While this specialization can increase efficiency, it also leads to significant institutional blind spots. In reality, people do not live within administrative divisions. The conditions that shape a person’s life—where they live, learn, work, and seek care—are deeply intertwined. As a result, a policy that may achieve desired outcomes in one department can unintentionally create harmful consequences in another, ultimately undermining broader goals of improving health and well-being.

For example, a city might fund a highly structured addiction treatment program that integrates counseling, medication, and case management. Yet without stable housing or employment opportunities, even the most effective interventions can falter once patients leave care. A state might pass legislation to improve public safety by increasing penalties for public drug use or expanding police authority to clear encampments. But without concurrent mental health and housing coordination, enforcement can produce the opposite of its intended outcome. Cities that increase enforcement without increasing services often see more frequent crisis calls, higher incarceration rates, and repeated emergency department visits, because individuals are cycled through short-term punitive responses instead of being stabilized through treatment, housing, or crisis-care coordination. These policy mismatches are a direct result of siloed policymaking, which is built to solve isolated problems rather than address the overlapping complexities of human behavior and institutional systems.

An interdisciplinary harm reduction approach identifies where policies intersect, overlap, or conflict, showing how siloed decisions can generate unintended harms elsewhere. It asks policymakers to view every issue as part of a larger ecosystem—what public health professionals call a “continuum of care.” The goal is to identify where policies may be incongruent, such as through gaps in care, conflicting mandates, or fragmented accountability, and to design coordinated responses that reduce those harms without creating new ones elsewhere. Though harm reduction is often associated with drug policy, its logic is conceptually applicable across disciplines. It is a pragmatic framework for thinking about risk mitigation that recognizes that human beings are not automatons and that each makes discreet decisions based on their own circumstances, background, and perceptions. A harm reduction approach doesn’t attempt to craft policy for a conceptualized version of humanity, but caters to the needs of real human beings by prioritizing practicality, coordination, and evidence over ideology. 

The value of an interdisciplinary approach can be better understood through economist Friedrich Hayek’s work on imperfect knowledge. Hayek argued that no single entity—whether a government agency, a business owner, or an expert committee—possesses all the information needed to make perfect decisions. Knowledge is distributed across countless individuals and institutions and is constantly in flux. This means that sound policymaking cannot rely on centralized control but must instead employ mechanisms that facilitate information sharing, test ideas in real-world conditions, and adapt based on feedback. While harm reduction does not originate from Hayek’s theories, an interdisciplinary harm reduction framework reflects this same insight. It brings together actors from different systems to identify shared goals, map where policies overlap, conflict, or create gaps, and build solutions that are both pragmatic and self-correcting.

In some arenas, these ideas are already being put into practice. For example, when police officers are trained in harm reduction principles, such as recognizing overdose symptoms, using naloxone, and collaborating with health providers, enforcement becomes more effective and safer for both patients and officers. When cities apply behavioral insights to design roads that naturally cue drivers to reduce speed—like using roundabouts instead of traditional intersections, as Golden, Colo., did—speeds and crash severity decline without relying on police presence. In healthcare, supervised consumption sites in Calgary, Alberta, Canada, have managed overdoses on-site, preventing deaths while reducing ambulance calls by 700 each year and saving more than $2.3 million annually in emergency costs. These examples spanning different sectors share the same underlying logic: measure concrete outcomes, coordinate across systems, and reduce avoidable harm.

This same logic can be successfully applied to housing, urban planning, education reform, governance, and beyond. By aligning their goals, data, and evaluation methods, agencies can prevent duplication, save public resources, and craft policy approaches that reinforce, rather than undermine, one another. 

Reason Foundation’s Interdisciplinary Harm Reduction Framework is built on that logic. Drawing on established models—including the National Harm Reduction Coalition’s core principles, continuum-of-care approaches used in public health, and Continuous Quality Improvement methods—it defines harm reduction as a pragmatic and evidence-informed approach to reducing avoidable harms across multiple areas of public policy, including health, housing, education, technology, finance, governance, and public safety. The framework provides policymakers with a guide to identify preventable harms, design proportionate responses, and evaluate their effectiveness in reducing risk for individuals and communities. Ultimately, it moves harm reduction policy design from theory to practice, creating a shared, interdisciplinary language for effective and measurable reform.

How to use this framework

This guide provides a clear explanation of the Interdisciplinary Harm Reduction Framework and its application across different areas of public policy. We begin by outlining the framework’s core principles and defining each one in the context of real-world decision-making. We then walk through the process of operationalizing these principles, offering a step-by-step guide for identifying harm, designing proportionate interventions, aligning incentives, and measuring outcomes. Each section is designed to be accessible for readers, whether or not they have a background in harm reduction or public policy. The ultimate goal is to translate this framework into a practical decision-making tool applicable to any policy area, from health and housing to education, governance, and technology.

Core principles

1. Outcome-Informed Decision-Making: An effective harm reduction approach must be grounded in reliable data, empirical research, and rigorous evaluation. This means prioritizing interventions with a demonstrable record of success in real-world conditions, using measurable indicators of harm reduction to track progress, and maintaining a willingness to adapt as new evidence emerges. Simultaneously, policies must proactively anticipate and minimize unintended consequences, such as fueling illicit markets, displacing harms to other populations or settings, or creating perverse incentives. This requires both pre-implementation analysis and ongoing monitoring to identify and correct harmful trends early. The emphasis should be on facts over ideology, ensuring that policy choices remain tethered to outcomes rather than political whim.

2. Risk Minimization Without Blanket Restrictions: This principle advocates for policies aimed at reducing the severity and likelihood of preventable harm without resorting to one-size-fits-all or authoritarian policy interventions. Overly broad restrictions affect entire populations, often imposing costs on the majority because a relatively small minority engages in higher-risk behaviors or encounters higher-risk conditions. A harm reduction approach focuses instead on identifying higher-risk individuals and areas to tailor interventions to have the greatest positive impact without unnecessarily limiting the freedoms of the general public.

3. Individual Autonomy and Voluntary Action: This principle prioritizes empowering people to make voluntary, informed choices about their own lives, so long as those choices do not cause direct and demonstrable harm to another person. Rather than relying on coercive mandates, the focus is on removing barriers to support and safeguarding personal agency. This allows individuals to voluntarily adopt safer behaviors when they are ready. This approach also recognizes that individual decisions can have ripple effects for families, communities, and broader society, and that these effects must also be addressed to strengthen both personal and collective outcomes. Lasting change is most effective when it is chosen willingly, not compelled. This principle acknowledges that responsibility for outcomes ultimately lies with individuals.

4. Targeted, Context-Specific Solutions: One-size-fits-all approaches are rarely effective and impose high costs, burdens, and harms on the general public. Harm reduction requires a nuanced understanding of specific communities, environments, and markets to tailor strategies that meet their unique needs. Whether applied to health, housing, finance, or technology, interventions should be proportional to the scale of the problem, appropriate for the target population, and feasible for sustained implementation.

5. Cross-Disciplinary Application: Harm reduction needn’t be confined to public health and drug policy. It offers a versatile framework applicable to housing stability, educational access, financial resilience, technology safety, governance reform, and public safety initiatives, among other issues. Viewing harm reduction through multiple policy lenses ensures more comprehensive solutions, prevents siloed thinking, and helps identify overlapping areas where small, well-designed policy changes can yield compounding benefits.

6. Practicality and Real-World Application: Proposed solutions must be operationally feasible, cost-effective, and workable in the real world. This requires an objective assessment of cost-effectiveness to ensure that both public and private resources are directed toward policies that deliver the greatest reduction in harm per dollar spent. Rather than pursuing unattainable ideals, this principle prioritizes tangible, incremental improvements that can be implemented within existing legal, economic, and cultural contexts. The goal is meaningful, sustainable progress over large-scale, disruptive changes that carry a high risk of both failure and unintended consequences.

7. Incentive Alignment: Sustainable harm reduction requires aligning the interests of individuals, communities, and institutions. Policies should be structured so that all stakeholders share a vested interest in achieving positive outcomes. This can be done through market-based incentives, regulatory flexibility, or public–private collaboration. Equally important is ensuring that policies do not create additional harms, allowing harm reduction efforts to gain long-term support based on shared value rather than enforcement or compliance mandates.

Step-by-step operational playbook

A successful operational playbook translates the Interdisciplinary Harm Reduction Framework into a six-step process that moves from problem identification to coordinated solution implementation. It begins with defining the policy problem and desired outcome, clarifying the harm being addressed, what measurable improvement looks like, and who is responsible for leading the effort. The next step involves mapping the systems and actors involved to visualize how different agencies, organizations, and individuals interact across health, justice, and community sectors. This step also includes establishing a steering committee composed of representatives from each partner agency and at least one community member with direct experience with the specific issue being addressed (e.g., substance use, homelessness, or navigating the justice system) to guide coordination and monitor progress.

Once these overlapping dynamics are mapped, the process turns to identifying points of risk, friction, or missed opportunity—areas where harm accumulates, or coordination fails—and recording them in a simple risk register to ensure accountability. After these risks are identified, teams apply the framework’s principles to decision-making, using the seven harm reduction principles as a lens to test whether proposed actions are practical, proportionate, and evidence-based. The fifth step focuses on designing coordinated interventions and evaluation plans that align funding, roles, and outcomes across systems while creating shared metrics to track progress transparently. Finally, the process concludes with implementation, learning, and adaptation, during which the steering committee meets regularly to review data, adjust strategies based on results, and share updates publicly to promote accountability and continuous improvement. 

Step 1. Define the policy problem and the desired outcome

Begin by clearly describing the specific problem and what measurable improvement would look like. Define the harm you are trying to reduce and how success can be measured. Before moving forward, assign a preliminary lead agency and identify all necessary stakeholders that should be involved in defining the problem. Early clarity about ownership of the issue prevents confusion later.

Questions to consider:

• What harm or challenge are you trying to reduce?
  
• Who is most affected, and in what environments or circumstances?
  
• What would improvement look like in both the short- and long-term?
  
• How will you measure success?
  

Step 2. Map the systems and actors involved

List and visualize all systems, organizations, and individuals that influence this issue. Include public agencies, community groups, non-governmental organizations, private entities, and informal supports, such as families or peer networks. Mapping reveals how decisions in one ambit of life can affect outcomes in another. As you map, identify who has authority, who provides data, and who will make final decisions. Assign a sponsor with budgetary or legal authority, an accountable lead for daily coordination, a data steward for evaluation, and at least one community representative to ensure real-world experiences inform every stage of the process.

Questions to consider:

• Which systems or organizations currently influence this issue?
  
• Where do people most often fall through the cracks?
  
• Who are the main decision-makers, funders, or gatekeepers?
  
• Where do responsibilities overlap or duplicate?
  

Step 3. Identify points of risk, friction, or missed opportunity

With the systems mapped, identify where harm accumulates or where efforts are misaligned. These are the points where coordination fails, incentives conflict, or barriers prevent access to support. Political or community pressures can also limit coordination, especially when proposed changes are controversial or misunderstood, and these should be identified as part of the same risk landscape. Recognizing these intersections early allows attention and resources to be focused where they can make the greatest impact.

Once identified, document these friction points in a simple tracking table or “risk register” that summarizes potential risks. For each, include its likelihood, impact, early warning signs, mitigation strategy, and responsible party. Review this document regularly in coordination meetings to ensure potential harms are identified early and addressed proportionately.

Questions to consider:

• Do any current or proposed laws, statutes, or ordinances create barriers to implementing coordinated policies?
  
• Where does harm most often occur within or between systems?
  
• Are there communication gaps or conflicting priorities among agencies?
  
• Do any current policies create or worsen unintended harms?
  
• Which groups or communities are most likely to be overlooked?
  
• What new risks could arise from this intervention?
  
• How will we monitor for unintended effects or privacy issues?
  
• Who is responsible for updating the risk register?

Step 4. Apply the framework’s principles to each decision area

Once the risks are identified, use the seven harm reduction principles to guide decision-making on how to address them. This framework is not meant for exclusive use by government officials. It is better understood as a shared checklist that independent actors can use when they convene to weigh tradeoffs, compare options, and discard approaches that do not work in practice. When public agencies participate, their role is primarily to bring partners together, share existing data, and remove unnecessary regulatory or administrative barriers so that those closest to the problem are free to test and refine solutions.

Apply each principle to the systems and decisions you have mapped to help ensure that responses are realistic, coordinated, and effective. The principles act as a filter to check whether proposed solutions reflect outcome-based, context-specific, and collaborative thinking grounded in local knowledge rather than top-down assumptions.

Every principle should be reviewed through the lens of those directly affected and those implementing support on the ground. Invite both service recipients and frontline practitioners to comment on how each principle applies in practice. When discussing context-specific design, confirm that diverse populations and geographic realities are represented.

Questions to consider:

• Are desired outcomes clear, measurable, and evidence-based?
  
• Is the proposed intervention proportional to the level of harm?
  
• Does it respect individual choice and autonomy?
  
• Is the approach tailored to local needs and contexts?
  
• Are agencies and partners collaborating toward a shared goal?
  
• Can it be implemented with available capacity and resources?
  
• Are incentives aligned to reinforce positive outcomes rather than process?
  
• Have affected communities been asked how proposed changes may impact them?
  
• What accommodations are needed for language, disability, or access?
  
• How will feedback be tracked and reported back?
  

Step 5. Design coordinated interventions and evaluation plans

With the principles applied, move from mapping to planning. Develop coordinated interventions across systems, assign clear roles, and clarify how each participating organization chooses to contribute. In an interdisciplinary harm reduction landscape, partners include public agencies, private providers, philanthropic funders, and community organizations. Each of these actors controls its own mission, budget, and internal accountability structures. Public officials may revise the way public programs are funded, contracted, or evaluated, but they do not direct or supervise the internal operations of independent institutions.

Within that constraint, “aligning funding” means using the tools that each actor legitimately controls to support the shared goals identified in earlier steps. Public agencies can decide how to structure their own grants, contracts, or reimbursement rules so that public dollars reward reductions in avoidable harm rather than simple service volume. Philanthropic organizations can voluntarily support parts of the effort that align with their missions. Service providers and community groups can decide how to allocate their own staff time and resources to participate in the coordinated response. No single institution sets funding levels for the others. Coordination emerges because different actors see value in the shared objectives and choose to orient some of their resources toward them.

Accountability is created similarly. Each partner remains accountable first to its own constituents, boards, donors, or voters. To make collaboration workable, partners can record their voluntary commitments in simple memoranda of understanding, contracts, or grant agreements that specify who is responsible for which activities and what indicators will be used to judge success. Where public funds are involved, outcome measures and reporting expectations should be defined clearly and published in advance, so that participation is both informed and voluntary. For purely private or philanthropic efforts, this framework still offers a template that organizations can adopt internally to clarify expectations and track results.

Once roles and commitments are clear, establish a shared evaluation plan that integrates information from these efforts and tracks progress across relevant sectors, not just within a single agency. The goal is to create a transparent picture of whether the overall approach is reducing harm, while respecting the independence of each participating institution.

Establish a feedback loop where results, risks, and community feedback are reviewed together at defined intervals. This integrated review structure replaces fragmented reporting and ensures that decisions remain transparent and data-driven.

Questions to consider:

• Who will lead and coordinate implementation across systems?
  
• How will roles and responsibilities be shared?
  
• What data or evaluation tools will be used to track progress?
  
• How will feedback and learning be used to improve the program over time?
  
• What process is in place for identifying and correcting unintended harms?

Step 6. Implement, learn, and adapt

Implementation should include a standing review meeting—monthly during pilots—to compare data to benchmarks, discuss new risks, and document lessons learned. Decisions about scaling up, sustaining, modifying, or stopping an initiative should be based on those reviews, not on intuition or politics. Publish concise progress reports regularly so partners and the public can follow the evidence and stay invested.

Questions to consider:

• Are we meeting regularly enough to detect problems early and adjust accordingly?
  
• What evidence or benchmarks will guide decisions about scaling, modifying, or discontinuing the intervention?
  
• How will we document lessons learned so they meaningfully inform future decisions?
  
• Are any political, organizational, or resource pressures influencing implementation decisions?
  
• How will we ensure transparency so partners and the public can track progress?
  
• Do we have a clear process for deciding when and how to adapt the approach if circumstances change?

Hypothetical example: applying the framework to post-release overdose prevention

This section demonstrates how the Interdisciplinary Harm Reduction Framework can be applied to a real-world issue: preventing overdose deaths among people recently released from prison.

Step 1. Define the policy problem and desired outcome

In this example, we begin with a clear definition of the harm to be addressed, which is the sharp rise in overdose deaths that occurs in the first two weeks among those released from prison, a period when overall mortality can be up to 10 times higher than in the general population and overdose deaths up to 15.5 times higher. 

In one Colorado cohort of 905 people released from state prison, nearly 78 percent of people had a chronic medical or psychological condition, yet only about 10 percent had even a single outpatient visit within 30 days of release, and only 31 percent used any health service at the main safety-net system within 180 days. Upon release, individuals frequently face delays in reinstating Medicaid coverage, securing stable housing, or reconnecting with treatment providers secondary to loss of access to medication, housing, or support networks they once had, thereby disrupting the continuity of care. 

These administrative and logistical barriers create dangerous interruptions in care precisely when overdose risk is highest. Using the framework, policymakers first define the problem as avoidable harm linked to gaps in post-release coordination. The desired outcome might be to reduce fatal and non-fatal overdoses within 90 days of release and increase access to and voluntary use of medication for opioid use disorder (MOUD).

Applying the principle of outcome-informed decision-making, the team might identify measurable targets as: (1) a 15 percent reduction in 90-day overdoses; (2) a 20 percent increase in MOUD initiation within 14 days of release; and (3) a decrease in emergency department visits or emergency calls related to overdose. These outcomes are clear, evidence-based, and trackable across systems.

Step 2. Map the systems and actors involved

Mapping this issue involves correctional health, probation, public health, community clinics, pharmacies, emergency medical services, and peer recovery organizations. It demonstrates that, while each system plays a role, none are responsible for the transition from custody to care, revealing a high-risk gap in care upon prisoner release.

To operationalize the principle of cross-disciplinary collaboration, the example establishes a shared governance model for addressing the target problem. The sponsor (county public health) holds decision-making authority and funding. The accountable lead (correctional health) manages daily coordination. The data steward and evaluator ensure data integrity and oversight. The team also establishes a steering committee composed of representatives from each lead agency, the data steward, and a community advisor. The committee oversees progress, reviews data, and ensures that decisions remain transparent and evidence-based throughout the project. This clear structure transforms the mapping exercise into a functional plan for coordination.

This shared governance structure reflects real-world models that have already reduced deaths after release from prison. For example, Rhode Island’s statewide corrections-based MOUD program is sponsored by a cross-agency overdose task force, with the Department of Corrections as the operational lead and community treatment providers and public health officials jointly responsible for data and evaluation. In that program, everyone entering custody is screened for opioid use disorder, offered all forms of medication treatment while incarcerated, and connected to community clinics and Medicaid coverage before release. Evaluations found that this coordinated approach was associated with a roughly 61 percent reduction in overdose deaths among people recently released from incarceration and a 12 percent decline in overdose fatalities statewide, illustrating how clearly defined roles, shared accountability, and continuous data review can translate into measurable reductions in avoidable harm.

Step 3. Identify points of risk, friction, and missed opportunity

Once the systems are mapped, policymakers can then identify key friction points where harm accumulates. In our example, the team identifies significant harm associated with evening releases that occur after treatment clinics and community providers have closed, leaving individuals without immediate access to medication or follow-up care; inconsistent naloxone access; inadequate data exchange between correctional facilities, community health providers, and social service agencies; and stigma encountered during the initial stages of treatment engagement in the community. 

Each of these issues is logged in the risk register with ratings for likelihood and impact, early indicators, and assigned mitigation responsibilities. For example, risks tied to evening releases may be reduced through partnerships with mobile response teams, while data-related risks are mitigated by implementing role-based access to shared records to protect privacy and improve continuity of care. This keeps risk management transparent, targeted, and proportionate to actual harm.

Step 4. Apply the framework’s principles to decision areas

This step illustrates how the framework’s principles inform design choices:

• Outcome-informed decision-making anchors each intervention to a specific measure.
  
• Risk-minimization keeps the focus on key transition moments without adding barriers.
  
• Individual autonomy ensures the program remains voluntary and participant-driven.
  
• Targeted, context-specific solutions allow scheduling and staffing to adapt to local needs.
  
• Cross-disciplinary collaboration connects correctional, clinical, and community systems.
  
• Practicality and real-world application keep interventions feasible with existing resources.
  
• Incentive alignment ties payments to performance measures, including successful post-release care coordination, treatment initiation, and retention in recovery services.

In the worked example, these principles directly shape the policy response: naloxone is offered at release, next-day MOUD appointments are reserved, peer recovery coaches facilitate linkage, and data dashboards track both health and justice outcomes.

Embedding input from people who have personally navigated the reentry process is also built into this step. The framework emphasizes participation from those most affected. In this example, individuals who have recently been released from custody review program materials, test the discharge workflow, and highlight gaps such as transportation and stigma.  Their feedback is formally documented and integrated into revisions, making engagement an accountability tool, rather than a symbolic exercise.

Step 5. Design coordinated interventions and evaluation plans

Here, the framework moves from planning to execution, including a pilot study for the proposed interventions. The mapped systems and agreed principles guide the design of an integrated pilot:

• Screening and identification: At the time of incarceration, individuals are screened for opioid use risk during the correctional health intake process and monitored throughout custody and release.
  
• Harm reduction at transition: Naloxone is provided at release, with a brief training before discharge.
  
• Linkage to treatment: Peer recovery coaches meet people at release or within 24 hours to connect them with clinics.
  
• Continuity of care: To prevent treatment interruption, pharmacies issue short-term bridge prescriptions, which are temporary supplies of medications like buprenorphine, to cover the period between release and a confirmed clinic appointment.
  
• Monitoring and evaluation: Public health and correctional partners share de-identified data through a secure dashboard.
  

Evaluation follows the framework’s rule of evidence before expansion. The pilot uses a stepped-wedge design, which means the program is rolled out in phases—starting with one jail and gradually expanding to the others. This allows researchers to compare outcomes before and after implementation at each site and see whether improvements, such as fewer overdoses and stronger treatment connections, are linked to the program rather than other changes over time.

Step 6. Implement, learn, and adapt

The final stage in the framework emphasizes learning as an ongoing function. In the worked example, the steering committee meets monthly to review performance data, risk indicators, and community feedback. New challenges, such as transportation gaps or clinic delays, trigger minor course corrections. Decisions to expand, sustain, or stop the intervention depend entirely on whether the predefined data-driven outcomes are met, ensuring that changes are based on evidence rather than assumptions. Transparent reporting ensures that progress, setbacks, and adaptations are documented and shared with partners and the public.

Outcome of the example

If the coordinated pilot is implemented effectively, the county might see promising indicators within the first year—more people accessing treatment, fewer overdose-related emergency responses, and improved coordination across systems.

However, if these outcomes do not materialize, the framework still provides a structure for identifying where breakdowns occurred, what barriers—political, operational, or resource-related—interfered, and how the approach should be adapted or scaled back. The purpose of the example is to illustrate how the framework guides both improvement and course correction.

Final note for policymakers and advocates

This framework is both a mindset and a method. It encourages policymakers to move beyond assumptions toward evidence, collaboration, and continuous learning. By clearly defining harms, designing proportionate responses, measuring outcomes, and adjusting based on results, public systems can reduce avoidable suffering and wasted public resources while preserving choice, privacy, and dignity.

The goal is progress that is practical, measurable, and humane. When public responses expressly recognize that knowledge is dispersed across individuals and institutions, approaches can be tested through evidence and refined through feedback, officials are able to not only reduce harm but also strengthen trust and accountability across every system they touch.

The post Interdisciplinary harm reduction: A practical guide appeared first on Reason Foundation.

In Ohio, lawmakers have taken a tentative step toward addressing this gap with House Bill 542, which would require all jails and prisons to report pregnancy outcomes—a proposal prompted by Linda Acoff’s preventable miscarriage while in the custody of Cuyahoga County Jail in 2024. However, the bill, sponsored by state Representatives Terrence Upchurch (D-District 20) and Josh Williams (R-District 44), does not define what constitutes a “pregnancy outcome,” leaving it unclear whether facilities must report live births, miscarriages, stillbirths, other medical conclusions, or all of the above.

There is a significant gap in the oversight of pregnancy in prisons. The Bureau of Justice Statistics’ most recent report found that more than 700 pregnancies were recorded in U.S. prisons in 2023, with 91 percent resulting in live births, 6 percent in miscarriages, and about 2 percent in abortions. The report did not include data like preterm deliveries, cesarean rates, and maternal complications, making it impossible to understand whether those births were healthy or whether complications were preventable. The report also did not determine how often incarcerated women actually received the prenatal care, nutritional support, or postpartum follow-up that state facilities claim to provide.

Data from the Prison Policy Initiative show that almost half of pregnant women who are incarcerated never receive prenatal testing or basic dietary adjustments during pregnancy, and some are forced to give birth without medical assistance. Without a comprehensive way to track this information, policymakers and health officials are left with an incomplete picture of what care looks like in practice in correctional settings, making it impossible to measure progress or hold individuals accountable.

In February 2024, 30-year-old Linda Acoff was 17 weeks pregnant and detained at the Cuyahoga County Jail in Cleveland. According to an investigation by The Marshall Project and News 5 Cleveland, she screamed in pain for hours, pleading for help as her condition worsened. A nurse, later fired, gave her Tylenol and sanitary napkins but did not call for medical care. When her cellmate eventually alerted a guard, Acoff was taken by stretcher to a hospital, where doctors confirmed she had already miscarried. An autopsy of the fetus later revealed that she lost her pregnancy due to a common infection that went untreated. The baby’s death became the catalyst for the introduction of House Bill 542. Acoff’s death exposed what happens when there is no system for tracking what goes wrong or why. And the “why” really matters—each pregnancy carries unique risks that require timely, evidence-based responses.

Poor outcomes like Acoff’s are not isolated. Across the country, reports of women giving birth alone in jail cells reveal a pattern of preventable harm. A ten-year review of jail births found that among the women who gave birth inside cells, nearly two-thirds delivered only after repeated pleas for medical help went unanswered, and one in four infants was stillborn or died within two weeks. Many of these tragedies stem from untreated infections, premature labor, and delayed medical response.

Beyond maternal healthcare, the risks for infectious diseases are magnified in correctional environments where pathogens spread far more easily than in the community. Studies show that people in custody experience infectious diseases at rates four to nine times higher than the general population. Crowded living spaces, inadequate ventilation, limited screening, and delays in care all heighten the risk. For pregnant women, these conditions can turn manageable illnesses into life-threatening emergencies, as in Acoff’s case. Yet infection control is rarely prioritized, and access to preventive care remains inconsistent across facilities.

On top of these failures, incarcerated people are still charged medical copays to access care, with rates up to $13.50, including for prenatal visits. For someone earning an average of just 55 cents an hour in wages, according to a 2024 analysis of state prison labor data, medical copays of up to $13.50 represent several full days of work. Although some skilled production jobs pay modestly higher rates, these positions account for fewer than 5% of all prison jobs. A 2021 study in the Journal of Correctional Health Care, a peer-reviewed healthcare journal, found that women in prison were 50% more likely than men to forgo medical treatment because of these fees, even when they had greater health needs. When medical care requires copays that exceed what people can realistically pay, it discourages responsible health decisions and undermines the stated goal of reducing long-term healthcare costs. For pregnant women whose health needs are urgent and often unpredictable, this creates another layer of disincentive that worsens an already fragile system.

Further policy recommendations

Data collection alone will not prevent harm if it does not inform intervention. House Bill 542 establishes the foundation by requiring correctional facilities to begin reporting pregnancy data. To make that reporting more meaningful, the state should ensure the data collected is consistent and detailed enough to identify where care is breaking down.

Define and Standardize Data Collection: Pregnancy outcomes and milestones must be clearly defined and standardized across all facilities to ensure accuracy and comparability. These measures should include live births, stillbirths, miscarriages, preterm deliveries, cesarean sections, untreated infections, and maternal complications. Recording these outcomes in a consistent and structured way will allow state health agencies to identify weak points in care—whether that involves inadequate prenatal screening, delays in treatment, or gaps in postpartum follow-up.

Create a Data Review and Oversight Process: To maintain trust and ensure objectivity, lawmakers could allow the data collected under HB 542 to be reviewed by an independent third-party organization—such as a public health research institute, auditing firm, or university partner. These external reviewers could assess the completeness and consistency of the reporting and publish statewide summaries that identify trends without compromising privacy. Independent evaluation promotes transparency while avoiding conflicts of interest that arise when agencies assess their own performance.

Mandate an Annual Public Report: HB 542 should require the Ohio Department of Rehabilitation and Correction to publish an annual public summary of statewide pregnancy data. The report should include total pregnancies, outcomes, and any identified patterns in medical care or response times, while maintaining de-identified and aggregated data to protect privacy. A publicly available brief would allow lawmakers, journalists, researchers, and community organizations to assess progress and hold institutions accountable. 

When implemented together, these policies can turn data into a mechanism for accountability and reform that not only tracks harm but actively prevents it.

Ohio’s House Bill 542 is an important first step toward transparency and accountability in a system where too many pregnancy outcomes still go unrecorded. By simply requiring correctional facilities to document and report this information, the bill fills a long-standing gap in maternal healthcare oversight behind bars. With consistent reporting, independent review, and public access to findings, Ohio can begin to build a framework that not only tracks outcomes but helps reduce the harm already occurring in its correctional facilities.

The post Tracking pregnancy behind bars: Why Ohio’s House Bill 542 could save lives appeared first on Reason Foundation.

These rules are often shaped by professional and regulatory organizations like the American Medical Association, whose influence on state and medical boards, as well as legislatures, affects who is authorized to prescribe and manage MOUD care. While rural areas frequently lack clinicians due to lower population densities, these restrictions make existing shortages worse by preventing qualified providers from offering care where it is most needed. 

Beyond these restrictions, outdated regulations on how and where patients can receive care, such as limits on telehealth and medication delivery, further compound access barriers. Reducing these unnecessarily restrictive occupational licensing and delivery barriers is a practical and evidence-based way to close these gaps and expand access to lifesaving care.

Nurse practitioners (NPs) are already a significant part of the solution. In 2016, Congress passed a law enabling some NPs to prescribe buprenorphine, one of three approved medications for opioid use disorder. However, in 22 states, NPs are not permitted to do so without a supervising physician. This limitation reduces access to MOUD, especially in areas where doctors are in short supply. In states that grant NPs autonomy in prescribing, the number of available MOUD prescribers roughly doubles and significantly increases local treatment access. A national analysis shows that expanding prescribing to NPs had a particularly significant impact in very rural areas, where NPs and physician assistants were responsible for 1.3 times more buprenorphine prescriptions than in urban areas. 

Additionally, the study found that areas where NPs were allowed to prescribe had roughly twice as many registered NPs compared to regions where NPs are barred from prescribing. This may be due in part to the fact that the lack of prescribing authority makes NPs seem less valuable to employers, who then instead opt for physicians. Because NPs are more likely than physicians to relocate to rural communities and to remain there long term, granting them prescribing power would be a meaningful step toward closing treatment gaps where they are most severe.

Pharmacists undergo the most extensive training in pharmacology of any healthcare professional. Idaho has successfully authorized pharmacists to prescribe medications for a range of conditions. Through House Bill 191, which passed in March of 2017, the state granted the Idaho Board of Pharmacy the authority to determine when pharmacists can prescribe medications independently using clinical judgment consistent with the standard practices of healthcare providers. This applied to minor or time-sensitive conditions that did not require a new diagnosis. Within the first year, pharmacists were able to treat over 20 common ailments, and the state reported no safety complaints, showing that pharmacist-led prescribing can safely expand access to care in underserved areas. 

At the national level, the 2021 Mainstreaming Addiction Treatment Act (MAT Act) eliminated the requirement for clinicians to register for and receive a waiver from the Drug Enforcement Administration (DEA) to prescribe buprenorphine for opioid use disorder. Any clinician who can prescribe DEA Schedule III drugs, such as buprenorphine, may now prescribe them in states that recognize pharmacists as prescribers. Within the first year of implementation, pharmacist-issued prescriptions increased eightfold, rising from about 0.1 percent to 0.8 percent of all buprenorphine dispensations nationwide. The increase was most pronounced in states that had already authorized pharmacist prescribers, such as Idaho, New Mexico, and Rhode Island. Still, 90 percent of states continue to restrict pharmacists from prescribing buprenorphine independently. Where pharmacists can prescribe independently, they primarily serve rural and medically underserved areas, increasing the number of filled buprenorphine prescriptions by 5 to 10 percent in counties that previously had no such prescribers. 

The Department of Veterans Affairs (VA) offers a clear example of how pharmacist prescribers can operate successfully as part of a coordinated healthcare team. Veterans experience disproportionately high rates of chronic pain and opioid dependence. Overdose deaths among veterans increased by more than 50 percent between 2010 and 2019, and as many as one in three service members prescribed opioids during active duty met the criteria for dependence. 

Building on the flexibility established under the MAT Act, the VA authorizes clinical pharmacist practitioners (CPPs) to initiate and manage buprenorphine treatment for opioid use disorder under collaborative practice agreements. In 2023, the first full year after the MAT Act’s passage, 110 CPPs prescribed buprenorphine to 1,090 veterans across 36 states, accounting for 4.8 percent of all veterans receiving buprenorphine in the VA system and 4.2 percent of total treatment episodes. Collectively, CPPs issued more than 5,200 prescriptions, over half delivered through telehealth, and served as the sole prescriber in 16 percent of cases. 

International approaches provide additional examples, with Canada, Australia, and the United Kingdom integrating pharmacists into the MOUD treatment infrastructure. 

Psychologists often serve as the first and most consistent point of contact for patients with addiction due to their role in addressing underlying mental or emotional health issues, and could serve as an important access point to medication for addiction treatment. The U.S. Department of Defense (DoD) demonstrated as early as 1991 that psychologists can be trained to safely prescribe medications. An independent review of the program found that the prescribing psychologists trained by DoD filled critical gaps in care, reduced patient wait times for treatment,  and safely managed medications with no reported adverse events linked to their prescribing. 

Today, just seven states allow psychologists with specialized training to prescribe medication. However, most of these states still prohibit them from prescribing the controlled substances that form the foundation of medication-assisted addiction therapy. In Illinois, for example, psychologists are barred from prescribing Schedule II drugs, including methadone—one of three FDA-approved drugs that serve as the foundation of medication-assisted addiction treatment. Granting psychologists this authority could create a crucial new pathway to treatment, especially for individuals managing co-occurring mental health and substance use challenges. 

These profession-specific reforms are a practical and low-cost way to expand access to treatment and care, but they are not the whole answer. These reforms must be paired with broader changes necessary to update America’s health delivery system. America needs to maintain telehealth access for addiction treatment and remove outdated licensing and delivery barriers that restrict how and where patients can receive care.

One of the most entrenched obstacles in expanding access to addiction treatment is the federal system governing methadone delivery. The current system, designed in the 1970s and changed little since, stipulates by law that methadone for opioid use disorder can only be dispensed through opioid treatment programs (OTPs) certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the DEA. OTP clinics operate under strict requirements, including daily observed dosing for new patients, regular drug testing, and frequent in-person counseling. 

Though intended to boost safety, these requirements often have the opposite effect by limiting the number of clinics patients can access. Clinics are concentrated in urban centers, forcing rural patients to travel daily, sometimes hours away for a single dose of medication—an impossible burden for many in rural areas. In many states, methadone access is severely limited—Wyoming has no opioid treatment programs at all, while West Virginia prohibits new clinics from opening, leaving some patients to cross state lines or travel hours each day to receive care.

During the COVID-19 pandemic, the United States implemented emergency waivers that allowed patients to take home several days’ worth of methadone instead of reporting daily to a clinic in person. The change proved safe and effective, improving patient retention without sacrificing safety outcomes or diverting the medication into the illicit market. 

These changes proved effective enough that SAMHSA made the COVID-19 flexibilities permanent. In its 2024 final rule, SAMHSA authorized prescribing up to 28 days of take-home methadone doses for stable patients and 14 days for less stable patients. It also permitted first-time prescribing of buprenorphine via telehealth, as well as expanded authorization for mobile medication units—mobile components of OTPs that can dispense medications at remote locations—to operate without requiring separate DEA registrations, improving access to care in rural and underserved communities.

Telehealth reform offers another opportunity to greatly increase access to care. Before COVID-19, clinicians were required to see patients in person before prescribing buprenorphine. The DEA temporarily waived this rule in March 2020, allowing treatment to begin through telehealth, including audio-only visits. A 2025 JAMA Network Open study analyzing more than 228,000 buprenorphine initiations from 2020 to 2022 found that about 10 percent occurred via telehealth, and roughly 20 percent of those would not have been possible under the DEA’s proposed post-pandemic rule requiring an in-person visit before or within 30 days of tele-initiation. Patients treated through telehealth had similar or better engagement and lower overdose rates than those treated in person, echoing earlier findings from JAMA Network Open and the Journal of General Internal Medicine. Telehealth tools have enabled clinicians to reach patients in rural communities, single parents unable to travel, and others who otherwise would have gone untreated.

The potential for telehealth to expand access to care, however, greatly depends on clinicians’ ability to practice across state lines. During the COVID-19 pandemic, many states temporarily permitted cross-state practice, allowing out-of-state healthcare providers in good standing elsewhere to deliver telehealth services when in-person visits were not possible. Those emergency measures demonstrate that interstate care can be safe and effective. Many states are making this flexibility permanent with universal recognition laws.” These laws permit licensed health professionals in good standing from other states to begin practicing immediately, whether they relocate to the state or provide care remotely. Twenty-eight states and Puerto Rico have already implemented such reforms. 

Research from the National Bureau of Economic Research shows that universal recognition improves physician distribution and increases access, particularly in underserved regions. Allowing addiction psychiatrists in Boston to treat patients in Nebraska or West Virginia without redundant licensing barriers could immediately relieve provider shortages in high-need areas.

These reforms form a coherent strategy for expanding access to evidence-based addiction care. Modernizing rules on methadone delivery, protecting access to telehealth, and enabling licensed healthcare providers to care for patients across state lines would allow trained clinicians, including pharmacists, psychologists, nurse practitioners, and physician assistants, to put their skills to work to treat opioid use disorder.

The path forward includes:

Leveraging underused professionals: Empower pharmacists, psychologists, and advanced practitioners to prescribe within their training, building on successful state and federal models such as Idaho’s pharmacist framework and the VA’s clinical pharmacist program, which achieved 87 percent retention among veterans treated for opioid use disorder.

Modernizing methadone delivery: Authorize office-based prescribing and pharmacy dispensing for stable patients under appropriate monitoring, following models proven in France, the U.K., and Canada.

Making telehealth permanent: Codify pandemic-era flexibilities for initiating buprenorphine virtually and reimburse telehealth visits for addiction care at parity with in-person treatment.

Promoting license portability: Expand universal recognition laws to allow qualified clinicians to serve patients across state lines without redundant requirements.

The opioid crisis is not a single-issue problem, and it cannot be solved by one profession alone. But we can drastically reduce the toll on individuals, families, and communities. By embracing practical, evidence-based reforms, we can strengthen the national response to the opioid epidemic. When more qualified people are empowered to provide care, more people survive.

The post Modernizing addiction regulations: How licensing, telehealth, and delivery reform can expand access to care appeared first on Reason Foundation.

Philadelphia Mayor Cherelle Parker signed a law that would restrict mobile health vans providing critical support, such as clean syringe access and naloxone for overdose emergencies, from operating in Kensington. The measure limits vans to just two pre-approved sites, caps each stop at 45 minutes, and requires providers to obtain a permit to operate. Groups that violate the rules face fines of up to $1,000—and if they incur three violations, they become permanently ineligible to obtain the required permits. 

Though the Philadelphia City Council has described the ordinance as a response to congestion and litter, many community complaints center on concerns about people who use drugs gathering near the vans. Regardless of the framing, these restrictions undermine the very purpose of making care mobile, which is to deliver care where it is most urgently needed.

Mobile health units exist mainly to serve people who use drugs, who often struggle to access traditional healthcare. But they also offer other kinds of support, like basic medical care and community outreach, to anybody, not just drug users, who would otherwise go without care. Between July 2022 and June 2023, Prevention Point Philadelphia’s mobile and stationary syringe services reached more than 30,000 people, provided 1,103 wound care visits, enrolled 357 new participants in medication-assisted treatment for drug addiction, and distributed over 95,000 doses of naloxone, the medication that reverses opioid overdoses. Demand for these services has surged, with the organization’s client numbers more than tripling over the past three years. 

Restricting vans to two fixed locations undermines their core strength: mobility. Outreach teams deploy based on real-time need. Much of Kensington falls within the 19134 zip code, where the Philadelphia Department of Public Health recorded 193 overdose deaths in 2022. A rigid permit system will leave many blocks without timely access to care. 

This policy also disrupts the trust and continuity that are the foundation of successful harm reduction services. Patients who might avoid hospitals or doctors’ offices because of past mistreatment—an exceptionally common experience for people who use drugs—might be willing to accept naloxone from a familiar outreach worker. That small act of trust may also allow the patient to receive wound care and, perhaps later, a discussion about treatment options. 

Philadelphia can address legitimate quality-of-life concerns without constraining lifesaving services. For example, it could establish rotating service zones for mobile vans to prevent clustering in one area, set voluntary sanitation and reporting standards, and offer grants to providers that meet sanitation standards. Programs like Project Reach already work alongside mobile harm-reduction providers to remove thousands of bags of trash and tens of thousands of discarded syringes from city streets each year, showing that public health and public space improvements can go hand in hand. 

The city can also better address the root causes of the problems mobile units seek to address by expanding low-threshold treatment programs and supportive housing. 

As a strategy, mobile outreach has demonstrated effectiveness in saving lives, building community trust, and improving neighborhood safety. Limiting these services to just two fixed locations—especially when Philadelphia is still losing nearly four residents a day to overdose—risks reversing the marked decrease in overdoses that the city has seen. Mayor Parker and city councilmembers should amend this new ordinance and collaborate with providers and the community to design a better approach that can preserve both neighborhood dignity and access to the types of flexible care on which our most vulnerable neighbors rely.

The post Restricting mobile health vans in Philadelphia will lead to more overdose deaths appeared first on Reason Foundation.

Despite $2.7 trillion in public spending to address the drug overdose crisis, the United States continues to experience alarmingly high death rates, strained emergency systems, and ineffective intervention pathways. Current strategies that are largely centered on enforcement and abstinence-only treatment are not meeting the scale or complexity of the drug problem. Public systems remain reactive rather than preventative, leaving taxpayers to fund a revolving door of crisis care that fails to produce meaningful or lasting outcomes.

This policy brief presents a case for integrating harm reduction into the federal response, not as a replacement for drug treatment, but as a pragmatic complement. Harm reduction includes proven tools like naloxone distribution, syringe service programs, fentanyl test strip access, and supervised consumption sites. These interventions reduce healthcare costs, lower disease transmission, and improve individual and community outcomes without requiring drug abstinence. They represent low-cost, high-impact strategies that support public health and public safety alike.

To assess the current drug policy landscape, the brief includes a 50-state matrix evaluating implementation of five core harm reduction policies, including: syringe service programs (SSPs), naloxone access, legality of fentanyl test strips, Good Samaritan laws, and supervised consumption sites (SCSs). While two states meet all five benchmarks, others fall short due to outdated paraphernalia laws, inconsistent naloxone access, and surveillance practices that discourage participation. These gaps reduce effectiveness, create preventable costs, and deter early intervention by eroding trust in care systems.

Key policy recommendations in this paper include decriminalizing essential health tools, strengthening “Good Samaritan” protection laws, limiting surveillance in service delivery, and funding flexible, community-led initiatives. These policy reforms do not expand federal authority or create new regulatory structures. They promote local autonomy and make room for innovation by empowering the organizations best positioned to serve people on the ground.

Harm reduction is a public health approach that prioritizes safety, dignity, and evidence-based care, aiming to build trust in healthcare systems and ensure public resources are used effectively. It’s a practical path forward that aligns with the core principles of reducing government waste, investing in what works, and protecting individual liberty.

Based on the existing evidence, Reason Foundation concludes that expanding access to harm reduction services may be one of the most cost-effective, community-driven uses of funds designated to reduce the harms of the opioid crisis.

Introduction

The United States is confronting a multifaceted drug crisis that carries not only a significant economic burden but a devastating human toll as well. Opioid overdoses alone are projected to claim between 543,000 and 842,000 lives between 2020 and 2032. Beyond the personal loss, these deaths strain emergency response systems, drive up healthcare costs, and contribute to lost productivity and long-term societal expense.

Although treatment options exist, access remains uneven, and relapse rates continue to hover between 40% and 60%. Despite these challenges, many policies continue to prioritize a one-size-fits-all rehabilitation model—often centered around abstinence—which is not sufficient to meet the diverse needs of individuals struggling with substance use disorders.

Traditional treatments for substance use disorders include psychological therapies such as cognitive behavioral therapy, motivational interviewing, contingency management, and family therapy. Medication-assisted treatments (MAT) like methadone, buprenorphine, and naltrexone also offer effective options, as do mutual support groups. However, psychological therapies have an average dropout rate of 30%, and medication-assisted treatments often suffer from limited accessibility and a lack of coordination with psychological or peer-based support systems.

This current system is inefficient, as it fails to reach or retain many of the individuals most in need at great financial cost. For example, among those who inject drugs, preventable infections like HIV and hepatitis C are common due to unsafe injection practices like sharing needles. The average lifetime medical cost of one HIV infection is over $261,000, while hepatitis C treatment can exceed $38,000 per case. Preventable hospitalizations due to abscesses, infections, or overdoses also drive up costs, with each non-fatal overdose costing thousands in emergency department use alone.

In addition to their limitations in efficacy and accessibility, these approaches can unintentionally reinforce harmful stereotypes about people who use drugs. Abstinence-centered rehabilitation often assumes complete sobriety as the only path to recovery. This misconception perpetuates the false notion that one-size-fits-all treatment is effective for everyone. It shapes public opinion of substance use disorder as a moral failing instead of a health issue. It also drives policy and healthcare decisions that discriminate against people who use drugs and restrict access to harm reduction and treatment programs. The persistent ethical condemnation of drug use exacerbates the challenges of treating substance use disorder and prevents people from receiving or even seeking the assistance they need.

Substance use exists on a spectrum. Research shows that most drug use is occasional, short-term, and not associated with addiction. A clinical diagnosis of substance use disorder requires meeting specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which classifies most drug use as “transient.” Unfortunately, treatment protocols often fail to reflect this definition, sidelining evidence-based approaches that could better align with actual patterns of use in communities.

Current research also supports the idea that addiction is not solely the result of individual behavior, but a complex condition influenced by biological, psychological, social, and environmental factors—including physical dependence. For many people with opioid use disorder, quitting abruptly can be dangerous. Unlike illnesses such as diabetes or cancer, which manifest with relatively uniform effects, the effects of addiction vary significantly from person to person. This complexity undermines the effectiveness of uniform treatment strategies. It also reinforces the importance of broadening public health responses to include harm reduction—a practical, compassionate approach that prioritizes health, safety, and human dignity without imposing immediate or total abstinence.

Harm reduction offers a pragmatic complement to existing treatment approaches. It prioritizes reducing the negative health consequences of drug use, particularly among individuals who are not yet ready or able to pursue abstinence. These programs include syringe service initiatives, naloxone distribution, and access to medication-assisted therapy—all of which have been shown to reduce emergency room visits, lower disease transmission, and improve long-term outcomes.

One illustrative example is Taiwan’s 2005 needle exchange program, launched during a surge in HIV among intravenous drug users. Despite the country’s strict anti-drug policies, the program reduced new HIV infections by 90% within four years—demonstrating the public health and fiscal power of targeted harm reduction policies. Similar evidence from cities like Vancouver and Lisbon supports this trend, showing how such approaches can relieve public health systems while improving the quality of life for individuals and families.

Despite the extensive data supporting harm reduction in mitigating drug-related harm, ongoing misinformation about drugs and those who use them continues to hinder widespread acceptance of these strategies in the United States.

However, other nations such as Portugal, Uruguay, the Netherlands, Canada, and Mexico have shifted towards more effective policies for mitigating the potential dangers of drug use. An international trend is emerging, with more nations adopting harm reduction approaches that uphold individual freedom and recognize the right of people to make informed decisions about drug use and treatment.

American policymakers should similarly refocus drug policies from the supply to the demand side and work primarily to reduce the harmful effects of drug use.

Full Policy Brief: Harm Reduction: An Evidence-Based Approach to the Drug War

The post Harm reduction: An evidence-based approach to the drug war appeared first on Reason Foundation.

Protecting children is essential, but reducing their future to a single toxicology report ignores the complexity of what’s truly at stake. One test cannot distinguish between untreated substance use disorder, medication-assisted recovery, or prescribed pain management. Each of these scenarios presents distinct risks, whether related to infant health, the impact of unnecessary family separation, or the consequences of inadequate treatment access, and should be addressed through appropriate, individualized responses.

While many state laws require hospitals to detain infants after a positive toxicology screen, there is often no requirement to conduct follow-up testing to verify the results. This is despite the fact that toxicology screens produce false positive results up to 50% of the time, lack context, and often reflect past use—not current use. Yet, they are often treated as the sole basis for governments to seize a mother’s newborn child.

A study done by Health Economics, a peer-reviewed journal focusing on the economic aspects of health and healthcare, shows that punitive policies, like those that define prenatal substance exposure as child maltreatment in child welfare statutes or as grounds for the termination of parental rights, were associated with a 10-18% increase in infants born with opioid withdrawal syndrome. When healthcare providers serve as part of a punitive system, it undermines trust for both the providers and patients and discourages families from seeking the support they need to remain stable, healthy, and safe.

In a 2019 University of Arizona survey, 35% of people who use drugs said they avoided needed healthcare over fears of being mistreated by medical providers because of their drug use, something nearly all of them said they’d experienced before. When pregnant mothers avoid this care, both maternal and infant health outcomes suffer.

Decades of public health evidence show New Mexico’s new mandate is a superficial fix that undermines effective, long-term solutions. Other states are seeking more effective answers. Nine states have adopted the Sobriety Treatment and Recovery Teams (START) model, which serves families in the child welfare system where a parent has been diagnosed with a substance use disorder. Families are enrolled within two weeks of a child welfare report and paired with a child welfare caseworker and a family peer mentor to guide long-term recovery. These professionals work as a team to coordinate care.

START Services include rapid connection to treatment, intensive recovery support, parenting and life-skills coaching, targeted case management, and counseling for parents, children, and other family members—all while keeping the family involved in decision-making. Evidence shows that START not only reduces child maltreatment and foster care placements but also strengthens parenting capacity. In Ohio, parents in START reported significant improvements in appropriate expectations for their children, healthier family role boundaries, and greater support for children’s independence. In interviews, parents described being more present, engaging in daily activities with their children, maintaining steady employment, and managing stress more effectively.

Nationally, more than 75 percent of children in START remain safely with their parents or reunify by program completion, mothers are nearly twice as likely to achieve sobriety compared to those in traditional services, and the model has roughly halved taxpayer expense overall by reducing foster care costs.

Similarly, the Native American Connections’ Patina Wellness Center in Phoenix, Arizona, is a culturally grounded residential treatment facility for pregnant and parenting women with substance use disorders. It incorporates core principles of the START model, with Indigenous healing practices, placing strong emphasis on the parent–child relationship throughout recovery. Their model achieves remarkable engagement, with 92 percent of participants completing treatment. Crucially, the model fosters lasting recovery, with 67 percent of pregnant and parenting women remaining substance-free six months post-treatment, rising to 75 percent at the 12-month mark.

Lasting progress will come from legislation that embeds family-centered recovery initiatives into state law. Such a framework would protect maternal autonomy by requiring informed consent for drug testing, prohibiting automatic removal of newborns based solely on toxicology results, and ensuring access to services like medication-assisted treatment, peer mentoring, and parenting support. When tied to proven models—such as START, which prioritizes family preservation, or residential programs like the Patina Wellness Center—these protections translate into higher treatment engagement, fewer foster care placements, and long-term cost savings while upholding individuals’ fundamental rights and dignity. This should be the way forward for New Mexico.

The post Why New Mexico’s newborn state custody directive is a harmful misstep appeared first on Reason Foundation.