4 June 2026
Ilana Hull works with pregnant and postpartum women who use drugs at a busy hospital in Western Pennsylvania, supporting everything from treatment and hepatitis C care to infection prevention and harm reduction.
As a physician and emerging researcher, she has seen firsthand how healthcare systems are often not built around the realities of people’s lives. Alongside her clinical work, she is exploring how harm reduction can be better integrated into pregnancy care and designed around what women actually need.
Now, as one of the first recipients of the INHSU Fellowship Program, Ilana is strengthening her skills in community-based research while learning from others working to improve health outcomes for women who use drugs globally.
The INHSU Fellowship Program is a nine-month initiative supporting early and mid-career professionals working to improve health outcomes for women who use drugs through mentorship, training and global collaboration.
Can you tell us a bit about yourself, your work, and how it connects with women who use drugs?
I am a family medicine physician and I have done additional training in addiction medicine. My clinical practice is primarily focused on addiction medicine, and particularly on working with women who use drugs.
I am based in Western Pennsylvania, where we have an inpatient consult service in a really busy hospital. The service sees patients across the hospital, but our main focus is on pregnant and postpartum patients who use drugs. We see people during their pregnancies while they are admitted, and support things like treatment if that is what they want, as well as infection prevention and hepatitis C care.
We also run an outpatient clinic where we see anyone who identifies as a woman and has a substance use issue.
Alongside my clinical work, I am now moving more into research which is focused on how we can better integrate harm reduction into care for pregnant people. We see a lot of harm reduction approaches working well in other settings, but historically that has not been part of how care is delivered during pregnancy.
So my research is really looking at how we can bring those approaches into both hospital and community settings, and work with communities to design services that actually meet people’s needs.
What led you into this area of work?
I can actually remember the week that I really got inspired.
During my first year of residency, my program was developing a service for pregnant people who were using substances, and I got to be part of building it and then follow those patients throughout my training.
What really stayed with me was seeing how even small changes can have ripple effects across someone’s life. You are meeting people where they are, and even small shifts can shape what happens next.
I also got to care for their children and see families change over time, which felt like a real privilege. That experience is what led me to focus my work in this area.
What are the most pressing gaps you are seeing for women who use drugs?
One of the biggest gaps is that care is still not built around the realities of people’s lives.
Many of the women we work with are parenting, working, and managing multiple responsibilities, but services are often very rigid, with fixed times and expectations that do not reflect that.
There are also barriers within services themselves. For example, some treatment settings do not allow access to phones, which can be a major barrier for someone who has children and needs to stay in contact.
More broadly, there is a lot of fear around engaging with care, particularly because of criminalisation and involvement from child protection services, which makes it much harder for people to seek support.
What challenges do you face in your work?
Social determinants of health have become such a buzzword, and all of our patients are screened for them before they come into clinic.
But our society is not actually set up to meet those needs.
We know these factors affect people’s ability to access care, follow through, and stay engaged, but we do not have real solutions. We do not have good ways to connect people to services so that they can actually address those needs in a meaningful way.
What is working well in your setting?
One of the most important things has been working in a multidisciplinary way and recognising the value of lived experience.
We have peers as part of our clinical teams, including people who have received care within our own system. When they are part of patient visits, you can really see the difference. People are more open, the walls come down, and there is a level of trust that would be much harder to build otherwise.
That changes how we are able to support people and helps us find solutions that actually fit their lives.
We are also increasingly using community engagement in our research, including involving people with lived experience in the design of services and following people over time to understand how needs change.
So, it’s not just about engaging people once, but supporting them throughout pregnancy, the postpartum period and into parenting, recognising that needs change over time and that a one-size-fits-all approach doesn’t work.
What does good gender-responsive care look like to you?
I think it’s hard, and it does take a lot of work, but moving the care community towards an acceptance that treatment is not going to look the same for everyone is really important.
We work in a pretty conservative setting where there are a lot of preconceptions about what we should and should not be doing, but we have been able to make small, incremental changes.
You start to see these moments with staff, like nurses and leadership, where there is more acceptance that even if someone is still using drugs, preventing something like hepatitis C is still an incredibly worthwhile goal.
And seeing the team move in that direction alongside our patients has been really rewarding.
What does being selected for this fellowship mean to you?
It is a really exciting opportunity to engage with others who are doing similar work.
I feel well supported in my local setting, but this is a chance to learn from people across the country and globally, and to see how different systems are approaching these challenges.
I am also interested in how research can inform policy, so being part of a program that brings those elements together is very meaningful.
What are you hoping to gain from the program?
I am particularly interested in strengthening my skills in community-based research.
I have more experience integrating lived experience into clinical care, but I want to build that further within research and better understand how to engage communities and develop advisory groups in a meaningful way.
I am also hoping to build connections with others doing this work in different settings.
What change would you most like to see in the next few years?
I think more control.
That is the main thing we see every day, because our patients are getting really sick right now from withdrawal. Just having more control over what they are using, and having different policies that allow for more choices to be made.
Right now, people feel like they have no control. The local drug supply is so contaminated and so adulterated that people are terrified, and it feels like those choices have been taken away from them.
Alongside that, it is also about having more choice in what treatment looks like for people who are interested.
So it is a simple answer, but really just more choice in how people live their lives and how they engage with the healthcare system.
What do you wish more people understood about the women you work with?
People who are coming for care are already carrying a lot of stigma, guilt and shame. They do not need more of that from the systems that are supposed to support them.
It is important to meet people where they are and understand what they are trying to change in their lives.
Women who use drugs are good moms, good parents. They want to be good parents, just like anyone else, and recognising that is really important.
The Fellowship program is supported by a grant from AbbVie, we thank them for their support of this program. Supporters have no control over content, tone, emphasis, allocation of funds, or selection of recipients.
