In Shasta, one in 10 moms gives birth with a substance use disorder. A fragmented system is trying to catch up

When Rindi Quinn found out she was three months pregnant with her son, she was devastated. 

Quinn had been regularly injecting heroin and methamphetamine and knew immediately she needed to get help to ensure the well-being of the new life inside her. But it still took two months before she was able to see a provider for medication-assisted treatment — also known as MAT. Shortly after, Quinn entered a residential treatment program at Visions of the Cross where she continued her MAT treatment, which involved the use of Suboxone, a prescription medicine used to treat opioid use disorder by managing withdrawal symptoms. 

Four months later, her baby was born. He spent 26 days in the Neonatal Intensive Care Unit, or NICU, at Mercy Medical Center, where Quinn remembers him struggling to breastfeed and, at times, seemingly unable to open his eyes.

“It was hell,” she said of the experience that was full of fear, uncertainty and shame. She felt some of the nurses were suspicious and judgmental of her as a mother, and even now she struggles to know what parts of her baby’s behavior might have been related to substances and what was just normal for a newborn. 

Quinn’s experience as a pregnant person with a substance use disorder is not an uncommon one. In Shasta County and across the North State, rates of neonatal abstinence syndrome, or newborn withdrawal, far exceed the state average, while limited access to appropriate prenatal and substance use care — along with the challenges that can follow a baby home from the hospital — make the issue especially consequential.

One theme surfaced repeatedly across more than a dozen interviews with medical professionals, treatment program staff and community leaders: Stigma among health care providers as well as the broader community can keep pregnant patients from visiting medical providers. And getting patients through the door is only the first hurdle. From there, they will have to navigate a fragmented system of prenatal care, substance use treatment, delivery, newborn care and in some cases, the child welfare system.

But across the county, a network of health care providers, treatment programs, social workers and foster parents is trying to fill those gaps. While Shasta has a long way to go, local providers say recent outreach and educational efforts are bringing more pregnant patients into care, changing how hospitals treat exposed newborns and supporting families after they leave the hospital. 

The biggest challenges remaining are addressing fear and stigma, expanding substance use disorder treatment capacity and building a system that supports mothers and children not just through delivery, but in the years afterward. Those are challenges that the county could use its millions in remaining opioid settlement funds to help address. But so far, no discussion of the needs of substance-affected babies has come before Shasta’s board of supervisors for consideration.  

Quinn is now a substance use counselor at Visions, the same program where she once sought treatment. She loves her job, saying every day she gets to see people begin to get their lives back. Nearly all of the substance use counselors at Visions are people who have been through recovery themselves, she said, adding that she’s open about her own story with her clients. 

“There’s a lot of power in being able to say ‘me too,’” Quinn explained. 

What is neonatal abstinence syndrome, and why are rates in Shasta so high?

NAS is an umbrella term for newborn withdrawal, while NOWS — neonatal opioid withdrawal syndrome — specifically describes withdrawal following opioid exposure. It can occur after opioids and other substances cross the placenta when used during pregnancy, in some cases causing the fetus to become dependent.

Withdrawal symptoms can include tremors, difficulty feeding, irritability and sleep problems. Depending on the severity, some babies may require hospital monitoring and, in more severe cases, medication to manage their symptoms.

For most opioid-exposed babies, those symptoms are temporary and treatable, lasting anywhere from a few days in the NICU to several months of treatment. But even a short period of withdrawal can mean days or weeks in the hospital during the earliest days of a parent’s relationship with their baby, and the harm can last long after withdrawal has ended.

In Shasta, current rates of NAS are about four times the state average — meaning one in every 100 babies is diagnosed as experiencing withdrawal. The percentage of mothers diagnosed with a substance use disorder at delivery is even higher: about six times the state average. 

One reason why Shasta’s NAS rates are disproportionately high could be because rates of substance use generally in Shasta nearly double state averages, meaning the problem can be tackled as part of the county’s overall approach to substance use reduction. But it’s also different from other substance use cases in that it affects a second life — one that has no power over its exposure to substances.

While data shows Shasta’s rate of NAS declining significantly in recent years, many health care providers in Shasta aren’t convinced these numbers tell the full story, saying they’re seeing more pregnant patients with a substance use disorder than ever before while rates of substance use at delivery have held steady. Shannon Carelli, the director of integrated behavioral health at Shasta Community Health Center, explained that she used to treat one or two pregnant substance use disorder patients a year — now, she said, she sees nearly 100. And Amber Boddy, a substance use navigator at Mercy Medical Center, said her substance use disorder-affected pregnant patient count has tripled since she started working at the hospital in 2021. 

Carelli and Boddy said their growing patient counts may reflect the success of an increase in community outreach and referral programs that are helping more pregnant patients make it through the door for help, despite stigma. 

What keeps patients from seeking care? 

At Mercy, Boddy said she meets most of her hospital patients while right before or after delivery, rather than earlier in pregnancy as part of prenatal care. When it comes to getting substance use disorder-affected pregnant patients medical services earlier, she said, “there’s definitely a gap.” 

Tianna Lucarelli, a clinician and clinical supervisor at Visions, has surveyed her clients for a perinatal substance use committee about their biggest barrier to accessing care. All of them said fear and judgment.

“Their fear is, ‘If I seek help, is somebody going to tell on me for using [and is] my baby going to get taken from me?’” Lucarelli said. 

Shasta County Public Health Director Katie Cassidy also acknowledged this challenge, writing in an email to Shasta Scout that “many people who are pregnant and using substances are not willing to engage with any type of medical care because of stigmas and fears of having their child(ren) removed.”

California does not criminalize substance use during pregnancy as a separate offense, a policy intended to avoid discouraging pregnant people from seeking care. Research has shown that punitive policies create a “chilling effect” that drives pregnant individuals away from necessary medical interventions. 

Evidence of prenatal substance exposure can trigger an assessment by a health practitioner or social worker of the mother and infant before discharge after a birth, but it does not automatically mean the family will enter the child welfare system. If substance use is the only concern and does not indicate a safety threat, the family may simply be connected with voluntary services.

Even when a baby does enter foster care as a result of their parent’s substance use, reunification with the family is generally the goal of California foster care, according to Sheri Wiggins, the program director for Shasta College’s Foster and Kinship Care Education Program. “More babies go home than anything else,” she said. 

She thinks the narrative should be reversed: “Instead of, ‘Come to us and you might lose your baby,’ families should hear, ‘Come get help so you can keep your baby.’”

How stigma impacts fears, reducing access to care 

Beyond the fear of losing parenting privileges is the fear of cultural judgment and the associated shame that can surround addiction. Because stigma is woven into the way people think and talk about substance use, changing it is harder than building a new program or referral pathway, necessitating a change in cultures. 

Additionally, the fear that a child could be taken away is often strengthened through experiences with providers who, either intentionally or inadvertently, show stigma in the way they approach care.  

“Even among providers, there’s stigma toward these patients,” said Dr. Leanna Sudhof, a maternal-fetal medicine specialist at the University of California, Davis. 

That’s something that could be addressed, much like the fear of losing custody, through expanded education. Experts spoken to for this story said just as parents need information, medical providers also need training to ensure that patients encounter respectful, trauma-informed care when they do seek help.

Sudhof described UC Davis’ efforts to lead implicit bias training for providers, such as through Project ECHO, which leads virtual training sessions on best practices across the North State. The program focuses on prenatal and perinatal care, with several sessions targeting stigma and bias. Dr. Sharon Conner, the outreach registered nurse for the program, said ECHO collaborates closely with clinicians at Mercy as well as informally with Shasta County Health and Human Services’ Maternal, Child and Adolescent Health unit. 

Dr. Shannon Clark, a maternal-fetal medicine physician involved with the program, said it is important to feature patient voices, sharing the story of one patient whose experience is now used in the program’s materials. She chose to get help, Clark said, and “one of the things that she couldn’t be told enough times, by enough providers, was that she was doing the right thing for her baby.” 

The language providers use matters, too, especially when it comes to acknowledging that substance addiction as a “chronic illness, not an inherent flaw,” Clark added. 

Lucarelli said that in recent years as the referral network has strengthened, she’s noticed a decrease in the fear of getting help. It’s something Carelli at Shasta Community Health Center has observed, too: As programs build reputations for treating patients respectfully, more patients find them through word of mouth. And when patients seek out a program or resource they already trust, Carelli said, the transition to prenatal care, a hospital or medication treatment can be easier. 

Building that trust takes time, Carelli said. The Shasta Community Health Center also has an outreach team that goes into encampments for those who are homeless, with the goal of cultivating trust. One of the doctors on the team even does prenatal care in the field, checking the vitals of mom and baby. 

“Providing compassionate, non-judgmental care is essential in helping them engage in treatment,” Boddy said. She hands out bracelets to her patients with her number on them in hopes that they’ll stay in touch and follow up for more resources.

Could opioid funds be used to get more pregnant people into care? 

Shasta Supervisor Matt Plummer has been pushing the board of supervisors to use data-backed approaches when spending opioid settlement funds. He told Shasta Scout he hopes the board will decide to spend more of those dollars on the kinds of education and outreach programs that are likely to impact Shasta’s high NAS rates. 

Plummer pointed to a door-to-door breastfeeding education campaign in Bangladesh as an example of how grassroots outreach can reach people who might not otherwise seek information or services, and he thinks Shasta could do something similar for prenatal care. He also wants to revisit a pitch he made last year to use settlement funds to hire a specialist to train physicians who are already working with pregnant patients in places like local emergency rooms on how to conduct substance-use screening and referrals. 

Shasta would not be the first community to use opioid settlement money for this kind of work. New York City is using opioid dollars to place addiction counselors in obstetric settings, where they screen patients, connect them to treatment and help train medical staff. And in California’s own Santa Cruz County, settlement grants are supporting treatment for newborns with NAS and establishing a multi-agency collaborative network to help high-risk families transition from the hospital to home — for a cost of less than $200,000. 

When asked where opioid settlement funds might be most useful in addressing perinatal substance exposure, Cassidy, the director of Shasta’s Public Health, shared a similar emphasis as Plummer, noting the need for education for health care providers to reduce stigma and increase effective communication. 

Cassidy shared that opioid settlement funds could also be used to implement evidence-based family education and support programs such as Celebrating Families, which help families understand the effects of substance use and trauma while building healthier home environments. The program also creates new ways for residents to connect with online education, case management and local treatment and support resources.

There are other gaps that opioid settlement funds could help address, too. Treating opioid use disorder during pregnancy can be complicated, Boddy said, and there aren’t yet enough services to help pregnant patients wean off drugs quickly. 

“We have more patients asking for help than we have resources,” Boddy said, referring broadly to community members who are seeking help via a variety of local networks and providers. MAT, or medication assisted treatment, though much more accessible than five years ago, remains limited, while detox facilities are constantly at capacity with waiting lists that can be months long. 

Why early care matters, and what comes next

Treatment doesn’t end when a patient leaves the hospital. For families affected by substance use, the harder question can be what happens after they go home, which often involves a network of residential programs, foster parents, social workers and other caregivers.

Many of the people interviewed for this story emphasized that residential treatment provides more than medical care: It gives patients a community. Visions of the Cross is Shasta’s only residential treatment facility with a perinatal program, allowing mothers to remain with their babies while they receive treatment. 

The perinatal program, which Visions clinician Lucarelli said has been operating for over 20 years, has seen more than 600 babies born. It coordinates MAT, specialized medical appointments and even parenting classes for clients, collaborating closely with local medical providers and community organizations like the Shasta Community Health Center.  

Quinn, who came to Visions when she was five months pregnant, said her time there was amazing. The program helped her understand her substance use and what fueled it, but most importantly, taught her that rebuilding her sense of self-worth was central to recovery.

“It was the first place that felt like I was understood, I was supported, I was seen, I was loved,” she said. 

The program has developed a reputation for its supportive, nonjudgmental approach, Lucarelli said, adding it always has a waiting list. That demand has prompted the program to expand, and a new residential facility, which will add 32 beds — doubling the current capacity of the women’s residential program — is under construction, backed by the state’s BCHIP funds.  

But not every family can leave the hospital together. When a child welfare assessment identifies a safety concern, a baby may enter foster care temporarily — placing the child in another part of the community’s care network. 

Wiggins said Shasta trains foster parents specifically to care for infants affected by prenatal substance exposure, since symptoms don’t always end after the hospital stay. She’s a licensed foster parent herself and has adopted four children who were exposed to substances during pregnancy. All of her children have faced significant mental health, attention and developmental challenges, which helps her understand, she said, that the effects of exposure can be permanent. 

“There’s no magic bullet,” she said. “They don’t outgrow it.” 

It’s why educating foster parents is so important, which she’s been doing for 17 years at Shasta College. The most important lessons she teaches revolve around how early intervention can help shape development, and then transitioning to a focus on compensatory skills and a supportive environment as they grow older. 

One foster parent that Wiggins has worked with, who asked to remain anonymous to protect the privacy of the children in her care, has taken these lessons to heart. She has fostered 11 babies and toddlers over three years, most of them with substance exposure. 

Most arrive after time in the NICU, and she quickly learned that caring for them can require more than the ordinary rhythms of infancy. For many children receiving early intervention services, it’s a carousel of doctor’s appointments. One recent morning, during an interview with a reporter at the foster parent’s house, a feeding specialist arrived to work with one of the children. 

Surrounded by children’s toys and colorful plants, the mother said she became a foster parent simply because: “I have a lot of love to give.” It’s a love she’s learned how to extend to the mothers of the children she fosters, too.

“Every parent I’ve interacted with, no matter what their mental health state is, if they can get their kids back, they have all loved their babies,” she said. 

She has watched one mother enter treatment, make major changes to her life and eventually reunify with her child, a story she considers the ideal outcome. The goal, which she and Wiggins both emphasized, is always reunification when it can be done safely. And that can mean holding two relationships at once: loving the baby in your home while rooting for the mother to get well enough to take the baby home.

Maternal-fetal medicine specialist Sudhof described how pregnancy can be a powerful motivation for patients to seek treatment, but maintaining recovery after delivery can be much harder without stable housing, continued counseling and other support. That’s why, she said, support has to extend beyond the hospital stay and into resources available in the wider community. 

Or, as Cassidy put it, ensuring that networks of care are there to help end the cycle of harm.

“Often, substance use is a coping mechanism for the many things not going well in a person’s life,” Shasta Public Health Director Cassidy wrote. “Finding ways to reinforce and enhance supportive resources such as violence prevention and recovery, substance use treatment and recovery services, peer support, victim assistance, housing and mental health counseling can help with early intervention.”

That’s especially significant because children who grow up with parental substance use face a higher risk of developing substance use problems themselves, but that risk is not destiny, and a well-resourced community can make the difference.

“A community is measured by how it cares for its most vulnerable members,” Wendy Dickens, the executive director at First 5 Shasta, said. During her time in child welfare and at First 5 Shasta, a nonprofit that supports the early health, development and learning of young children, she’s learned a few lessons from the mothers she’s worked with: Never make assumptions, respond with kindness first and remember that it takes a community to raise a child. 

Quinn, who is now leading programs at Visions, urged other mothers struggling with substance use to reach out for help, saying “the longer you wait, the harder it will be.” 

When asked what she would tell a woman struggling to seek help, Quinn didn’t hesitate: “No matter what, you are worth it. You can do it, and know that I will be here right next to you every step of the way, so you don’t have to do it alone.”

Maya Nelson is a student at Brown University. She’s reporting for Shasta Scout as a 2026 summer intern with support from the Nonprofit Newsroom Internship Program — created by The Scripps Howard Fund and the Institute for Nonprofit News.

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Aug. 20, 2026 4:24 a.m.: We have updated the story to correct a reference to Suboxone.

Do you have a correction to share? Email us: editor@shastascout.org.