Harm-reduction program for mothers struggling with substance use expands to Northern NV 

In 2015, Andria Peterson, a clinical pharmacist at a neonatal intensive care unit (NICU) in Las Vegas, noticed an increase in babies born with neonatal abstinence syndrome, or withdrawal from substances.  

Half of the babies in NICU were in withdrawal, Peterson said, recalling how a mother in labor was turned away because there wasn’t a NICU bed for her. “I realized what we were seeing at the NICU was a symptom of a bigger problem,” she said.  

It was then Peterson realized that something needed to improve long before the delivery room. That was when Empowered was initiated — a  program that helps pregnant and postpartum mothers who use or have used opioids or stimulants for any reason through a harm-reduction and non-judgmental approach, one of only a handful of such programs known to exist in the U.S., said Rachel Mack, a licensed clinical social worker and the associate program director at Empowered. 

The Nevada Department of Health and Human Services (DHHS) Office of Analytics estimates that an average of 42 babies are born each year with prenatal opioid substance use in Nevada.

While the program initially focused on treating mothers and children with opioid addictions, it has broadened to include all drugs, because many women were using multiple substances or unaware that their substance was laced with opioids, Mack said. 

The program, which started in 2018 in Southern Nevada, is currently helping roughly 140 women throughout their pregnancy and postpartum recovery, which can be anywhere from nine months to two years.

By this spring Empowered, which is administered under the auspices of the private Roseman University of Health Sciences, will be operating in Washoe, Lyon, Carson City, Dayton, and Fernley counties, an expansion made possible by a Substance Abuse and Mental Health Services Administration (SAMHSA) grant of $894,497 for Nevada. 

The program also received $230,360 per year through the Fund for a Resilient Nevada, established to distribute the state’s portion of opioid litigation settlements. 

Overdoses are the leading underlying cause of pregnancy-related deaths in the state, according to the most recent Maternal Mortality and Severe Maternal Morbidity Nevada report, released by DHHS in December 2022. 

But preventing overdose deaths isn’t as simple as treating substance use alone — the bulk of the population that Empowered serves also struggles with food and housing insecurity, a history of experiencing domestic violence, mental health conditions, and lack of a support network. 

“If a client is not in a safe space or has something to eat and [doesn’t] feel safe in the space and environment, they’re not thinking about scheduling appointments…because their basic needs are not met, and that’s usually housing, food, all those social determinants that impact their ability to take care of themselves,” Mack said. 

Peterson, who now serves as the executive director of the Empowered program, started to help meet mothers who struggle with substance use where they’re at, and with the needs the mothers deem most urgent, which may not always be addiction treatment. 

Empowered helps connect those mothers with medical treatment, peer recovery, mental health services, and health insurance. The program also helps clients obtain food and housing assistance and access to other services, including government IDs, education and job training.

A unique — and broader — approach

According to SAMHSA, recovery from a substance use disorder rests on four pillars: health, including mental health; having a stable and safe place to live; having a purpose, including a job; and making connections to a community. While Empowered’s model emphasizes those priorities, many programs for recovery make sobriety a condition of assistance — making it hard for those who may relapse to recovery or enter a program. 

Most of the 140 women currently served by Empowered in Southern Nevada are in their mid-30s, with previous children, and over half of the program participants have experienced domestic violence, Mack said. 

Amani Wilson, a former client who was recently hired as a program coordinator at Empowered, started using meth at 30 when a friend offered it to her. 

“I thought, what’s the harm in trying it this one time?” she said, noting that it helped take the stress off the tumultuous relationship with her first child’s father. In the four years since that encounter, Wilson became pregnant with her daughter, has been incarcerated, homeless, and relapsed. She joined the Empowered program in May 2021 on a judge’s recommendation. 

She periodically relapsed while in the program. However, because support services offered through Empowered were not tied to her sobriety, she said she ultimately learned to identify – and cope with – her triggers.

“You have to change your people, places, and things,” Wilson said, noting that it took time for her to leave old connections, find a home that wasn’t in a place where other people were using, and fill her time with activities that would address her trigger of boredom. She said she has been sober for a year. 

Wilson, by her own account, came from a well-supported family. Her parents are still married and had custody of her son while she was in the Empowered program. Since finishing the program, she regained custody of her son and appreciates the everyday moments they have together — doing chores, completing homework, or making cherry jello after work. 

The program is also offered to those who have had their children removed by and have active cases with the Clark County Department of Family Services. 

Empowered completed a needs assessment of Northern Nevada — noting that while each individual’s needs for recovery are different, the services a person receives is contingent on what services are offered in their community or region. 

In Washoe and the rural Northern Nevada counties, the biggest barriers to substance use recovery for pregnant and postpartum people are limited prenatal and medical care, housing assistance, transportation, assistance in obtaining government-issued IDs, job placement, food, hygiene products, clothing, including for job interviews, and baby necessities, according to the research by Empowered. 

Other gaps include access to child care, long waits for care for Medicaid populations, providers not knowing how to screen for substance use properly, and stigma faced by mothers with substance use problems, not merely from the public but from law enforcement and policymakers.