Harm reduction refers to a set of strategies aimed to limit the negative consequences associated with drug use, but without requiring complete abstinence. Some harm-reduction strategies aim to reduce the risk of overdose, such as the use of naloxone rescue kits, fentanyl testing strips, and implementation of Good Samaritan laws. Other strategies lower the risk of overdose but also the likelihood of contracting infectious diseases such as HIV and hepatitis. Syringe services programs, also referred to as needle exchange programs, and supervised consumption facilities all fall under this category. Medications for opioid use disorder (MOUD), which include methadone, buprenorphine, and naltrexone, have been proven to lower the risk of overdose, improve the likelihood of maintaining sobriety, and therefore lower rates of disease transmission. Finally, harm reduction is utilized in criminal justice system through the use of drug decriminalization, police diversion programs, and drug treatment courts.

This chapter begins the book’s focus on the prosecutions themselves by asking and answering some basic questions: Who was prosecuted, who was not prosecuted, and did the legislature accomplish its purported aim to use prosecution to target mothers who gave birth to infants with NAS?

Fox News called them The Tiniest Addicts.1 Living in East Tennessee, the billboards and posters are everywhere – in the courthouse, along the highway, and in the grocery store. The image you see is a close-up of two tiny white feet, held stiffly flexed. Around the arch of the right foot is a grey, rubber-looking strap connected to thin tubes that travel beyond the border of the photo. On the left ankle is a blue hospital band, folded over itself several times to accommodate the tiny limb. In bold, centered text: A Baby’s Life Shouldn’t Begin with Detox. Other images you see in press coverage: overwhelmed neonatal intensive care nurses and white infants abandoned into the arms of beneficent elderly volunteer cuddlers. The sounds too are front and center: shrill, persistent cries that nurses say are a sure tell that the infant is withdrawing.