Can you tell me a bit about yourself and why you are involved in harm reduction work?
Joelle Puccio: I got into Harm Reduction for a school assignment to write a paper about service work,
and then kept coming back for 11 years. I was drawn to the needle exchange because I had been in so
many churches and schools and communities that claimed to be based on love, but this was the real thing. I had also been slowly realizing that everything I had been taught about drug use from child-
hood to nursing school was wrong. The mix of radical love and the practical philosophy of “Any Posi-
tive Change” made sense to me.
Ria Tsinas: I live in Portland, OR. I have been working in harm reduction for over a decade. Much of
my work focuses on harm reduction and its intersections with reproductive health and justice. I am a person with lived experience. I do this work in an effort to improve availability of gender specific ser-
vices in harm reduction spaces, as well as to improve the lives of pregnant and parenting people who use drugs. I hope to ensure that people who use drugs will not have to suffer such egregious losses as a result of bad policy and bias. I do this work because I cannot think of doing anything else. It is my passion, my community, and the space in which I am always pushed to grow, question, and advocate.
Erika Goyer: I come from a background in Neonatal Intensive Care Unit (NICU) parent advocacy.When I began learning about Perinatal Substance Use, I was struck by the shaming and guilt experienced by mothers. It was so different from the typical NICU experience, where mothers are told “It’s not your fault. These things happen.” In contrast, with substance use, despite any strong evidence of harm, we tell mothers “This is your fault. You don’t deserve to be a mother.” Once I saw that, I could no longer
stand by and let it happen.
Please share on how the Academy of Perinatal Harm Reduction was founded.
Joelle: I met Ria in 2010, volunteering for the needle exchange. We recognized that there was a lack of evidence-based information and wrap-around services for pregnant and parenting people who used drugs. We knew that this was something we wanted to work for in the future. After a conference in 2015, a group was formed to work on a comprehensive guideline for care of families with perinatal substance use. Erika was a founding member, and I didn’t waste any time asking Ria to join. We worked on the guideline under the umbrella of the National Perinatal Association (NPA) for 3 years until we had a first draft product. At that time, NPA decided that they would only support some of the documents, declining to approve certain content, such as safer injecting. For us, that was a deal breaker. We looked for a new home for about a year, and then the National Harm Reduction Coalition offered to work with us to expand the guideline into the Perinatal Substance Use Toolkit. We decided that since we had a client, we should form an organization, and so we founded APHR in June 2019.
What are the main principles of the Academy of Perinatal Harm Reduction? Are there feminist underpinnings you might detail for us?
Joelle: Our mission is to improve the lives of pregnant and parenting people who use substances. We work toward a community where all families are safe, intact, and informed regardless of what they put into their bodies. We know that in order to realize this vision, we must celebrate the expertise, honor the courage, and center the voices of members of our community who have lived experience. We see Reproductive Harm Reduction as essential in any intersectional feminist framework. The drug war is a war on women and children; it is a war on us. We know that people within our systems of healthcare do not experience one oppression at a time, but all intersecting and all at once. We recognize that to achieve equity and end the drug war, we have to fight against misogyny, white supremacy, ableism, capitalism, United States imperialism, homophobia, environmental destruction, and the drug war all at the same time.
What kind of feedback are you getting on the work of the Academy?
Joelle: Most of the feedback we get from participants in our trainings is positive. There is a saying in Harm Reduction that we “meet people where they’re at”. This can be literally where they are at, like exchanging needles with people in a park or at their homes, or it can mean finding common ground with someone who disagrees with you. The beauty of Harm Reduction is that it is so simple and so broad that everyone can be included. We all want to do good. Our goal is to help our trainees realize that they are already Harm Reductionists and give them the tools and resources to go out and do good in the world.
What specific challenges do pregnant women who use drugs have to face and how do you assist with those challenges?
In addition to many intersecting oppressions, pregnant people who use substances in the United States face systems designed to sabotage them at every step as well as a culture of misinformation and stigma that has been absorbed as truth by everyone in their life from doctors to family members. They become accustomed to being treated as “less than”. They come to believe that they deserve it. The most important thing that APHR does is to counter this ugly and false narrative. We know that people who use drugs are smart and capable of making decisions for their health and their families. We know that doctors, social workers, and other professionals are in these jobs because they want to do good, and that they are positioned to use their power within systems to advocate for positive change. APHR provides evidence-based information and resources that challenge our systems and give people the tools to make informed decisions and advocate for themselves, their families, and their patients.
Do you feel that the impact of drugs in pregnancy are overstated in popular media?
The impact of substance use in pregnancy is not only overstated in the media, but it is overstated in academic literature. It is typical to find a research study with data showing no effect that is misinterpreted as an effect, or an article openly blaming pregnant people for being victims of violence or poverty.
Please tell us about “NAS” verses “NOW” and why the distinction is important.
The concept of Neonatal Abstinence Syndrome (NAS) was developed in the 1970s by Dr. Loretta Finnegan solely to describe withdrawal from opioids. Despite this, some infants with no opioid exposure at all have been diagnosed with NAS and treated with unnecessary medications. There are no long-term or permanent effects of NAS, different from more well known “syndromes” such as fetal alcohol syndrome. The term Neonatal Opioid Withdrawal (NOW) specifies that it is a condition associated only with opioids, and withdrawal is better understood by the general public as temporary.
Do you have any tips for advocates in other countries who may wish to emulate harm reduction perinatal work?
We know that many of the practical challenges faced by other countries will be different from ours, but we also understand that US imperialism has spread our harmful and ineffective drug policy all around the world, with disastrous effects. We believe that information is power and we would love to translate and share our work with anyone interested. We want to collaborate with more international allies and learn from work that is being done outside the US.
