared its ugly face yet again. The opposition cited my prior child welfare investigation in Florida—the one that was triggered by my daughter’s NAS. It was a routine investigation that had been deemed unsubstantiated. These types of investigations are typically labeled “harmless.” I had been in compliance with my methadone program, and my daughter’s doctors had no concerns—but five years later, the opposition used that prior methadone prescription as a basis for deeming me an unreliable witness: the dirty, lying junkie.
When I was asked under oath whether I had spoken with one of my husband’s siblings about possibly purchasing marijuana, I admitted that I had. Clinicians in addiction treatment recognize that drug cravings are normal and applaud us when we admit that we think about buying drugs but then decide against it. But the guardian ad litem attorney—the counsel whose job it is to protect my daughters’ interests—argued that by considering using marijuana, I placed my sobriety and therefore my children at risk. It didn’t matter that I canceled the purchase and honestly acknowledged that I’d thought about it. The judge called my process of considering marijuana but then deciding against it “drug-seeking behavior.” She gave custody of my daughters to my husband’s parents.
The terribly irony underscoring the entire proceeding is that if I were still living in a state that embraced the most current research on addiction, I would never even have been in a courtroom. The accusation against me stated that I left my daughters in the care of their grandparents for three days while I used drugs outside of the home. According to the U.S. Department of Health and Human Services, “drug tests do not provide sufficient information for substantiating allegations of child abuse or neglect or for making decisions about the disposition of a case.” Drug use on its own, away from any children, is not child abuse. A parent who leaves their child with a family member to go to a bar for an evening is generally considered to be engaging in responsible substance use.
The federal government recognizes that child abuse cannot reasonably be defined as placing a child with a trusted caregiver, leaving the home for a couple days, and returning sober. It doesn’t much matter what went on during those two days. True or false—the accusation against me never described child abuse. A more enlightened jurisdiction would have recognized that. The separation trauma that my children and I have endured over the past nine months is completely attributable to our location.
I used to write about addiction and drug policy from a place of privilege. Now I am writing from the deep trenches. I feel as though I am performing a kind of literary necromancy whenever I publish—except that instead of communing with the dead or demonic, I am writing from within that unillumined place, hoping that, by disseminating research, facts, and the words of distant experts, I can summon reason back into my life.
