Objectives. To identify key gaps in overdose prevention interventions for mothers who use drugs and the paradoxical impact of institutional practices that can increase overdose risk in the context of punitive drug policies and a toxic drug supply.
Methods. Semistructured interviews were conducted with 40 women accessing 2 women-only, low-barrier supervised consumption sites in Greater Vancouver, British Columbia, Canada, between 2017 and 2019. Our analysis drew on intersectional understandings of structural, everyday, and symbolic violence.
Results. Participants’ substance use and overdose risk (e.g., injecting alone) was shaped by fear of institutional and partner scrutiny and loss (or feared loss) of child custody or reunification. Findings indicate that punitive policies and institutional practices that frame women who use drugs as unfit parents continue to negatively shape the lives of women, most significantly among Indigenous participants.
Conclusions. Nonpunitive policies, including access to safe, nontoxic drug supplies, are critical first steps to decreasing women’s overdose risk alongside gender-specific and culturally informed harm-reduction responses, including community-based, peer-led initiatives to maintain parent–child relationships. (Am J Public Health. 2022;112(S2):S191–S198. https://doi.org/10.2105/AJPH.2022.306776)
The epidemic of overdose deaths driven by fentanyl- and fentanyl analog‒adulterated drugs in the United States and Canada represents a pressing public health concern.1,2 While overdose mortality rates are significantly higher among men than women in both countries, overdoses among women in the United States (aged 30–64 years) have increased at higher rates than among men, and are disproportionately high for Indigenous women in British Columbia (BC), Canada.3–5 Despite making up approximately 3.3% of BC’s population, Indigenous Peoples accounted for 12% of overdose deaths in 2018 and 16% in early 2020,4,5 with Indigenous women 8.7 times more likely to have a fatal overdose than non-Indigenous women.5 The toxic drug supply in BC is the leading cause of unnatural deaths, with unprecedented numbers of drug poisonings.2 In response, a range of overdose prevention interventions have been implemented, including peer-led, low-barrier supervised consumption sites (SCS), buprenorphine and naloxone (Suboxone; BC’s first-line treatment of opioid use disorder), and the expansion of access to opioid-agonist medications.6,7 However, women’s, especially Indigenous women’s, and gender-diverse persons’ (e.g., nonbinary, transgender, Two-Spirit) needs are underserved by harm-reduction services.
