Jamie Lang was using drugs when she realized she was pregnant. At the time, she was homeless and living in a tent on the streets of San Francisco. It was difficult to do laundry and stay clean and when she sought help to get off drugs and find a place to live, “I didn’t look like what a pregnant person is supposed to look like,” she said. ““I was also really scared, because the people that I knew on the street, when they would get pregnant, they would be gone for a week, and they would come back and they wouldn’t have a baby… I went to, like, three different emergency rooms at different times. They said, ‘We can’t help you get into treatment. You can’t stay here. We don’t have housing.’”
Many pregnant people with a substance use disorder, like Lang, don’t have a regular healthcare provider. Many also fear — with good reason — that if they do access care, their infant will be taken away or that they will face stigma, discrimination or even criminal charges. This fear keeps many from seeking essential prenatal and postpartum services.
One small program in San Francisco is making a big difference for people like Lang. Team Lily, a University of California San Francisco program based at Zuckerberg San Francisco General Hospital, aims to remove barriers to care for pregnant and postpartum people — particularly those with a substance use disorder, as well as people experiencing homelessness, mental illness, incarceration and/or intimate partner violence.
Recognizing that pregnancy is a vulnerable period, but also a time when people are particularly motivated to get treatment, Team Lily provides wraparound services including addiction, mental health and pregnancy and postpartum care; it also offers case management support with housing and other needs.
Today, Lang is off drugs; she has a home and a job and her daughter Rosie is thriving. She told her story in a Foundation for Opioid Response Efforts (FORE) video. FORE has been supporting Team Lily since 2022. The foundation was created in 2018 by McKesson, one of the largest pharmaceutical distributors in the U.S., after the company was implicated, along with a number of pharmaceutical giants, for its role in fueling the opioid crisis.
Today, FORE is the only national U.S. funder that maintains a singular focus on the opioid epidemic. Along with backing family and community-based prevention programs like Team Lily, FORE works to provide professional education, raise public awareness, inform policy and “find and foster innovative solutions to ending the nation’s opioid and drug overdose crisis.”
FORE has worked hard to highlight the connection between opioid use and risks to maternal and infant health. A pregnant woman in the U.S. is three times more likely to die from pregnancy complications than a woman in Germany, France or the U.K., according to the Commonwealth Fund.
Opioid use is a major contributing factor: The fund reported that substance use or overdose is the leading cause of pregnancy-related death in a number of states.
As FORE President Karen Scott told IP last year, “This is a high priority for the foundation, because there has been much more recognition and attention on maternal mortality and morbidity overall. We’re trying to do some of the work of bringing the issues together — issues related to substance use and overdose and not getting treatment — that are contributing to maternal mortality.”
How Team Lily works
Programs like Team Lily aim to make pregnancy a less hazardous experience for those with substance use disorder and their infants.
Dominika Seidman, Team Lily cofounder and medical director, described the experience that many pregnant people faced before the program was established: “In 2018, the housing crisis was exploding,” she said in the FORE video. “Fentanyl was coming to San Francisco. The opioid epidemic was also exploding. At [the UCSF’s] Family Birth Center, we were seeing more and more people come into the hospital who had not had any interactions with the healthcare system, at least in the prenatal care sense. People were coming into labor and delivery, having a baby and having a horrible birth experience. People were withdrawing during labor. Right after birth, a social worker would come in and say, ‘we’re calling CPS,’ and a person’s baby would be removed from their room ridiculously quickly. It was an incredibly traumatic experience.”
Team Lily was established as a pilot program in 2018. In 2022, FORE provided a $1,320,000 grant to evaluate the program’s effectiveness, as well as overall costs and benefits. The grant will continue through 2026, and results are expected later this year.
Early results are impressive: Data for 2021 and 2022 show that while Child Protective Services was involved with 57% of participating families, three quarters of the Team Lily clients left the hospital with their babies and were undergoing or about to start substance use disorder treatment. As Seidman said in a FORE grantee spotlight, “When we looked at longer-term outcomes for that group, we saw there were no overdose deaths and 85% of babies were up to date on their well-child visits.”
Scott at FORE attributes the program’s effectiveness to the breadth of the services it offers. “[Team Lily has] peer recovery coaches who are out on the street engaging with potential patients,” she said. “They have social workers, they have obstetricians and family medicine clinicians that continue to provide services postpartum and medications for opioid use disorder, if that is what clients require.”
Team Lily has worked to develop a strong relationship with Child Protective Services in San Francisco, and Scott said that has helped keep families together. Still, a lot depends on individual circumstances. “The decision to remove the child often depends on who the worker is and their prior experiences with families affected by substance use,” Seidman said. “We always emphasize to patients that there is a lot of uncertainty built in and that we will advocate to keep them together if they are willing to go into residential treatment with their baby.”
Scott emphasized the importance of Team Lily’s low-barrier approach. Its clients face a variety of daily challenges: Simply getting to the clinic can be difficult, for example. Team Lily staff provide a warm, nonjudgemental environment where pregnant people are welcome — however they show up.
“If a woman has an appointment at eight o’clock in the morning and she shows up at four in the afternoon, they’re ready to see her,” Scott said. “I think that removing those barriers and making it welcoming for that patient population is so important. There is so much stigma around substance use and mental illness, and all of that makes it hard to come to a big hospital or doctor’s office to seek care.”
Will Trump cuts reverse a recent drop in opioid overdoses?
2024 brought welcome good news: a nearly 27% drop in the number of U.S. overdose deaths — down from over 110,000 deaths in 2023. But overdose rates remain high, and those working to get a handle on the crisis consider any progress to be extremely fragile. San Francisco recently saw an uptick in overdose deaths in recent months, for example. Many in the field are concerned that Trump administration policies will upend the tenuous gains.
There has also been ongoing chaos and disruption at the Department of Health and Human Services since Robert F. Kennedy Jr. took over as health secretary. Key federal databases that help track, among other things, drug use in different populations, like the Pregnancy Risk Data Monitoring System, the Youth Risk Behavioral Surveillance System,and the National Survey on Drug Use and Health, have been frozen, and it’s unclear if or how they will operate going forward.
“The overall big picture there is that, to the extent we had data to help drive good decisions about informing interventions to address overdose, we’re looking at a period where we may not even have that,” Scott said. She is in discussions with other funders about potential ways to work with states to collect data in the interim.
In another example, the White House has announced disruptions in funding for the Overdose Data to Action Program (OD2A), a grant program that supports local and state public health department efforts to lower drug use and overdose deaths. The administration’s actions worry staffers who have seen many government agencies paralyzed by DOGE cuts and funding disruptions.
It also concerns those on the front lines. “[OD2A funding has] been a critical piece of the decreases we’ve seen in overdose deaths,” Chrissie Juliano, executive director of the Big Cities Health Coalition, which includes 35 urban public health departments, told NPR. “Any changes to funding levels would be catastrophic and would really send us backwards.”
Meanwhile, the Substance Abuse and Mental Health Administration has undergone several rounds of layoffs, and even though Kennedy claims the agency is not being shuttered altogether, its activities, including crucial grants to local treatment programs, have been severely curtailed, according to NPR.
But it’s the Medicaid cuts included in Trump’s One Big Beautiful Bill Act that may pose the biggest threat to recent gains. According to KFF, “Medicaid covers 47% of all nonelderly adults with OUD [opioid use disorders] and is the primary coverage source among those receiving treatment services.” Many Team Lily patients rely on Medicaid.
Kaitlin May, a clinical psychologist based in West Virginia, warned that Medicaid cuts will threaten progress in a state ravaged by opioids. “The majority of my patients with OUD use Medicaid to access lifesaving treatment and care,” she wrote in West Virginia Watch. “I have seen, over and over, how Medicaid saves and changes lives.”
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Philanthropy’s role as the Trump administration undermines fragile progress on opioids
If the Trump administration has a strategy when it comes to combating drug use, it appears to be prioritizing enforcement over prevention. But experts fear that jeopardizing programs like Team Lily and other initiatives that provide access to treatment and support will cause overdose deaths to inch up once again.
As IP detailed in 2023, philanthropic funders have failed to deploy sufficient resources to fight the opioid epidemic, and with the administration cutting support for treatment and prevention programs, that support is more important than ever. Some funders, including FORE, are stepping up to help with the distribution of opioid settlement dollars, as IP reported last year. But compared to the nation’s mammoth health foundations, FORE is tiny — with total assets of just over $102 million last year — and can only do so much. “As a small foundation, we’re just continually trying to figure out where and how we can have the most impact,” Scott said.
Meanwhile, Trump administration plans to cut access to food and basic healthcare also threaten recent progress — and put more lives at risk. As Team Lily’s Seidman put it, “What we’ve learned, time and time again, is that people’s basic needs need to be met in order for them to be able to prioritize treatment and recovery.”
