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Hill AL, Keil MA, Chang JC, Krans EE, Kim E, Nostrand EV, Miller E, Pallatino C. Help-Seeking Among Pregnant and Postpartum Women With Lifetime Experiences of Opioid Use Disorder and Intimate Partner Violence. Violence Against Women 2024; 30:812-831. [PMID: 36437759 DOI: 10.1177/10778012221140134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
We performed content analysis using a qualitative descriptive approach of 15 semistructured interviews with pregnant and postpartum women who have experienced opioid use disorder (OUD) and intimate partner violence (IPV) regarding their experiences seeking help with both issues. Participants described that their partners impacted their ability to seek OUD care; seeking help for OUD and IPV was siloed; they felt more comfortable disclosing OUD than IPV; they perceived pregnancy as a barrier and facilitator to OUD care; and they wished for integrated services. Pregnant and postpartum women experiencing OUD and IPV acknowledged these phenomena intersect and identified a need for more comprehensive services.
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Affiliation(s)
| | | | - Judy C Chang
- University of Pittsburgh, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Elizabeth E Krans
- University of Pittsburgh, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Esther Kim
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | | | - Elizabeth Miller
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Chappell CA, Stewart E, Laird HJ, Jonassaint N, Kasula K, Patterson M, Krans EE. Postpartum Treatment for Chronic Hepatitis C Virus Among People With Opioid Use Disorder: A Prospective Pilot Clinical Trial. J Addict Med 2024; 18:160-166. [PMID: 38258866 DOI: 10.1097/adm.0000000000001266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE The objective of this study was to evaluate the feasibility and acceptability of postpartum hepatitis C virus (HCV) treatment integrated within a substance use treatment program for pregnant and postpartum people with opioid use disorder (OUD). METHODS We conducted a prospective pilot clinical trial of sofosbuvir/velpatasvir (SOF/VEL) treatment among postpartum people with OUD and HCV. Feasibility outcomes included rates of HCV treatment utilization and completion, medication adherence, and sustained virologic response 12 weeks after treatment completion (SVR12). Acceptability was measured through self-reported adverse effects and medication adherence. RESULTS From January 2018 to August 2021, 164 pregnant people received care for OUD at the study site. Among those, 64 (39.0%) were HCV antibody positive and 45 (27.4%) had active HCV infection. Among 45 eligible patients, 32 (71.1%) enrolled and 21 (46.7%) initiated HCV treatment. Of 21 participants who initiated treatment, 16 (76.2%) completed the SOF/VEL treatment, and 11 (52.4%) completed the SVR12. All participants who completed treatment were cured. Common reasons for dropout during the HCV clinical care cascade were OUD treatment discontinuation, illicit substance use recurrence, and lost to follow-up. Participants reported high satisfaction with HCV treatment, including minimal adverse effects, and no HCV treatment concerns. CONCLUSIONS Nearly half of pregnant people with HCV initiated postpartum treatment within an integrated care model of HCV treatment within a substance use treatment program. Postpartum SOF/VEL was efficacious, tolerable, and acceptable. Despite this, postpartum HCV treatment among people with OUD remains challenging, and many barriers remain.
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Affiliation(s)
- Catherine A Chappell
- From the Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA (CAC, EEK); Magee-Womens Research Institute, Pittsburgh, PA (CAC, ES, HJL, NJ, KK, MP, EEK); and Department of Gastroenterology, University of Pittsburgh, Pittsburgh, PA (NJ)
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Bosak J, Messersmith L, Bryer C, Drainoni M, Goodman D, Adams M, Barry T, Flanagan C, Flanagan V, Wolff K, Declercq E. "They just looked at me like I was human": The experiences of parenting women and providers with substance use disorder treatment. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209240. [PMID: 38061633 DOI: 10.1016/j.josat.2023.209240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/11/2023] [Accepted: 11/30/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND The current US addiction treatment system does not effectively meet the needs of pregnant and parenting women with substance use disorder (SUD). The aim of this research was to identify barriers and facilitators to engagement and retention in SUD residential treatment for pregnant and parenting women. This research was part of a co-design process to collaboratively create a more patient-centered long-term residential program. DESIGN AND METHODS The study conducted semi-structured individual interviews with both parenting women with lived experience (WWLE) in residential SUD treatment and SUD treatment providers. Interviews aimed to elicit participants' experiences either receiving or providing care. The study team analyzed data in NVivo-12 using a deductive codebook based on the six principles of trauma informed care (TIC). RESULTS We conducted a total of 32 interviews (WWLE =13, SUD providers =19). The study identified four major themes: 1) peer relationships provide inspiration and diminish shame; 2) providing individuals safe space to stumble in recovery creates opportunities for growth and builds self-efficacy; 3) reasonable, clear boundaries create a structured, protective environment for early recovery; 4) nonjudgmental connections facilitate engagement and build trust. We identified small pivotal moments along the continuum of care that showed how the elements in the four themes enhanced engagement and retention in treatment. These interactions, along the care continuum, are either structural (workflow process) or relational (interpersonal). CONCLUSION This research increases understanding of the interplay of the structural and relational barriers and facilitators to engagement and retention in treatment. These seemingly minor positive or negative interactions along the care continuum are pivotal to fully operationalizing TIC and optimizing women's engagement in treatment. Improvement strategies that integrate the voices of WWLE and collaboratively co-design a more patient-centered system are critical steps to improving engagement in SUD treatment and more equitable SUD treatment services.
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Affiliation(s)
- J Bosak
- Community Health Services, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118, United States; Dartmouth Hitchcock Medical Center, 1 Medical Drive, Lebanon, NH 03766, United States; Dartmouth Geisel School of Medicine, 1 Medical Drive, Lebanon, NH 03766, United States.
| | - L Messersmith
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118, United States
| | - C Bryer
- Dartmouth Hitchcock Medical Center, 1 Medical Drive, Lebanon, NH 03766, United States
| | - M Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, 801 Massachusetts Ave, Boston, MA 02118, United States; Department of Health Law Policy & Management, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA, United States
| | - D Goodman
- Dartmouth Hitchcock Medical Center, 1 Medical Drive, Lebanon, NH 03766, United States; Dartmouth Geisel School of Medicine, 1 Medical Drive, Lebanon, NH 03766, United States
| | - M Adams
- Families Flourish Northeast, P.O Box 20, Enfield Center, NH 03749, United States
| | - T Barry
- Dartmouth Hitchcock Medical Center, 1 Medical Drive, Lebanon, NH 03766, United States
| | - C Flanagan
- Families Flourish Northeast, P.O Box 20, Enfield Center, NH 03749, United States
| | - V Flanagan
- Dartmouth Hitchcock Medical Center, 1 Medical Drive, Lebanon, NH 03766, United States
| | - K Wolff
- Independent Researcher, 566 Hanover Center Rd, Hanover, NH 03755, United States
| | - E Declercq
- Community Health Services, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118, United States
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Creel LM, Feygin YB, Shipley M, Davis DW, Cole Hall T, Downs C, Hoskins S, Pasquenza N, Duncan SD. A case study on variations in network structure and cross-sector alignment in two local systems serving pregnant and parenting women in recovery. Health Serv Res 2024; 59 Suppl 1:e14251. [PMID: 37848179 PMCID: PMC10796293 DOI: 10.1111/1475-6773.14251] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE To describe network structure and alignment across organizations in healthcare, public health, and social services sectors that serve pregnant and parenting women with substance use disorder (SUD) in an urban and a rural community. DATA SOURCES AND STUDY SETTINGS Two community networks, one urban and one rural with each including a residential substance use treatment program, in Kentucky during 2021. STUDY DESIGN Social network analysis measured system collaboration and cross-sector alignment between healthcare, public health, and social services organizations, applying the Framework for Aligning Sectors. To understand the alignment and structure of each network, we measured network density overall and between sectors, network centralization, and each organization's degree centrality and effective size. DATA COLLECTION/EXTRACTION METHODS Computer-assisted telephone interviews were conducted to document alignment around shared purpose, data, financing, and governance. PRINCIPAL FINDINGS On average, overall and cross-sector network densities in both communities were similar. However, alignment was highest for data sharing and financing in the urban community and for shared purpose and governance in the rural community. Cross-sector partnerships involving healthcare organizations were more prevalent in the rural county (44% vs. 38% for healthcare/public health, 44% vs. 29% for healthcare/social services), but more prevalent for those involving public health/social services organizations in the urban county (42% vs. 24%). A single healthcare organization had the highest degree centrality (Mdn [IQR] = 26 [26-9.5]) and effective size (Mdn [IQR] = 15.9 [20.6-8.7]) within the rural county. Social services organizations held more central positions in the urban county (degree centrality Mdn [IQR] = 13 [14.8-9.5]; effective size Mdn [IQR] = 10.4 [11.4-7.9]). CONCLUSIONS Cross-sector alignment may strengthen local capacity for comprehensive SUD care for pregnant and parenting women. Healthcare organizations are key players in cross-sector partnerships in the rural community, where one healthcare facility holds the central brokerage role. In contrast, public health agencies are key to cross-sector collaboration with social services in the urban community.
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Affiliation(s)
- Liza M. Creel
- Division of Health Care Policy and Research, Department of Medicine, School of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Yana B. Feygin
- Norton Children's Research Institute affiliated with the University of Louisville School of MedicineUniversity of Louisville School of MedicineLouisvilleKentuckyUSA
| | - Madeline Shipley
- Scientific and Health Policy InitiativesISPOR – The Professional Society for Health Economics and Outcomes ResearchLawrencevilleNew JerseyUSA
| | - Deborah W. Davis
- Norton Children's Research Institute affiliated with the University of Louisville School of MedicineUniversity of Louisville School of MedicineLouisvilleKentuckyUSA
| | | | - Chaly Downs
- Addition Recovery ServicesVolunteers of America, Mid‐StatesLouisvilleKentuckyUSA
| | - Stephanie Hoskins
- Addition Recovery ServicesVolunteers of America, Mid‐StatesLouisvilleKentuckyUSA
| | - Natalie Pasquenza
- External RelationsVolunteers of America, Mid‐StatesLouisvilleKentuckyUSA
| | - Scott D. Duncan
- Division of Neonatal Medicine, Department of Pediatrics, School of MedicineUniversity of LouisvilleLouisvilleKentuckyUSA
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Seger C, Tuten M, Storr CL, Majer JM. Delivery Outcomes Among Pregnant Women With Comorbid Psychiatric and Substance Use Disorders Receiving Comprehensive Treatment. J Am Psychiatr Nurses Assoc 2024; 30:121-131. [PMID: 35184607 DOI: 10.1177/10783903221079384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Pregnant women with substance use disorders (SUDs) are at risk for adverse delivery outcomes, and some of these women have psychiatric comorbidities that increase this risk. AIMS: Although comprehensive care models offering prenatal care services and substance abuse treatment have been found to positively affect delivery outcomes for pregnant women with SUDs, there is a dearth of research to support such models for women who have psychiatric comorbidities. METHODS: A secondary data analysis was conducted to understand the relationship between pretreatment psychiatric comorbidity and delivery outcomes for pregnant clients with SUDs receiving comprehensive treatment. We analyzed two groups of pregnant women with SUDs and hypothesized that women with psychiatric comorbidities would have worse neonatal and maternal outcomes compared with those who did not have any pretreatment psychiatric comorbidity. Regression models were used to examine changes in delivery outcome criteria (birthweight, neonatal abstinence syndrome, maternal urine toxicology screens at delivery, and hospital length of stay) in relation to psychiatric comorbidity among a sample of 74 mother-baby dyads receiving comprehensive care treatment. RESULTS: Results did not support our hypothesis as delivery outcomes were statistically similar for both groups. CONCLUSION: Findings suggest comprehensive care can reduce the risk of negative delivery outcomes among women with SUDs who have psychiatric comorbidities. Treatment and research implications are provided.
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Affiliation(s)
- Celeste Seger
- Celeste Seger, PhD, RN, University of Maryland, Baltimore, MD, USA
| | - Michelle Tuten
- Michelle Tuten, MSW, LCSW-C, PhD, University of Maryland, Baltimore, MD, USA
| | - Carla L Storr
- Carla L. Storr, ScD, MPH, University of Maryland, Baltimore, MD, USA
| | - John M Majer
- John M. Majer, PhD, Harry S. Truman College, Chicago, IL, USA
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Sternberger L, Sorensen-Alawad A, Prescott T, Sakai H, Brown K, Finkelstein N, Salomon A, Schiff DM. Lessons Learned Serving Pregnant, Postpartum, and Parenting People with Substance Use Disorders in Massachusetts: The Moms Do Care Program. Matern Child Health J 2023; 27:67-74. [PMID: 37792152 PMCID: PMC10692242 DOI: 10.1007/s10995-023-03775-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE The purpose of this paper is to describe the design and implementation of a multidisciplinary, integrated approach to supporting pregnant, postpartum, and parenting people (PPPP) and their families affected by substance use disorders (SUD). DESCRIPTION Between 2015 and 2022, the Moms Do Care (MDC) Program, sponsored by the Massachusetts Department of Public Health Bureau of Substance Addiction Services, established or expanded 11 co-located medical and behavioral health teams in locations across Massachusetts. These teams provided trauma-informed primary and obstetrical health care, SUD treatment and recovery services, parenting support, and case management for approximately 1048 PPPP with SUD. ASSESSMENT By enhancing the capacity of medical and behavioral health providers offering integrated care across the perinatal health care continuum, MDC created a network of support for PPPP with SUD. Lessons learned include the need to continually invest in staff training to foster teambuilding and improve integrated service delivery, uplift the peer recovery coach role within the care team, improve engagement with and access to services for communities of color, and conduct evaluation and sustainability planning. CONCLUSION MDC prioritizes trauma-informed integrated care, peer recovery, and commits to addressing inequities and stigma; thus, this program represents a promising approach to supporting PPPP impacted by SUD. The MDC model is relevant for those working to build multidisciplinary, integrated systems of health care and perinatal SUD services for marginalized populations.
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Affiliation(s)
| | | | | | - Hibiki Sakai
- Advocates for Human Potential, Inc. Center for Research and Evaluation, Chicago, USA
| | - Kayla Brown
- Advocates for Human Potential, Inc. Center for Research and Evaluation, Sudbury, USA
| | | | - Amy Salomon
- Advocates for Human Potential, Inc. Center for Research and Evaluation, Sudbury, USA
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Flannigan K, Murphy L, Pei J. Integrated Supports for Women and Girls Experiencing Substance Use and Complex Needs. Subst Abuse 2023; 17:11782218231208980. [PMID: 37954218 PMCID: PMC10637139 DOI: 10.1177/11782218231208980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/29/2023] [Indexed: 11/14/2023]
Abstract
There is strong research to support integrated and gender-sensitive harm reduction approaches for supporting women, girls, and gender diverse people. For individuals who are pregnant, flexible and integrated treatment approaches may be especially important. In this study, we report on an integrated program in rural Canada designed to support pregnant women, girls, and gender diverse people experiencing substance use and other complex needs. Program data (N = 393) from the 2nd Floor Women's Recovery Centre (2nd Floor) at the Lakeland Centre for Fetal Alcohol Spectrum Disorder (LCFASD) was analyzed with several aims. Study goals were to (1) describe characteristics and needs of clients, (2) identify factors associated with program completion, and (3) for a subset of clients, examine resources, wellbeing, and social and behavioral outcomes after treatment. Clients (Mage = 27.4 years, range 15-64) presented at the 2nd Floor with complex medical and mental health needs, and experiences of significant socioenvironmental adversity. However, almost two-thirds (63.4%) successfully completed the program, which was more likely for clients who had stable housing at intake and a possible or confirmed diagnosis of FASD. After treatment, clients reported high levels of wellbeing, and most were connected to health care and community resources. In the year after program completion, clients who were contacted for follow-up maintained strong connection to resources and reported notable improvements in social and behavioral functioning. Many were working or volunteering, most were in stable home environments, rates of substance use and legal involvement were substantially reduced, and many clients were actively caring for their children. This study offers important findings to inform future research, practice, and policy for supporting health and wellbeing for women, children, families, and communities.
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Affiliation(s)
- Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Lisa Murphy
- Lakeland Centre for Fetal Alcohol Spectrum Disorder, Cold Lake, AB, Canada
| | - Jacqueline Pei
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
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Lee EM, O'Connor SK, Pancholi R, White KO, Woodhams E, Patton EW. "Meeting Patients Where They're at": Clinician Perspectives on Integration of Family Planning Services into Office-Based Addiction Treatment. J Addict Med 2023; 17:702-707. [PMID: 37934535 DOI: 10.1097/adm.0000000000001220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVES To study clinician perspectives on the feasibility of incorporating family planning services within office-based addiction treatment (OBAT) clinics. We sought to understand the unique facilitators of and barriers to the integration of contraceptive services within the OBAT model with a goal to support the design and implementation of a program tailored to meet the reproductive health needs of patients with substance use disorder. METHODS After obtaining institutional review board approval, we conducted qualitative semistructured interviews with OBAT clinicians (registered nurses, advanced practice registered nurses, and physicians) at a tertiary-care safety-net hospital. Interview transcripts were analyzed using deductive codes utilizing key components of the Promoting Action on Research Implementation in Health Services and Ottawa Decision Support Frameworks. RESULTS We analyzed 20 interviews. Our data noted 3 major themes: (1) evidence to support integration of family planning and OBAT, (2) inherent strengths and facilitative factors of the OBAT model, and (3) barriers and challenges of the OBAT model influencing successful integration. Strengths included the destigmatizing and trust-building OBAT approach to care, common use of patient-centered counseling, and providers' nuanced understanding of substance use disorder-specific impacts on reproductive health. Barriers included time constraints, balancing urgent patient recovery needs, the desire for additional contraception provision training, and concern for potential contraceptive coercion. CONCLUSIONS Office-based addiction treatment clinics have inherent strengths that may make it a beneficial location for integrated family planning services. Future research should elicit patient perspectives to ensure the implementation of a family planning program in OBAT that supports patients' reproductive goals while avoiding stigma or reproductive coercion.
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Affiliation(s)
- Eung-Mi Lee
- From the UPMC-Magee Womens Hospital Pittsburgh, PA (E-ML); Boston Medical Center, Boston, MA (SKO, RP); and Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA (KOW, EW, EWP)
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Board A, D’Angelo DV, von Essen BS, Denny CH, Miele K, Dunkley J, Park Y, Bauman B, Kim SY. The Postpartum Period: An Opportunity for Alcohol Screening and Counseling to Reduce Adverse Health Impacts. J Addict Med 2023; 17:528-535. [PMID: 37788605 PMCID: PMC10585373 DOI: 10.1097/adm.0000000000001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
OBJECTIVES The postpartum period presents an opportunity to engage in discussions about alcohol consumption and related health harms. This study examined the prevalence of alcohol consumption among a sample of postpartum persons with a recent live birth and screening and brief intervention (alcohol SBI) or counseling by their providers. METHODS We analyzed 2019 data from a telephone survey conducted 9 to 10 months postpartum among individuals who responded to the standard Pregnancy Risk Assessment Monitoring System survey in 6 states. Weighted prevalence estimates were calculated for alcohol consumption and alcohol SBI after birth through up to 10 months postpartum. RESULTS Among 1790 respondents, 53.1% reported consuming alcohol postpartum. Among those who drank postpartum, 70.8% reported being asked about alcohol use by a healthcare provider. Slightly more than half of respondents who drank postpartum and were trying to get pregnant (52.4%) or were not using birth control at the time of the survey (59.8%) reported being asked about alcohol use. Approximately 25% of respondents who drank alcohol postpartum were advised about risky alcohol levels by a healthcare provider. Small proportions of individuals who drank alcohol postpartum and were pregnant or trying to get pregnant at the time of the survey were advised to reduce or stop drinking alcohol (10.6% and 2.3%, respectively). CONCLUSIONS These findings suggest missed opportunities to promote health and prevent adverse alcohol-related health outcomes during the postpartum period through evidence-based tools such as alcohol SBI.
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Affiliation(s)
- Amy Board
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Denise V. D’Angelo
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Beatriz Salvesen von Essen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
- CDC Foundation, Atlanta, GA
| | - Clark H. Denny
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kathryn Miele
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Janae Dunkley
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Youngjoo Park
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Brenda Bauman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Shin Y. Kim
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
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Charron E, Kent-Marvick J, Gibson T, Taylor E, Bouwman K, Sani GM, Simonsen SE, Stone RH, Kaiser JE, McFarland MM. Barriers to and facilitators of hormonal and long-acting reversible contraception access and use in the US among reproductive-aged women who use opioids: A scoping review. Prev Med Rep 2023; 32:102111. [PMID: 36747991 PMCID: PMC9898069 DOI: 10.1016/j.pmedr.2023.102111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/04/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Existing research has found that women who use opioids (WWUO) experience challenges to hormonal and long-acting reversible contraception (HC-LARC) access and use. Facilitators of such use are unclear. We conducted a scoping review to comprehensively map the literature on barriers to and facilitators of HC-LARC access and use in the United States among reproductive-aged WWUO. In accordance with the JBI Manual of Evidence Synthesis, we conducted literature searches for empirical articles published from 1990 to 2021. Independent reviewers screened references, first by titles and abstracts, then by full-text, and charted data of eligible articles. We coded and organized HC-LARC barriers and facilitators according to a four-level social-ecological model (SEM) and categorized findings within each SEM level into domains. We screened 4,617 records, of which 28 articles focusing on HC-LARC (n = 18), LARC only (n = 6), or testing an intervention to increase HC-LARC uptake (n = 4) met inclusion criteria. We identified 13 domains of barriers and 11 domains of facilitators across four SEM levels (individual, relationship, community, societal). The most frequently cited barriers and facilitators were methods characteristics, partner and provider relations, transportation, healthcare availability and accessibility, cost, insurance, and stigma. Future studies would benefit from recruiting participants and collecting data in community settings, targeting more diverse populations, and identifying neighborhood, social, and policy barriers and facilitators. Reducing barriers and improving equity in HC-LARC access and use among WWUO is a complex, multifaceted issue that will require targeting factors simultaneously at multiple levels of the social-ecological hierarchy to effect change.
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Affiliation(s)
- Elizabeth Charron
- Hudson College of Public Health, University of Oklahoma Health Sciences Center, Schusterman Center, 4502 E. 41st Street, Tulsa, OK 74135, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 383 Colorow Lane, Salt Lake City, UT 84108, USA
| | | | - Tyler Gibson
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112, USA
| | - Eliza Taylor
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112, USA
| | - Kelsey Bouwman
- College of Pharmacy, University of Georgia, 250 W. Green St, Athens, GA 30602, USA
| | - Gelina M. Sani
- College of Pharmacy, University of Georgia, 250 W. Green St, Athens, GA 30602, USA
| | - Sara E. Simonsen
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112, USA
| | - Rebecca H. Stone
- College of Pharmacy, University of Georgia, 250 W. Green St, Athens, GA 30602, USA
| | - Jennifer E. Kaiser
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah Health, 50N Medical Drive, Salt Lake City, UT 84132, USA
| | - Mary M. McFarland
- Spencer S. Eccles Health Sciences Library, University of Utah, 10 N. 1900 E, Salt Lake City, UT 84112, USA
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Horan H, Mobley E, Lavender C, Thompson A, Bryant W, McDaniel J, Robertson E, McIntosh S, Albright DL. "I am busy enough…": Navigating challenges experienced by Medicaid providers serving pregnant people living with substance use disorders in Alabama. J Nurs Scholarsh 2023; 55:556-565. [PMID: 36642921 DOI: 10.1111/jnu.12867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Perinatal substance use is a clinical and public health concern. The purpose of the study was to understand the perspectives and experiences of perinatal healthcare providers serving pregnant people who receive Medicaid and are living with a substance use disorder. DESIGN AND METHODS We conducted a secondary data analysis of the responses from perinatal healthcare providers who completed a survey to assess the state of Alabama's capability to effectively identify and treat individuals with substance use disorder. We analyzed short answer responses using consensus coding. FINDINGS Nine-hundred and ninety-five Medicaid providers completed the survey, 36 of the respondents identified that they were employed in an obstetric practice. Health insurance limitations, a lack of time and resources, and limited treatment options were the primary barriers indicated in the participants' responses. CONCLUSIONS Structural and health system barriers negatively impact the capacity of perinatal healthcare providers in Alabama to serve pregnant people who receive Medicaid and are living with a substance use disorder. CLINICAL RELEVANCE Perinatal healthcare providers need educational opportunities, training, and up-to-date resources to provide supportive, comprehensive care programming for perinatal populations with substance use disorders.
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Affiliation(s)
- Holly Horan
- Department of Anthropology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Emmily Mobley
- Department of Anthropology, The University of Alabama, Tuscaloosa, Alabama, USA
| | | | - Alyssa Thompson
- Department of Anthropology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Wesley Bryant
- Department of Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
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Berger BO, Horton LG, Gemmill A, Strobino DM. Postpartum Care Visit Attendance Within 60 Days of Delivery Among Women With and Without Opioid Use During Pregnancy: An Analysis of Commercial Insurance Data. Womens Health Issues 2023; 33:67-76. [PMID: 36117076 DOI: 10.1016/j.whi.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 07/07/2022] [Accepted: 08/15/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Postpartum care (PPC) is a key component of maternal health, particularly for people who use opioids during pregnancy. Little is known about the prevalence and correlates of PPC visit attendance among those using opioids compared with nonusers in a privately insured population. METHODS A retrospective cohort study was conducted using nationwide private insurance claims between 2011 and 2017 (N = 1,291,352 women) comparing the following opioid use groups: nonusers, nonchronic prescription users, chronic prescription users, and women with opioid use disorder (OUD). Multivariable logistic and linear regressions evaluated the odds of PPC attendance and the mean time to an initial PPC visit for each user group. Stratified models identified factors associated with PPC attendance by opioid use type. RESULTS Overall, 45% of the cohort attended a PPC visit and nearly 10% had any opioid use during pregnancy. More women in the three opioid use categories attended PPC than nonusers (50-56% vs. 45%). Opioid use regardless of type was associated with higher odds and earlier PPC visitation than women with no opioid use; nonchronic and chronic users had 17% and 40% greater odds of PPC than nonusers (adjusted odds ratio [aOR]: 1.17; 95% confidence interval [CI]: 1.16-1.19; aOR: 1.40, 95% CI: 1.34-1.46), whereas women with OUD had 7% higher odds (aOR: 1.07; 95% CI: 1.00-1.13). Antenatal care and psychiatric, hypertensive, and pain conditions were most strongly associated with higher odds of attending PPC; older maternal age was negatively associated with PPC. Stratified analysis showed opioid correlates varied similarly across user groups. CONCLUSIONS PPC use was generally low in this study cohort of privately insured women. Women who used opioids and those with chronic conditions had greater odds of attending PPC. Improved efforts are needed to engage people in PPC, as well as service integration and coordination for people who use opioids during pregnancy.
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Affiliation(s)
- Blair O Berger
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, Baltimore, Maryland.
| | - Leah G Horton
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, Baltimore, Maryland
| | - Alison Gemmill
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, Baltimore, Maryland
| | - Donna M Strobino
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, Baltimore, Maryland
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Lim G, Soens M, Wanaselja A, Chyan A, Carvalho B, Landau R, George RB, Klem ML, Osmundson SS, Krans EE, Terplan M, Bateman BT. A Systematic Scoping Review of Peridelivery Pain Management for Pregnant People With Opioid Use Disorder: From the Society for Obstetric Anesthesia and Perinatology and Society for Maternal Fetal Medicine. Anesth Analg 2022; 135:912-925. [PMID: 36135926 PMCID: PMC9588509 DOI: 10.1213/ane.0000000000006167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The prevalence of pregnant people with opioid use disorder (OUD), including those receiving medications for opioid use disorder (MOUD), is increasing. Challenges associated with pain management in people with OUD include tolerance, opioid-induced hyperalgesia, and risk for return to use. Yet, there are few evidence-based recommendations for pain management in the setting of pregnancy and the postpartum period, and many peripartum pain management studies exclude people with OUD. This scoping review summarized the available literature on peridelivery pain management in people with OUD, methodologies used, and identified specific areas of knowledge gaps. PubMed and Embase were comprehensively searched for publications in all languages on peripartum pain management among people with OUD, both treated with MOUD and untreated. Potential articles were screened by title, abstract, and full text. Data abstracted were descriptively analyzed to map available evidence and identify areas of limited or no evidence. A total of 994 publications were imported for screening on title, abstracts, and full text, yielding 84 publications identified for full review: 32 (38.1%) review articles, 14 (16.7%) retrospective studies, and 8 (9.5%) case reports. There were 5 randomized controlled trials. Most studies (64%) were published in perinatology (32; 38.1%) journals or anesthesiology (22; 26.2%) journals. Specific areas lacking trial or systematic review evidence include: (1) methods to optimize psychological and psychosocial comorbidities relevant to acute pain management around delivery; (2) alternative nonopioid and nonpharmacologic analgesia methods; (3) whether or not to use opioids for severe breakthrough pain and how best to prescribe and monitor its use after discharge; (4) monitoring for respiratory depression and sedation with coadministration of other analgesics; (5) optimal neuraxial analgesia dosing and adjuncts; and (6) benefits of abdominal wall blocks after cesarean delivery. No publications discussed naloxone coprescribing in the labor and delivery setting. We observed an increasing number of publications on peripartum pain management in pregnant people with OUD. However, existing published works are low on the pyramid of evidence (reviews, opinions, and retrospective studies), with a paucity of original research articles (<6%). Opinions are conflicting on the utility and disutility of various analgesic interventions. Studies generating high-quality evidence on this topic are needed to inform care for pregnant people with OUD. Specific research areas are identified, including utility and disutility of short-term opioid use for postpartum pain management, role of continuous wound infiltration and truncal nerve blocks, nonpharmacologic analgesia options, and the best methods to support psychosocial aspects of pain management.
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Affiliation(s)
- Grace Lim
- University of Pittsburgh Department of Anesthesiology & Perioperative Medicine, Pittsburgh, PA
- University of Pittsburgh Department of Obstetrics & Gynecology, UPMC Magee-Women’s Hospital, Pittsburgh, PA
| | - Mieke Soens
- Brigham & Women’s Hospital, Department of Anesthesiology & Perioperative Medicine, Boston, MA
| | - Anne Wanaselja
- University of Pittsburgh Department of Anesthesiology & Perioperative Medicine, Pittsburgh, PA
| | - Arthur Chyan
- Brigham & Women’s Hospital, Department of Anesthesiology & Perioperative Medicine, Boston, MA
| | - Brendan Carvalho
- Stanford University Department of Anesthesiology, Perioperative & Pain Medicine, Palo Alto, CA
| | - Ruth Landau
- Columbia University Department of Anesthesiology & Perioperative Medicine, New York City, NY
| | - Ronald B. George
- University of California San Francisco Department of Anesthesiology & Perioperative Care, San Francisco, CA
| | - Mary Lou Klem
- University of Pittsburgh Health Sciences Library System, Pittsburgh, PA
| | - Sarah S. Osmundson
- Vanderbilt University, Department of Obstetrics & Gynecology, Nashville, TN
| | - Elizabeth E. Krans
- University of Pittsburgh Department of Obstetrics & Gynecology, UPMC Magee-Women’s Hospital, Pittsburgh, PA
| | | | - Brian T. Bateman
- Stanford University Department of Anesthesiology, Perioperative & Pain Medicine, Palo Alto, CA
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Stressful life events and prescription opioid use during pregnancy: findings from the 2019 pregnancy risk assessment monitoring system. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2181-2191. [PMID: 35947167 DOI: 10.1007/s00127-022-02349-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Prescription opioid use during pregnancy poses risk to maternal and infant health. However, there is limited research on proximate risk factors for prescription opioid use during pregnancy. This study aimed to evaluate the relationship between stressful life events experienced in the 12 months prior to birth and prescription opioid use during pregnancy. METHODS Data from the 2019 Pregnancy Risk Assessment Monitoring System were analyzed (N = 17,812 women who delivered a live birth in 2019). Logistic regression and multinomial logistic regression analyses were used to assess the association between levels of stressful life events (0, 1-2, 3-5, or 6+) on (1) prescription opioid use, (2) combined opioid use (mono- or poly-opioid use), and (3) patterns of opioid use (pain management, opioid misuse) during pregnancy while controlling for socio-demographic characteristics, patterns of substance use prior to pregnancy, and pregnancy-related characteristics. RESULTS Women with a greater accumulation of stressful life events in the 12 months prior to birth-especially 6 or more-had increased likelihood of prescription opioid use. Accumulating stressful life events were also associated with a higher risk of poly-opioid use, as well as using prescription opioids for pain management and patterns of opioid misuse. CONCLUSION Stressful life events are a risk factor for prescription opioid use during pregnancy. Considering the harms posed by both stressors and opioid use for maternal and infant wellbeing, future research should assess efforts to prevent and manage stressful life events to reduce opioid use during pregnancy.
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Attanasio LB, Ranchoff BL, Cooper MI, Geissler KH. Postpartum Visit Attendance in the United States: A Systematic Review. Womens Health Issues 2022; 32:369-375. [PMID: 35304034 DOI: 10.1016/j.whi.2022.02.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Adequate postpartum care, including the comprehensive postpartum visit, is critical for long-term maternal health and the reduction of maternal mortality, particularly for people who may lose insurance coverage postpartum. However, variation in previous estimates of postpartum visit attendance in the United States makes it difficult to assess rates of attendance and associated characteristics. METHODS We conducted a systematic review of estimates of postpartum visit attendance. We searched PubMed, CINAHL, PsycInfo, and Web of Science for articles published in English from 1995 to 2020 using search terms to capture postpartum visit attendance and use in the United States. RESULTS Eighty-eight studies were included in this analysis. Postpartum visit attendance rates varied substantially, from 24.9% to 96.5%, with a mean of 72.1%. Postpartum visit attendance rates were higher in studies using patient self-report than those using administrative data. The number of articles including an estimate of postpartum visit attendance increased considerably over the study period; the majority were published in 2015 or later. CONCLUSIONS Our findings suggest that increased systematic data collection efforts aligned with postpartum care guidelines and attention to postpartum visit attendance rates may help to target policies to improve maternal wellbeing. Most estimates indicate that a substantial proportion of women do not attend at least one postpartum visit, potentially contributing to maternal morbidity as well as preventing a smooth transition to future well-woman care. Estimates of current postpartum visit attendance are important for informing efforts that seek to increase postpartum visit attendance rates and to improve the quality of care.
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Affiliation(s)
- Laura B Attanasio
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts.
| | - Brittany L Ranchoff
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts
| | - Michael I Cooper
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts
| | - Kimberley H Geissler
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts
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Schiff DM, Work EC, Foley B, Applewhite R, Diop H, Goullaud L, Gupta M, Hoeppner BB, Peacock-Chambers E, Vilsaint CL, Bernstein JA, Bryant AS. Perinatal Opioid Use Disorder Research, Race, and Racism: A Scoping Review. Pediatrics 2022; 149:e2021052368. [PMID: 35156121 PMCID: PMC9044279 DOI: 10.1542/peds.2021-052368] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Racial/ethnic inequities are well documented in both maternal-infant health and substance use disorder treatment outcomes. OBJECTIVE To systematically review research on maternal-infant dyads affected by opioid use disorder (OUD) to evaluate for racial/ethnic disparities in health utilization or outcomes and critically assess the reporting and inclusion of race/ethnicity data. DATA SOURCES Peer-reviewed literature in MEDLINE, Embase, and Web of Science from 2000 to 2020. STUDY SELECTION Research reporting health utilization and outcomes data on dyads affected by OUD during pregnancy through the infant's first birthday. DATA EXTRACTION We extracted data on race/ethnicity, study exposures/outcomes, how race/ethnicity data were analyzed, how authors discussed findings associated with race/ethnicity, and whether racism was mentioned as an explanation for findings. RESULTS Of 2023 articles reviewed, 152 quantitative and 17 qualitative studies were included. Among quantitative studies, 66% examined infant outcomes (n = 101). Three articles explicitly focused on evaluating racial/ethnic differences among dyads. Among quantitative studies, 112 mentioned race/ethnicity, 63 performed analyses assessing for differences between exposure groups, 27 identified racial/ethnic differences, 22 adjusted outcomes for race/ethnicity in multivariable analyses, and 11 presented adjusted models stratified by race/ethnicity. None of the qualitative studies addressed the role that race, ethnicity, or racism may have had on the presented themes. CONCLUSIONS Few studies were designed to evaluate racial/ethnic inequities among maternal-infant dyads affected by OUD. Data on race/ethnicity have been poorly reported in this literature. To achieve health equity across perinatal OUD, researchers should prioritize the inclusion of marginalized groups to better address the role that structural racism plays.
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Affiliation(s)
- Davida M. Schiff
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Erin C. Work
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Bridget Foley
- Substance Use Disorder Initiative, Department of Psychiatry
| | | | - Hafsatou Diop
- Massachusetts Department of Public Health, Boston, Massachusetts
| | | | - Munish Gupta
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | - Judith A. Bernstein
- Division of Community Health Sciences, Boston University School of Public Health, Boston Massachusetts
| | - Allison S. Bryant
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
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Pregnancy-Associated Deaths Due to Drugs, Suicide, and Homicide in the United States, 2010-2019. Obstet Gynecol 2022; 139:172-180. [PMID: 34991132 PMCID: PMC8849543 DOI: 10.1097/aog.0000000000004649] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/05/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate the prevalence of pregnancy-associated deaths due to drugs, suicide, and homicide nationwide from 2010 to 2019. METHODS Using U.S. death certificate records from 2010 to 2019 for 33 states plus the District of Columbia, we identified pregnancy-associated deaths using the pregnancy checkbox and International Classification of Diseases, Tenth Revision codes, calculated pregnancy-associated death ratios, and categorized deaths by cause, timing relative to pregnancy, race or ethnicity, and age. RESULTS Of 11,782 pregnancy-associated deaths identified between 2010 and 2019, 11.4% were due to drugs, 5.4% were due to suicide, and 5.4% were due to homicide, whereas 59.3% were due to obstetric causes and the remaining 18.5% were due to other causes. Drug-related deaths, suicide, and homicide accounted for 22.2% of pregnancy-associated deaths. All three causes of death increased over the study period, with drug-related pregnancy-associated deaths increasing 190%. Homicide during pregnancy and drug-related deaths, suicides, and homicide in the late postpartum period (43-365 days) accounted for a larger proportion of all deaths in these time periods than the contribution of these causes to all deaths among females of reproductive age. Pregnant and postpartum people identified as non-Hispanic American Indian or Alaska Native were at highest risk of drug-related and suicide death, and people identified as non-Hispanic Black were at highest risk of homicide. CONCLUSION Deaths due to drug use, suicide, and homicide constitute more than one fifth of all deaths during pregnancy and the first year postpartum. Drug-related deaths and homicides have increased over the past decade. Substantial racial and ethnic inequities in these deaths exist.
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Forray A, Mele A, Byatt N, Londono Tobon A, Gilstad-Hayden K, Hunkle K, Hong S, Lipkind H, Fiellin DA, Callaghan K, Yonkers KA. Support Models for Addiction Related Treatment (SMART) for pregnant women: Study protocol of a cluster randomized trial of two treatment models for opioid use disorder in prenatal clinics. PLoS One 2022; 17:e0261751. [PMID: 35025898 PMCID: PMC8758001 DOI: 10.1371/journal.pone.0261751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction The prevalence of opioid use disorder (OUD) in pregnancy increased nearly five-fold over the past decade. Despite this, obstetric providers are less likely to treat pregnant women with medication for OUD than non-obstetric providers (75% vs 91%). A major reason is many obstetricians feel unprepared to prescribe medication for opioid use disorder (MOUD). Education and support may increase prescribing and overall comfort in delivering care for pregnant women with OUD, but optimal models of education and support are yet to be determined. Methods and analysis We describe the rationale and conduct of a matched-pair cluster randomized clinical trial to compare the effectiveness of two models of support for reproductive health clinicians to provide care for pregnant and postpartum women with OUD. The primary outcomes of this trial are patient treatment engagement and retention in OUD treatment. This study compares two support models: 1) a collaborative care approach, based upon the Massachusetts Office-Based-Opioid Treatment Model, that provides practice-level training and support to providers and patients through the use of care managers, versus 2) a telesupport approach based on the Project Extension for Community Healthcare Outcomes, a remote education model that provides mentorship, guided practice, and participation in a learning community, via video conferencing. Discussion This clustered randomized clinical trial aims to test the effectiveness of two approaches to support practitioners who care for pregnant women with an OUD. The results of this trial will help determine the best model to improve the capacity of obstetrical providers to deliver treatment for OUD in prenatal clinics. Trial registration Clinicaltrials.gov trial registration number: NCT0424039.
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Affiliation(s)
- Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
| | - Amanda Mele
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts School of Medicine, Worcester, Massachusetts, United States of America
- Department of Ob/Gyn, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Amalia Londono Tobon
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, United States of America
| | - Kathryn Gilstad-Hayden
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Karen Hunkle
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Suyeon Hong
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Heather Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - David A. Fiellin
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Katherine Callaghan
- Department of Ob/Gyn, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Kimberly A. Yonkers
- Department of Psychiatry, University of Massachusetts School of Medicine, Worcester, Massachusetts, United States of America
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Schiff DM, Partridge S, Gummadi NH, Gray JR, Stulac S, Costello E, Wachman EM, Jones HE, Greenfield SF, Taveras EM, Bernstein JA. Caring for Families Impacted by Opioid Use: A Qualitative Analysis of Integrated Program Designs. Acad Pediatr 2022; 22:125-136. [PMID: 33901729 PMCID: PMC8542059 DOI: 10.1016/j.acap.2021.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/13/2021] [Accepted: 04/18/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We sought to 1) identify models of integrated care that offer medical care and social services for children and families impacted by opioid use disorder (OUD) in the postpartum year; and 2) describe how each program was developed, designed, and sustained, and explore facilitators and barriers to implementation of a dyadic, two-generation approach to care. METHODS In-depth semi-structured interviews (n = 23) were conducted with programs for women and children affected by OUD across North America. Using a phenomenologic approach, key program components and themes were identified. Following thematic saturation, these results were triangulated with experts in program implementation and with a subset of key informants to ensure data integrity. RESULTS Five distinct types of programs were identified that varied in the degree of medical and behavioral care for families. Three themes emerged unique to the provision of dyadic care: 1) families require supportive, frequent visits with a range of providers, but constraints around billable services limit care integration across the perinatal continuum; 2) individual program champions are critical, but degree and reach of interdisciplinary care is limited by siloed systems for medical and behavioral care; and 3) addressing dual, sometimes competing, responsibilities for both parental and infant health following recurrence of parental substance use presents unique challenges. CONCLUSIONS The key components of dyadic care models for families impacted by OUD included prioritizing care coordination, removing barriers to integrating medical and behavioral services, and ensuring the safety of children in homes with ongoing parental substance use while maintaining parental trust.
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Affiliation(s)
- Davida M. Schiff
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA, 02114
| | - Shayla Partridge
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA, 02114
| | - Nina H. Gummadi
- Boston University School of Medicine, 72 E. Concord St, Boston, MA
| | - Jessica R. Gray
- Department of Medicine and Pediatrics, Massachusetts General Hospital, 55 Fruit St, Boston, MA
| | - Sara Stulac
- Boston University School of Medicine, 72 E. Concord St, Boston, MA,Department of Pediatrics, Boston Medical Center, 801 Albany Street, Boston, MA 02119, USA
| | - Eileen Costello
- Boston University School of Medicine, 72 E. Concord St, Boston, MA,Department of Pediatrics, Boston Medical Center, 801 Albany Street, Boston, MA 02119, USA
| | - Elisha M. Wachman
- Department of Pediatrics, Boston Medical Center, 801 Albany Street, Boston, MA 02119, USA
| | - Hendrée E. Jones
- UNC Florizons and Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, 410 North Greensboro St., Carrboro, NC
| | - Shelly F. Greenfield
- Boston University School of Medicine, 72 E. Concord St, Boston, MA,Division of Women’s Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, 115 Mill St, Belmont, MA 02478,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA, 02114,Boston University School of Medicine, 72 E. Concord St, Boston, MA
| | - Judith A. Bernstein
- Division of Community Health Sciences, Boston University School of Public Health, 715 Albany St, Boston, MA 02118
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Goodman DJ, Saunders EC, Frew JR, Arsan C, Xie H, Bonasia KL, Flanagan VA, Lord SE, Brunette MF. Integrated vs nonintegrated treatment for perinatal opioid use disorder: retrospective cohort study. Am J Obstet Gynecol MFM 2022; 4:100489. [PMID: 34543754 DOI: 10.1016/j.ajogmf.2021.100489] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/31/2021] [Accepted: 09/09/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pregnant women with opioid use disorder and their infants often experience worse perinatal outcomes than women without opioid use disorder, including longer hospitalizations after delivery and a higher risk for preterm delivery. Integrated treatment models, which combine addiction treatment and maternity care, represent an innovative approach that is widely endorsed, however, limited studies have compared the outcomes between integrated and standard, nonintegrated programs from real-world programs. OBJECTIVE This study aimed to evaluate the perinatal and substance use outcomes for pregnant women with opioid use disorder receiving coordinated, colocated obstetrical care and opioid use disorder treatment (integrated treatment) and to compare it with those of women receiving obstetrical care and opioid use disorder treatment in distinct programs of care (nonintegrated treatment). STUDY DESIGN In this observational, retrospective cohort study, we abstracted the perinatal and opioid use disorder treatment data from the records of pregnant women with opioid use disorder (n=225) who delivered at a rural, academic medical center from 2015 to 2017. The women either received integrated (n=92) or nonintegrated (n=133) opioid use disorder treatment and obstetrical care. Using inverse probability weighted regression models to adjust for a potential covariate imbalance, we evaluated the impact of the treatment model on the risk for preterm delivery and positive meconium or umbilical cord toxicology screens. We explored whether the number of obstetrical visits mediated this relationship by using a quasi-Bayesian Monte Carlo algorithm. RESULTS Women receiving integrated treatment were less likely to deliver prematurely (11.8% vs 26.6%; P<.001) and their infants had shorter hospitalizations (6.5±4.8 vs 10.7±16.2 days). Using a robust inverse probability weighted model showed that receiving integrated treatment was associated with a 74.7% decrease in the predicted probability of preterm delivery (average treatment effect, -0.19; standard error, 0.14; P<.001). There were no differences in the risk for a positive meconium or umbilical cord toxicology screen, a marker for second and third trimester substance use, between women receiving integrated treatment and those receiving coordinated treatment (29.4% vs 34.6%; P=.41), however, integrated treatment was associated with significantly lower rates of positive maternal urine toxicology screens at the time of delivery (35.9% vs 74.4%; P<.001). CONCLUSION Among a cohort of rural pregnant women with opioid use disorder, receiving integrated obstetrical care and opioid use disorder treatment was associated with a reduced risk for preterm birth, a lower risk for positive maternal urine toxicology screen at the time of delivery, and shorter infant hospitalization. This relationship was mediated by the number of obstetrical visits attended during pregnancy, suggesting that increased engagement with obstetrical care through integration of services may contribute to improved perinatal outcomes.
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Affiliation(s)
- Daisy J Goodman
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Dr Goodman and Ms Flanagan); The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH (Dr Goodman)
| | - Elizabeth C Saunders
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette).
| | - Julia R Frew
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette); Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Drs Frew, Arsan, Lord, and Brunette)
| | - Cybele Arsan
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette); Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Drs Frew, Arsan, Lord, and Brunette); Department of Psychiatry, Los Angeles County and Keck Medical Center of University of Southern California, Los Angeles, CA (Dr Arsan)
| | - Haiyi Xie
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette)
| | - Kyra L Bonasia
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette)
| | - Victoria A Flanagan
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Dr Goodman and Ms Flanagan)
| | - Sarah E Lord
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette); Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Drs Frew, Arsan, Lord, and Brunette)
| | - Mary F Brunette
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette); Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Drs Frew, Arsan, Lord, and Brunette)
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Charron E, Tahsin F, Balto R, Eichelberger KY, Dickes L, Simonsen SE, Mayo RM. Provider Perspectives of Barriers to Contraceptive Access and Use among Women with Substance Use Disorders. Womens Health Issues 2021; 32:165-172. [PMID: 34930641 DOI: 10.1016/j.whi.2021.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 10/17/2021] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Previous studies conducted from the patient perspective indicate that women with substance use disorders (SUDs) experience extensive barriers to contraceptive access and use (CAU), but there is limited research investigating this topic from the provider perspective. We explored provider perspectives on the barriers to CAU for women with SUDs. As a secondary objective, we highlighted provider contraceptive counseling strategies to address patient CAU barriers. METHODS We conducted 24 qualitative interviews with a purposeful sample of women's health providers, including medical doctors, nurse practitioners, and certified nurse-midwives. We used thematic analysis to code the interviews with inductive codes and organized findings according to levels of influence within the Dahlgren and Whitehead rainbow model, a socioecological model of health. RESULTS Provider-reported barriers to CAU were identified at four levels of socioecological influence and included reproductive misconceptions; active substance use; trauma, interpersonal violence, and reproductive coercion; limited social support; lack of housing, employment, health insurance, and transportation; stigma; discrimination; and punitive prenatal substance use policies and child welfare reporting requirements. Strategies for addressing CAU barriers mainly focused on patient-centered communication, including open information exchange, shared decision-making, and relationship building. However, providers described disproportionately highlighting the benefits of long-acting reversible contraception (LARC) and directing conversations toward LARC when they perceived that such methods would help patients to overcome adherence and other challenges related to active substance use or logistical barriers. Notably, there was no mention of CAU facilitators during the interviews. CONCLUSIONS Providers perceived that women with SUDs experience a range of CAU barriers, which they addressed within the clinical setting through use of both patient-centered communication and highlighting the benefits of LARC when they perceived that such methods would help clients to overcome barriers. Improving CAU for women with SUDs will require multidisciplinary, multipronged strategies that prioritize reproductive autonomy and are implemented across clinical, community, and policy settings.
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Affiliation(s)
- Elizabeth Charron
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
| | - Farah Tahsin
- Department of Political Science, Clemson University, Clemson, South Carolina
| | - Rwina Balto
- University of Utah College of Nursing, Salt Lake City, Utah
| | | | - Lori Dickes
- Department of Political Science, Clemson University, Clemson, South Carolina
| | | | - Rachel M Mayo
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina
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22
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Darlington CK, Compton PA, Teitelman AM, Alexander K. Non-pharmacologic interventions to improve depression and anxiety among pregnant and parenting women who use substances: An integrative literature review. DRUG AND ALCOHOL DEPENDENCE REPORTS 2021; 2:100017. [PMID: 36845894 PMCID: PMC9949346 DOI: 10.1016/j.dadr.2021.100017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022]
Abstract
Pregnant and parenting women who use substances report high rates of comorbid depression and anxiety. Due to the significant impact of this comorbidity on treatment adherence and maternal/child outcomes, effective psychosocial and behavioral interventions to address depression and anxiety in this population are necessary. A directed search of PubMed, PsycINFO, and CINAHL databases produced 22 articles from 20 distinct studies examining non-pharmacologic interventions with an effect on depression and anxiety among pregnant or parenting women using substances. Of the 20 studies reviewed, 8 were randomized controlled trials, 7 were quasi-experimental studies, and 5 were cohort studies. Results revealed a wide array of interventions targeting intrapersonal, interpersonal, and/or structural factors within these women's lives. Parenting therapy and psychosocially enhanced treatment programs had the strongest evidence for positive treatment effect in improving symptoms of depression and anxiety. The use of contingency-management, case-managed care, patient or wellness navigators, mindfulness-based therapy, maternal-child relationship-focused therapy, family therapy, peer support, and therapeutic community-based interventions show promise but warrant further experimental exploration. Comprehensive and gender-specific residential treatment was observationally associated with improvements in depression and anxiety; however, the specific modality of efficacy is unclear. Future research should focus on identifying which modalities are most cost-effective, feasible, and acceptable among this uniquely vulnerable population.
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Affiliation(s)
- Caroline K. Darlington
- University of Pennsylvania School of Nursing, Address: 418 Curie Blvd, Philadelphia, PA 19104, USA
- Corresponding author.
| | - Peggy A. Compton
- University of Pennsylvania School of Nursing, Address: 418 Curie Blvd, Philadelphia, PA 19104, USA
| | - Anne M. Teitelman
- University of Pennsylvania School of Nursing, Address: 418 Curie Blvd, Philadelphia, PA 19104, USA
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23
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Doerzbacher M, Sperlich M, Hequembourg A, Chang YP. Scoping Review of Barriers and Facilitators of Breastfeeding in Women on Opioid Maintenance Therapy. J Obstet Gynecol Neonatal Nurs 2021; 51:29-40. [PMID: 34655544 DOI: 10.1016/j.jogn.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To synthesize the literature on the barriers and facilitators of breastfeeding among women on opioid maintenance therapy (OMT) to inform nursing interventions and improve breastfeeding outcomes. DATA SOURCES We searched 11 databases using the following key terms: breastfeeding, barriers, facilitators, promotion, and opioid. STUDY SELECTION We included articles published in English since 2015 that addressed barriers and facilitators of breastfeeding in women on OMT. We did not limit our search to specific types of studies. Our search produced 65 records. After reviewing titles and abstracts, we assessed 21 full-text articles and excluded seven for lack of data related to our key terms. As a result, we included five qualitative studies, three reviews, three mixed-methods studies, two retrospective cohort studies, and one case report (14 articles) in our final review. DATA EXTRACTION We extracted data from each article and sorted them in a table for analysis and synthesis. Data included study purpose, research questions, design and methodology, and findings specifically pertaining to the identification of barriers and facilitators of breastfeeding for women on OMT. DATA SYNTHESIS We identified three themes related to facilitators of and barriers to breastfeeding: Information, Support, and Health Care System Factors. CONCLUSION The results of our review suggest that most barriers and facilitators of breastfeeding in women on OMT are manageable with improved health care practices. Primary and acute care health professionals should modify practices to minimize barriers to breastfeeding. Nurses should provide better breastfeeding education and preparation, sensitive care in the immediate postpartum period, and extended follow-up after hospital discharge for women on OMT.
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24
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Raffi ER, Gray J, Conteh N, Kane M, Cohen LS, Schiff DM. Low barrier perinatal psychiatric care for patients with substance use disorder: meeting patients across the perinatal continuum where they are. Int Rev Psychiatry 2021; 33:543-552. [PMID: 34406106 DOI: 10.1080/09540261.2021.1898351] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pregnant and postpartum patients with substance use disorders (SUD) often have other co-occurring mental health disorders. Complications of substance use and mental health conditions, such as overdose and suicide, are a significant contributor to maternal morbidity and mortality. For individuals dually diagnosed with SUD and other mental health disorders, the perinatal period can be both a motivating and a vulnerable period for care. Barriers to optimal care include, but are not limited to, lack of screening, lack of referrals for care, a limited number of psychiatric providers available to care for pregnant patients, and stigma around mental health and addiction care in pregnancy. In this review, we discuss approaches to low-barrier perinatal psychiatric care for women with SUD to promote engagement in care. We review (1) appropriate psychiatric assessment and diagnostic work-up; (2) treatment planning incorporating shared-decision making, non-punitive and culturally sensitive patient-centred care, and principles of harm reduction with a focus on psychopharmacology, and (3) the benefits of an integrated and collaborative multidisciplinary care model for this subpopulation of vulnerable patients.
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Affiliation(s)
- Edwin R Raffi
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica Gray
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,MassGeneral Hospital for Children, Harvard Medical School, Boston, MA, USA
| | - Nkechi Conteh
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Martha Kane
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lee S Cohen
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Davida M Schiff
- MassGeneral Hospital for Children, Harvard Medical School, Boston, MA, USA
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25
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Joshi C, Skeer MR, Chui K, Neupane G, Koirala R, Stopka TJ. Women-centered drug treatment models for pregnant women with opioid use disorder: A scoping review. Drug Alcohol Depend 2021; 226:108855. [PMID: 34198134 DOI: 10.1016/j.drugalcdep.2021.108855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND While there is a high unmet need for drug treatment services tailored to the needs of pregnant women, fewer than half of the opioid use disorder (OUD) treatment programs in the U.S. offer such services. We conducted a scoping review of the literature to identify women-centered drug treatment models that address access, coordination, and quality of care, and their facilitators and barriers. METHODS We searched PubMed, EMBASE, PsycInfo, Sociology Database, Web of Science, CINAHL, EBSCO Open Dissertations, Health Services Research Projects in Progress, and relevant agency websites from 1990 to 2020. We included studies that evaluated multicomponent models of care that provided medication for OUD (MOUD) to pregnant women in the U.S. RESULTS Of the 1,578 unduplicated articles screened, 26 articles met the inclusion criteria, which reported on 19 different studies and included 3,193 women. We identified seven different models of care and found that: (1) access was improved by co-locating various services for drug treatment and care, (2) coordination was enhanced by inter-professional collaboration, (3) quality was improved by treating pregnant patients in groups, and (4) stigmatization and criminalization of substance use during pregnancy was a significant barrier to care. CONCLUSIONS There is an urgent need to bolster patient-provider relationships that are built on trust, are free of stigma, and that empower patients to make their own decisions. Improved policies and regulations to reduce stigma around the use of opioids and MOUD are needed, so that pregnant women with OUD can access high quality care.
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Affiliation(s)
- Chandni Joshi
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, United States.
| | - Margie R Skeer
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, United States.
| | - Kenneth Chui
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, United States.
| | - Gagan Neupane
- Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, United States.
| | | | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, United States.
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26
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McQuade M, Reddy N, Barbour K, Owens L. Integrating reproductive health care into substance use disorder services. Int Rev Psychiatry 2021; 33:572-578. [PMID: 33974476 DOI: 10.1080/09540261.2021.1904845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
People who use drugs face layered stigma and barriers to accessing reproductive health care services. At the same time, they have unique needs for compassionate, trauma-informed, low-barrier reproductive health care. We review the literature on collocated reproductive health care and substance use treatment services in this population and advocate for expansion of reproductive health care services at sites providing care for substance use disorder. Through this review article, we outline the evidence for and best practices in collocating reproductive health care within substance use disorder services.
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Affiliation(s)
- Miriam McQuade
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Neha Reddy
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Kyle Barbour
- Department of Emergency Medicine, University of Rochester, Rochester, NY, USA
| | - Lauren Owens
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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27
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A Review of Unintended Pregnancy in Opioid-Using Women: Implications for Nursing. J Addict Nurs 2021; 32:107-114. [PMID: 34060761 DOI: 10.1097/jan.0000000000000396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Opioid use among reproductive-age women has greatly increased, resulting in high rates of opioid-exposed pregnancies, which are associated with negative outcomes, such as neonatal abstinence syndrome. Prevention of unintended pregnancy among opioid users is a critical pathway to reducing opioid-exposed pregnancies; however, little is known about pregnancy intention in this group. This article estimates the prevalence of unintended pregnancy among opioid-using women, thereby supporting efforts to develop interventions to reduce unintended pregnancy. METHODS A systematic literature search was conducted in PubMed, Web of Science, PsycINFO, and CINAHL, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses framework. Reference lists of articles were searched. Eligibility criteria included reported unintended pregnancy rates within a population of opioid-using women of reproductive age. The search was completed in July 2018 and updated in October 2019. RESULTS We identified 115 citations, screened 64 titles/abstracts, reviewed 31 full-text articles, and included 12 articles for this review. Rates of unintended pregnancy in opioid users were estimated in two ways, across the lifetime and for a current pregnancy, depending on study samples. Rates for both groups were high, with rates among currently pregnant opioid-using women (85%) compared with 45% among the general population. CONCLUSIONS AND IMPLICATIONS Unintended pregnancy rates in opioid-using women were strikingly high, indicating a critical need for intervention. Routine inclusion of pregnancy planning in opioid treatment care is indicated. Education regarding contraception and opioid treatment services is essential for nurses in these settings. Family planning and opioid treatment efforts can be optimized by care coordination, with focus on nurse training for screening and patient education.
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28
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Bello JK, Johnson A, Skiöld-Hanlin S. Perspectives on preconception health among formerly incarcerated women with substance use disorders. J Subst Abuse Treat 2021; 131:108545. [PMID: 34218993 DOI: 10.1016/j.jsat.2021.108545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 05/11/2021] [Accepted: 06/14/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Women involved in the criminal justice system have high rates of substance use disorders (SUD) placing them at increased risk for unintended pregnancy and adverse pregnancy outcomes. Little is known about the factors that influence the decision-making of formerly incarcerated women with SUD prior to becoming pregnant, in the preconception period. The goal of this study is to understand formerly incarcerated women's perceptions of changing substance use behaviors before pregnancy. METHODS We analyzed 33 semi-structured interviews with formerly incarcerated women in Saint Louis, Missouri. We asked questions about factors that influenced decision-making related to substance use and pregnancy. Interviews were recorded and transcribed verbatim. Transcripts were coded and analyzed using a grounded theoretical approach with ATLAS.ti software. RESULTS Four main themes emerged: (1) participants' understanding of preconception behavior change was influenced by their experiences with unplanned pregnancies and lack of control over outcomes; (2) substance use created challenges for women in considering their reproductive wishes; (3) while pregnant, participants weighed the medical and legal risks in their decision-making about their substance use; and (4) participants described how the internal motivation necessary to stop substance use during pregnancy was influenced by factors such as hitting rock bottom and witnessing negative outcomes experienced by others. CONCLUSIONS Preconception health services must be provided to women with SUD during opportunistic times such as during incarceration or while in SUD treatment. Services need to be non-judgmental and supportive rather than penalizing and should increase internal motivation to adopt behavior change.
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Affiliation(s)
- Jennifer K Bello
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring Ave., Saint Louis 63110, USA.
| | - Alysia Johnson
- Saint Louis University School of Medicine, 1402 S. Grand Blvd., Saint Louis, MO 63104, USA.
| | - Sarah Skiöld-Hanlin
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring Ave., Saint Louis 63110, USA.
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29
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Abstract
Opioid use disorder (OUD) is a common, treatable chronic disease that can be effectively managed in primary care settings. Untreated OUD is associated with considerable morbidity and mortality-notably, overdose, infectious complications of injecting drug use, and profoundly diminished quality of life. Withdrawal management and medication tapers are ineffective and are associated with increased rates of relapse and death. Pharmacotherapy is the evidence based mainstay of OUD treatment, and many studies support its integration into primary care settings. Evidence is strongest for the opioid agonists buprenorphine and methadone, which randomized controlled trials have shown to decrease illicit opioid use and mortality. Discontinuation of opioid agonist therapy is associated with increased rates of relapse and mortality. Less evidence is available for the opioid antagonist extended release naltrexone, with a meta-analysis of randomized controlled trials showing decreased illicit opioid use but no effect on mortality. Treating OUD in primary care settings is cost effective, improves outcomes for both OUD and other medical comorbidities, and is highly acceptable to patients. Evidence on whether behavioral interventions improve outcomes for patients receiving pharmacotherapy is mixed, with guidelines promoting voluntary engagement in psychosocial supports, including counseling. Further work is needed to promote the integration of OUD treatment into primary care and to overcome regulatory barriers to integrating methadone into primary care treatment in the US.
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Affiliation(s)
- Megan Buresh
- Department of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert Stern
- Department of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Darius Rastegar
- Department of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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30
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Conceptualizing stigma in contexts of pregnancy and opioid misuse: A qualitative study with women and healthcare providers in Ohio. Drug Alcohol Depend 2021; 222:108677. [PMID: 33775446 DOI: 10.1016/j.drugalcdep.2021.108677] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/25/2021] [Accepted: 01/31/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Women with histories of opioid misuse face drug-related stigma, which can be amplified during pregnancy. While women are often blamed for their drug use and urged to change, the social contexts that create and reinforce stigma are largely unchallenged. Drawing on a multidimensional model of stigma, we examine how stigma manifested across women's pregnancy journeys to shape access and quality of care. METHODS We triangulate in-depth interviews with 28 women with histories of opioid misuse who were pregnant or recently gave birth and 18 healthcare providers in Ohio. Thematic analysis examined how stigma operates across contexts of care. RESULTS Providers represented physicians, nurses, social workers, counselors, and healthcare administrators. Among 28 women, average age was 30 (range: 22-41) and 79 % were White. Most women used prenatal medication-assisted treatment (MAT), including Suboxone (n = 19) or methadone (n = 8), and 15 were pregnant. Evidence of stigma emerged across healthcare contexts. Structural stigma encoded barriers to care in insurance practices and punitive drug treatment, while enacted stigma manifested as mistreatment and judgment from providers. Unpredictability of an infant diagnosis of neonatal abstinence syndrome (NAS), even when women were "doing everything right" by using MAT, perpetuated anticipated stigma from fear of loss of custody and internalized stigma among women who felt guilty about the diagnosis. Providers recognized the harmful effects of these stigmas and many actively addressed it. CONCLUSIONS We recommend harm reduction approaches to address the multiplicity of stigmas that women navigate in opioid misuse and pregnancy to improve healthcare experiences.
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31
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Asta D, Davis A, Krishnamurti T, Klocke L, Abdullah W, Krans EE. The influence of social relationships on substance use behaviors among pregnant women with opioid use disorder. Drug Alcohol Depend 2021; 222:108665. [PMID: 33775448 PMCID: PMC8627830 DOI: 10.1016/j.drugalcdep.2021.108665] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/26/2021] [Accepted: 01/31/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the social network characteristics of pregnant women with opioid use disorder (OUD) and explore how changes in social relationships during pregnancy may influence substance use behaviors. METHODS Between 2017 and 2018, we conducted an exploratory pilot study among 50 pregnant women with OUD. Participants completed a detailed social network inventory to describe the behaviors (e.g. substance-using), social support characteristics (e.g. financial, emotional, informational) and roles (e.g. family member, friend) of network members. The primary outcome was a self-reported decrease in substance use during pregnancy. Pearson correlations were used to test for associations between covariates reflecting different aspects of participants' social networks and decreased substance use during pregnancy. RESULTS Most participants (84.0 %) decreased substance use during pregnancy and stated that pregnancy motivated them to engage in treatment (94.0 %). Participants had a median of 8 (IQR: 4-18) network members with differing proportions of those who did and did not use substances. Pregnancy prompted participants to significantly increase contact with (26.4 % vs. 5.0 %), have increased support from (35.7 % vs. 7.5 %), and a have a feeling of increased closeness with (26.1 % vs. 3.3 %) network members who did not use substances. However, decreased substance use during pregnancy was most strongly (negatively) associated with the proportion of network members who used substances and provided informational support (r=-0.25, p = 0.08) and a feeling of closeness (r=-0.26, p = 0.08). CONCLUSIONS Our findings indicate that pregnancy has a profound influence on women's substance use behaviors and that changes in social relationships due to pregnancy may influence substance use.
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Affiliation(s)
- Dena Asta
- Department of Statistics, The Ohio State University, 1958 Neil Ave, Columbus, OH, 43210, USA; Translational Data Analytics Institute, The Ohio State University, 1760 Neil Ave, Columbus, OH, 43210, USA.
| | - Alex Davis
- Department of Engineering and Public Policy, Carnegie Mellon University, 5000 Forbes Ave, Baker Hall 129, Pittsburgh, PA, 15213, USA
| | - Tamar Krishnamurti
- Department of General Internal Medicine, University of Pittsburgh School of Medicine, 200 Meyran Ave. Suite 200, Pittsburgh, PA, 15213, USA
| | - Leah Klocke
- Magee-Womens Research Institute, 204 Craft Ave, Pittsburgh, PA, 15213, USA
| | - Walitta Abdullah
- Magee-Womens Research Institute, 204 Craft Ave, Pittsburgh, PA, 15213, USA
| | - Elizabeth E. Krans
- Magee-Womens Research Institute, 204 Craft Ave, Pittsburgh, PA, 15213, USA,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA, 15213, USA
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32
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Charron E, Rennert L, Mayo RM, Eichelberger KY, Dickes L, Truong KD. Contraceptive initiation after delivery among women with and without opioid use disorders: A retrospective cohort study in a statewide Medicaid population, 2005-2016. Drug Alcohol Depend 2021; 220:108533. [PMID: 33513446 DOI: 10.1016/j.drugalcdep.2021.108533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study examined contraceptive initiation patterns in the 12 months following childbirth among women with opioid use disorder (OUD), women with non-opioid substance use disorders (SUDs), and women without SUDs. METHODS We conducted a retrospective cohort study using claims data from South Carolina Medicaid-enrolled women aged 15-44 who had singleton live birth between January 2005 and December 2016. Study outcomes were initiation of most or moderately effective (MME) contraceptive methods. Using multivariable and propensity score-weighted logistic regression, we analyzed the relationship between OUD and contraceptive initiation within 12 months after delivery. RESULTS We identified 71,283 live birth deliveries during the study period. In multivariable analysis, women with non-opioid SUDs and women without SUDs compared to women with OUD were more likely to initiate a MME method vs a least effective method or no method by 3 months (non-opioid SUDs: odds ratio [OR] = 1.32, 95 % confidence interval [CI] = 1.14-1.52; no SUDs: OR = 1.55, 95 % CI = 1.36-1.77) and 12 months (non-opioid SUD: OR = 1.23, 95 % CI = 1.06-1.42; no SUD: OR = 1.46, 95 % CI = 1.27-1.66) after delivery. With regards to the timing of initiation, women with non-opioid SUDs and women without SUDs were more likely than women with OUD to initiate a MME method vs a least effective method or no method after the immediate postpartum period through 3 months following delivery (non-opioid SUDs: OR = 1.41, 95 % CI = 1.18-1.68; no SUDs: OR = 1.87, 95 % CI = 1.59-2.21). We detected the similar patterns in analyses that used propensity score weighting. CONCLUSION OUD was associated with decreased likelihood of initiating a MME contraceptive method within 12 months after delivery.
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Affiliation(s)
- Elizabeth Charron
- Department of Public Health Sciences, 503 Edwards Hall, Clemson University, Clemson, SC 29634, USA; Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, USA.
| | - Lior Rennert
- Department of Public Health Sciences, 503 Edwards Hall, Clemson University, Clemson, SC 29634, USA
| | - Rachel M Mayo
- Department of Public Health Sciences, 503 Edwards Hall, Clemson University, Clemson, SC 29634, USA
| | - Kacey Y Eichelberger
- University of South Carolina School of Medicine Greenville/Prisma Health Upstate, 701 Grove Road, Greenville, SC 29605, USA
| | - Lori Dickes
- Department of Parks, Recreation and Tourism Management, 263 Lehotsky Hall, Clemson University, Clemson, SC 29634, USA
| | - Khoa D Truong
- Department of Public Health Sciences, 503 Edwards Hall, Clemson University, Clemson, SC 29634, USA
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33
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Macfie J, Towers CV, Fortner KB, Stuart GL, Zvara BJ, Kurdziel-Adams G, Kors SB, Noose SK, Gorrondona AM, Cohen CT. Medication-assisted treatment vs. detoxification for women who misuse opioids in pregnancy: Associations with dropout, relapse, neonatal opioid withdrawal syndrome (NOWS), and childhood sexual abuse. Addict Behav Rep 2020; 12:100315. [PMID: 33364323 PMCID: PMC7752716 DOI: 10.1016/j.abrep.2020.100315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/10/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022] Open
Abstract
A professional organization does not recommend opioid detoxification in pregnancy. Medically-assisted treatment (MAT) is recommended to reduce relapse and dropout. We sampled 55 pregnant women who misused opioids who chose detoxification or MAT. There was no dropout in either group and more relapse with MAT than detoxification. Replication and follow-up are needed to assess relative rates of relapse postpartum.
The American College of Obstetricians and Gynecologists recommends medication-assisted treatment (MAT) for pregnant women who misuse opioids rather than detoxification because of possible relapse and dropout from treatment (ACOG, 2017). In a prospective study, fifty-five pregnant women with an opioid use disorder were offered a choice of MAT or detoxification. Ethical concerns precluded random assignment. We assessed dropout, treatment outcome, relapse, other illicit drug use, infant neonatal opioid withdrawal syndrome (NOWS), and childhood sexual abuse. Of 55 women, 13 initially chose MAT and 42 women chose detoxification. All women received behavioral support. No one dropped out of treatment prior to delivery. All women who chose MAT initially remained on MAT. Of women who chose detoxification, 23% switched to MAT, 30% tapered below initial MAT doses, and 45% fully detoxified by delivery. There was a significant difference in opioid relapse between women on MAT (26%) and those who detoxified (0%), but no differences for other illicit drug use. Infants of women on MAT were more likely to have neonatal NOWS (91%) than infants of women who tapered below initial MAT doses but did not fully detoxify (62%). Infants of mothers who tapered (62%) were more likely to have NOWS than infants of women who fully detoxified (0%). Women on MAT reported significantly lower sexual abuse severity than did women who tapered or detoxified. It is critical to replicate the current findings and to follow up with mothers and their infants postpartum to ascertain the long-term impact of tapering or detoxification during pregnancy.
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Affiliation(s)
- Jenny Macfie
- Psychology Department, University of Tennessee Knoxville, Knoxville, TN 37996-0900, United States
| | - Craig V Towers
- High Risk Obstetrical Consultants, Knoxville, TN, United States
| | - Kimberly B Fortner
- Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, TN, United States
| | - Gregory L Stuart
- Psychology Department, University of Tennessee Knoxville, Knoxville, TN 37996-0900, United States
| | - Bharathi J Zvara
- Gillings School of Global Public Health, University of North Carolina, United States
| | | | - Stephanie B Kors
- Psychology Department, University of Tennessee Knoxville, Knoxville, TN 37996-0900, United States
| | - Samantha K Noose
- Psychology Department, University of Tennessee Knoxville, Knoxville, TN 37996-0900, United States
| | - Andrea M Gorrondona
- Psychology Department, University of Tennessee Knoxville, Knoxville, TN 37996-0900, United States
| | - Chloe T Cohen
- Psychology Department, University of Tennessee Knoxville, Knoxville, TN 37996-0900, United States
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Cleveland LM, McGlothen‐Bell K, Scott LA, Recto P. A life-course theory exploration of opioid-related maternal mortality in the United States. Addiction 2020; 115:2079-2088. [PMID: 32279394 PMCID: PMC7587012 DOI: 10.1111/add.15054] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/22/2020] [Accepted: 03/17/2020] [Indexed: 12/04/2022]
Abstract
BACKGROUND AND AIMS Between 2007 and 2016, pregnancy-associated mortality resulting from overdose more than doubled in the United States. This study explored the circumstances surrounding maternal opioid-related morbidity and mortality, using the life-course theory as a sensitizing framework to examine how each participant's life-course contributed to her substance use, relapse, recovery or overdose. DESIGN A mixed-methods study using semi-structured, in-depth face-to-face interviews and focus groups were conducted. SETTING Texas, United States. PARTICIPANTS Women who had relapsed into opioid use or experienced a 'near-miss' overdose and family members of women who had died during the maternal period due to opioid overdose were interviewed (n = 99). MEASUREMENTS A socio-demographic questionnaire captured participants' ethnicity, age, marital status, medical and mental health history and employment status. The Stressful Life Events Screening Questionnaire-revised (SLESQ-R) assessed life-time exposure to trauma. FINDINGS Women reported histories of abuse and loss of a loved one through homicide or suicide. Participants indicated that limited social support, interpersonal conflict with their partner and unaddressed mental illness made recovery more challenging. Additionally, losing their children through the child welfare system was described as punitive and placed them at greater risk for relapse and overdose. CONCLUSIONS A life-course theory approach to examining maternal opioid-related morbidity and mortality in Texas, United States reveals the complex needs of women at risk for opioid use relapse and overdose and the significant role of previous traumatic experiences.
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Affiliation(s)
- Lisa M. Cleveland
- School of NursingThe University of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Kelly McGlothen‐Bell
- School of PharmacologyThe University of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Leticia A. Scott
- School of NursingThe University of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Pamela Recto
- School of NursingThe University of Texas Health Science Center at San AntonioSan AntonioTXUSA
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Young-Wolff KC, Tucker LY, Armstrong MA, Conway A, Weisner C, Goler N. Correlates of Pregnant Women's Participation in a Substance Use Assessment and Counseling Intervention Integrated into Prenatal Care. Matern Child Health J 2020; 24:423-431. [PMID: 32056081 DOI: 10.1007/s10995-020-02897-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Screening and referral for substance use are essential components of prenatal care. However, little is known about barriers to participation in substance use interventions that are integrated within prenatal care. METHODS Our study examines demographic and clinical correlates of participation in an initial assessment and counseling intervention integrated into prenatal care in a large healthcare system. The sample comprised Kaiser Permanente Northern California pregnant women with a live birth in 2014 or 2015 who screened positive for prenatal substance use via a self-reported questionnaire and/or urine toxicology test given as part of standard prenatal care (at ~ 8 weeks gestation). RESULTS Of the 11,843 women who screened positive for prenatal substance use (median age = 30 years; 42% white; 38% screened positive for alcohol only, 20% for cannabis only, 5% nicotine only, 17% other drugs only, and 19% ≥ 2 substance categories), 9836 (83%) completed the initial substance use assessment and counseling intervention. Results from multivariable logistic regression analyses indicated that younger age, lower income, single marital status, and a positive urine toxicology test predicted higher odds of participation, while other/unknown race/ethnicity, greater parity, receiving the screening later in pregnancy, and screening positive for alcohol only or other drugs only predicted lower odds of participation (all Ps < .05). DISCUSSION Findings suggest that integrated substance use interventions can successfully reach vulnerable populations of pregnant women (e.g., younger, lower income, racial/ethnic minorities). Future research should address whether differences in participation are due to patient (e.g., type of substance used, perceived stigma) or provider factors (e.g., working harder to engage traditionally underserved patients).
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Affiliation(s)
- Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA. .,Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Lue-Yen Tucker
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Mary Anne Armstrong
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Amy Conway
- Early Start Program, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.,Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Nancy Goler
- Regional Offices, Kaiser Permanente Northern California, Oakland, CA, USA
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Dopp A, Zabel Thornton M, Kozhimannil K, Jones CW, Greenfield B. Hospital care for opioid use disorder in pregnancy: Challenges and opportunities identified from a Minnesota survey. ACTA ACUST UNITED AC 2020; 16:1745506520952006. [PMID: 32833589 PMCID: PMC7448132 DOI: 10.1177/1745506520952006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: The prevalence of opioid use disorder continues to rise in the United States, with a simultaneous increase in the diagnosis of both opioid use disorder during pregnancy and neonatal opioid withdrawal syndrome. Despite these increases in pregnancy-related care, little is known about hospital policy and policy implementation related to opioid use disorder in pregnancy. In addition, it is unknown whether policies might differ in rural or urban hospitals. To better examine these issues, Minnesota hospitals were surveyed regarding the existence and implementation of policies related to opioid use disorder in pregnancy and whether any policy implementation challenges had been identified. Methods: From August to December 2017, the research team contacted all Minnesota hospitals that offered obstetric services (n = 82) to survey challenges to implementing policies for opioid use disorder during pregnancy, among other questions. Fifty-nine hospitals had respondents (primarily obstetric department supervisors) who provided information about policy implementation challenges for a 72% response rate. Qualitative responses were analyzed using qualitative description and according to hospital location: metropolitan (urban), micropolitan (rural), or non-core (rural). Results: Ninety-one percent of respondents said that they had pregnancies affected by opioid use disorder at their hospital within the last year. Four major challenges to policy implementation were identified in qualitative responses: (1) provider consensus, (2) patient response to policy, (3) lack of resources, and (4) low frequency of occurrence. All four challenges were more frequently identified by respondents at rural hospitals compared to urban hospitals. Conclusion: This study identified challenges in standardizing hospital care for pregnancies affected by opioid use disorder, and these challenges were identified more frequently in rural locations. These non-urban hospitals may require increased state and federal support and funding.
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Affiliation(s)
- Alana Dopp
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
| | - Morgan Zabel Thornton
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
| | - Katy Kozhimannil
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Cresta W Jones
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Brenna Greenfield
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
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Preis H, Garry DJ, Herrera K, Garretto DJ, Lobel M. Improving Assessment, Treatment, and Understanding of Pregnant Women With Opioid Use Disorder: The Importance of Life Context. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/23293691.2020.1780395] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Heidi Preis
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - David J. Garry
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Kimberly Herrera
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Diana J. Garretto
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
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Galvin SL, Ramage M, Mazure E, Coulson CC. The association of cannabis use late in pregnancy with engagement and retention in perinatal substance use disorder care for opioid use disorder: A cohort comparison. J Subst Abuse Treat 2020; 117:108098. [PMID: 32811635 DOI: 10.1016/j.jsat.2020.108098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/07/2020] [Accepted: 07/25/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Prenatal use of cannabis and opioids are increasing and very concerning. Engagement and retention in comprehensive, perinatal substance use disorder (PSUD) care are associated with better outcomes for mothers and babies. We compared the characteristics and engagement in care among women with opioid use disorder who used cannabis late in pregnancy versus those who didn't. METHODS The primary outcome, "overall engagement and retention in PSUD care" included: utilization of substance use treatment prenatally, negative screening/toxicology at delivery (excluding cannabis), and attendance at expected prenatal and postpartum visits. Cannabis use late in pregnancy was objectively assessed at delivery via maternal urine drug screen and/or neonatal meconium/cord toxicology. Between-group comparisons utilized chi square, t-test or Mann-Whitney. Associations were assessed using Spearman Rho and two multivariate, binary logistic regressions for cannabis use and the primary outcome. RESULTS 18.0% (85/472) consumed cannabis late in pregnancy. Women of color, younger women, and those diagnosed with concurrent cannabis use disorder were more likely to consume cannabis. Engagement and retention in PSUD care was not associated with cannabis use, but rather, with prescribed pharmacotherapy for psychiatric disorders. The use of prescribed buprenorphine+naloxone was associated with cannabis avoidance late in pregnancy. CONCLUSIONS Cannabis use late in pregnancy, compared to none, did not impact engagement and retention in our PSUD program. Adjunctive psychotropic medication and/or buprenorphine+naloxone prescription were associated with cannabis avoidance suggesting the use and interactions of pharmacotherapies in an opioid dependent population is complex. A shared decision-making process during PSUD care is warranted.
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Affiliation(s)
- Shelley L Galvin
- MAHEC, Department of Obstetrics and Gynecology, 119 Hendersonville Road, Asheville 28805, NC, USA.
| | - Melinda Ramage
- MAHEC, Department of Obstetrics and Gynecology, 119 Hendersonville Road, Asheville 28805, NC, USA.
| | - Emily Mazure
- UNC Health Sciences at MAHEC, Department of Library Services, 121 Hendersonville Road, Asheville 28805, NC, USA.
| | - Carol C Coulson
- MAHEC, Department of Obstetrics and Gynecology, 119 Hendersonville Road, Asheville 28805, NC, USA.
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Rutman D, Hubberstey C, Poole N, Schmidt RA, Van Bibber M. Multi-service prevention programs for pregnant and parenting women with substance use and multiple vulnerabilities: Program structure and clients' perspectives on wraparound programming. BMC Pregnancy Childbirth 2020; 20:441. [PMID: 32746789 PMCID: PMC7397660 DOI: 10.1186/s12884-020-03109-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Canada, several community-based, multi-service programs aimed at reaching vulnerable pregnant or parenting women with substance use and complex issues have emerged. These programs offer basic needs and social supports along with perinatal, primary, and mental health care, as well as substance use services. Evaluations of these 'one-stop' programs have demonstrated positive outcomes; nevertheless, few published studies have focused on how these programs are structured, on their cross-sectoral partnerships, and on clients' perceptions of their services. METHODS The Co-Creating Evidence (CCE) project was a three-year evaluation of eight multi-service programs located in six Canadian jurisdictions. The study used a mixed-methods design involving semi-structured interviews, questionnaires, output data, and de-identified client data. This article focuses on qualitative interviews undertaken with 125 clients during the first round of site visits, supplemented by interview data with program staff and service partners. RESULTS Each of the programs in the CCE study employs a multi-service model that both reflects a wrap-around approach to care and is intentionally geared to removing barriers to accessing services. The programs are either operated by a health authority (n = 4) or by a community-based agency (n = 4). The programs' focus on the social determinants of health, and their provision of primary, prenatal, perinatal and mental health care services is essential; similarly, on-site substance use and trauma/violence related services is pivotal. Further, programs' support in relation to women's child welfare issues promotes collaboration, common understanding of expectations, and helps to prevent child/infant removals. CONCLUSIONS The programs involved in the Co-Creating Evidence study have impressively blended social and primary care and prenatal care. Their success in respectfully and flexibly responding to women's diverse needs, interests and readiness, within a community-based, wraparound service delivery model paves the way for others offering pre- and postnatal programming.
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Affiliation(s)
- Deborah Rutman
- Principal, Nota Bene Consulting Group, 1434 Vining St, V8R 1P8 Victoria, BC Canada
| | - Carol Hubberstey
- Principal, Nota Bene Consulting Group, 1434 Vining St, V8R 1P8 Victoria, BC Canada
| | - Nancy Poole
- Centre of Excellence for Women’s Health, V6H 3N1 Vancouver, BC Canada
| | - Rose A. Schmidt
- Centre of Excellence for Women’s Health, V6H 3N1 Vancouver, BC Canada
| | - Marilyn Van Bibber
- Principal, Nota Bene Consulting Group, 1434 Vining St, V8R 1P8 Victoria, BC Canada
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Singh R, Rothstein R, Ricci K, Visintainer P, Shenberger J, Attwood E, Friedmann P. Partnering with parents to improve outcomes for substance exposed newborns-a pilot program. J Perinatol 2020; 40:1041-1049. [PMID: 32203180 DOI: 10.1038/s41372-020-0662-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/02/2020] [Accepted: 03/11/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Assess impact of parental involvement in care provision for term substance exposed newborns (SENs). STUDY DESIGN Prospective observational cohort study included mothers with opioid use disorder and their SENs over 4 year study period. Maternal-Infant dyads enrolled in EMPOWER and rooming-in (RI) programs were included and received care 24/7 in a private room until newborn's discharge. Outcomes were compared for dyads participating in EMPOWER/RI with historical controls. RESULTS Ninety of 156 historical SENs were RI eligible, while 49 of 108 SENs born during RI period had mothers enrolled in EMPOWER. EMPOWER/RI SENs had lower rates for and duration of pharmacotherapy, shorter neonatal intensive care unit (NICU) and hospital lengths of stay. EMPOWER/RI increased initiation and continuation of breastfeeding at discharge. CONCLUSIONS Parental participation was associated with a decrease in initiation and duration of pharmacotherapy, NICU admission, length of stay and hospital charges while increasing breastfeeding initiation and continuation at discharge.
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Affiliation(s)
- Rachana Singh
- Baystate Medical Center, Springfield, MA, USA. .,University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
| | - Rachel Rothstein
- Baystate Medical Center, Springfield, MA, USA.,Penn State College of Medicine, Hershey, PA, USA
| | - Karen Ricci
- Baystate Medical Center, Springfield, MA, USA
| | - Paul Visintainer
- University of Massachusetts Medical School-Baystate, Springfield, MA, USA.,Office of Research, UMMS-Baystate, Springfield, MA, USA
| | - Jeffrey Shenberger
- Baystate Medical Center, Springfield, MA, USA.,Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Eilean Attwood
- Baystate Medical Center, Springfield, MA, USA.,University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Peter Friedmann
- Baystate Medical Center, Springfield, MA, USA.,Office of Research, UMMS-Baystate, Springfield, MA, USA
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Adesomo A, Gonzalez-Brown V, Rood KM. Infective Endocarditis as a Complication of Intravenous Drug Use in Pregnancy: A Retrospective Case Series and Literature Review. AJP Rep 2020; 10:e288-e293. [PMID: 33274121 PMCID: PMC7704245 DOI: 10.1055/s-0040-1716732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/04/2020] [Indexed: 01/04/2023] Open
Abstract
Objective An increase in opioid use disorder and subsequent intravenous drug use has led to an increase in sequalae that may complicate pregnancy, such as infective endocarditis. Infective endocarditis has the potential for significant maternal and neonatal morbidity and mortality. We sought to examine the management considerations and clinical implications of intravenous drug use-related infective endocarditis in pregnancy from our center's experience. Study Design Retrospective study of management of pregnancies complicated by infective endocarditis as a result of active intravenous drug use at an academic tertiary care hospital from January 2012 through December 2019. Results Twelve women with active intravenous drug use histories were identified as having clinical and echocardiographic features consistent with infective endocarditis. Six women were discharged against medical advice and did not complete the full course of recommended antibiotic regimen. Eight women were started or continued on opioid agonist therapy during their hospitalization. Four neonates required neonatal intensive care unit admission for pharmacologic treatment for neonatal abstinence syndrome. Conclusion Management of intravenous drug use-associated infective endocarditis in pregnancy involves more than treating the acute condition. In pregnant women with opioid use disorder and infective endocarditis, addiction and chronic psychosocial conditions need to be addressed to optimize care.
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Affiliation(s)
- Adebayo Adesomo
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Veronica Gonzalez-Brown
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Kara M Rood
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
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Shen Y, Lo-Ciganic WH, Segal R, Goodin AJ. Prevalence of substance use disorder and psychiatric comorbidity burden among pregnant women with opioid use disorder in a large administrative database, 2009-2014. J Psychosom Obstet Gynaecol 2020:1-7. [PMID: 32067526 DOI: 10.1080/0167482x.2020.1727882] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/30/2020] [Accepted: 02/05/2020] [Indexed: 10/25/2022] Open
Abstract
Objectives: Using data from the Healthcare Cost and Utilization Project (HCUP), we estimated prevalence of individual substance use disorders (SUDs) and psychiatric comorbidities among pregnant women with opioid use disorder (OUD) in the New York State from 2009 to 2014.Methods: In this cross-sectional study, pregnancy outcome and gestational age at delivery were estimated, and OUD diagnosis during pregnancy or at delivery discharge was identified. Prevalence of SUDs and psychiatric comorbidities were then calculated.Results: Among 1,463,302 pregnant women, 8324 (0.57%) were diagnosed with OUD during pregnancy or at delivery. The most frequent SUDs or psychiatric comorbidities among pregnant women with OUD were non-opioid SUD (78.2%), followed by tobacco use disorder (74.9%), generalized anxiety disorder (38.0%), major depressive disorder (36.9%), cannabis use disorder (28.3%) and cocaine use disorder (27.4%).Conclusions: Most pregnant women with OUD were diagnosed with at least one non-opioid SUD and tobacco use disorder. Generalized anxiety disorder and major depressive disorder were also common, suggesting that mental health screenings should be prioritized for pregnant women with OUD.
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Affiliation(s)
- Yun Shen
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA
| | - Richard Segal
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA
| | - Amie J Goodin
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA
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Grassley JS, Ward M, Tivis R. Development and Psychometric Testing of the Nurses' Confidence Scale: Unique Families. J Obstet Gynecol Neonatal Nurs 2019; 49:101-112. [PMID: 31758912 DOI: 10.1016/j.jogn.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To develop and evaluate an instrument designed to measure the confidence of nurses in their ability to provide neutral, compassionate care to unique families in perinatal settings: the Nurses' Confidence Scale: Unique Families. DESIGN Prospective instrument development and psychometric study. SETTING Health system in the U.S. Mountain West region. PARTICIPANTS Convenience sample of 62 perinatal/neonatal nurses. METHODS We developed a two-part scale to measure the confidence of nurses in their ability to care for complex/nontraditional families, termed unique families. Part A was focused on nursing care behaviors for any unique family; Part B was focused on providing care to seven specific unique family populations. Five experts in perinatal nursing or adoption evaluated the scale's content validity. To test the psychometric properties of the scale, we used item analysis, reliability analysis, and exploratory factor analysis. RESULTS The content validity index was 0.82. The Cronbach's alpha coefficient estimate of internal consistency for Part A was .92. Principal component analysis resulted in two factors that explained 64% of the total variance: skills and resources (Cronbach's alpha coefficient = .89) and awareness and sensitivity (Cronbach's alpha coefficient = .87). Part B had a Cronbach's alpha coefficient of .90. Parts A and B showed a strong positive relationship with one another (r = .77). The general self-efficacy measure was strongly and positively correlated with Part A (r = .81) and moderately and positively correlated with Part B (r = .48). CONCLUSION The Nurses' Confidence Scale: Unique Families is a new tool with which to measure the confidence of perinatal/neonatal nurses in providing sensitive, specific care to complex/nontraditional families. Results of our psychometric evaluation supported initial acceptable reliability and validity of the scale.
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Abstract
PURPOSE OF REVIEW Perinatal opioid use is a major public health problem and is associated with a number of deleterious maternal and fetal effects. We review recent evidence of perinatal outcomes and treatment of opioid use disorder (OUD) during pregnancy. RECENT FINDINGS Opioid exposure in pregnancy is associated with multiple obstetric and neonatal adverse outcomes, with the most common being neonatal opioid withdrawal syndrome (NOWS). Treatment with buprenorphine or methadone is associated with NOWS, but neither medication appears to have significant adverse effects on early childhood development. Buprenorphine appears to be superior to methadone in terms of incidence and severity of NOWS in exposed infants. The long-term effects of opioid exposure in utero have been inconclusive, but recent longitudinal studies point to potential differences in brain morphology that may increase vulnerability to future stressors. Maintenance therapy with methadone or buprenorphine remains the standard of care for pregnant women with OUD given its consistent superiority to placebo in terms of rates of illicit drug use and pregnancy outcomes. New non-pharmacologic management options for NOWS appear promising. Future research is needed to further evaluate the effects of opioid exposure in utero and determine the optimal delivery model for maintenance therapy.
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Affiliation(s)
- Amalia Londono Tobon
- Department of Psychiatry, Yale School of Medicine, 40 Temple Street, Suite 6B, New Haven, CT, 06510, USA
| | - Erin Habecker
- Department of Psychiatry, Yale School of Medicine, 40 Temple Street, Suite 6B, New Haven, CT, 06510, USA
| | - Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, 40 Temple Street, Suite 6B, New Haven, CT, 06510, USA.
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Heil SH, Melbostad HS, Rey CN. Innovative approaches to reduce unintended pregnancy and improve access to contraception among women who use opioids. Prev Med 2019; 128:105794. [PMID: 31398412 PMCID: PMC6879827 DOI: 10.1016/j.ypmed.2019.105794] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/03/2019] [Accepted: 08/06/2019] [Indexed: 12/24/2022]
Abstract
Dramatic increases in the rate of opioid use disorder (OUD) during pregnancy have been paralleled by substantial increases in the number of neonates diagnosed with neonatal abstinence syndrome (NAS). Women with OUD have reliably reported high rates of unintended pregnancy and a number of studies also indicate they desire easier access to contraception. Recent statements from the Centers for Disease Control and Prevention and the American Academy of Pediatrics/American College of Obstetricians and Gynecologists have drawn increased attention to efforts to prevent unintended pregnancy and improve access to contraception among women with OUD. We briefly review a number of innovative clinical approaches in these areas, including efforts to integrate family planning services into substance use disorder (SUD) treatment and other settings that serve people with OUD and interventions that aim to make family planning a higher priority among women with OUD. Results suggest many of these approaches have led to increases in contraceptive use and may aid in efforts to reduce unintended pregnancy and improve access to contraception among women with OUD now and in the future.
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Affiliation(s)
- Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Psychological Sciences, University of Vermont, United States of America; Department of Psychiatry, University of Vermont, United States of America.
| | - Heidi S Melbostad
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Psychological Sciences, University of Vermont, United States of America
| | - Catalina N Rey
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Psychiatry, University of Vermont, United States of America
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Paterno MT, Jablonski L, Klepacki A, Friedmann PD. Evaluation of a Nurse-Led Program for Rural Pregnant Women With Opioid Use Disorder to Improve Maternal–Neonatal Outcomes. J Obstet Gynecol Neonatal Nurs 2019; 48:495-506. [DOI: 10.1016/j.jogn.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 01/28/2023] Open
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Landau R. Post-cesarean delivery pain. Management of the opioid-dependent patient before, during and after cesarean delivery. Int J Obstet Anesth 2019; 39:105-116. [DOI: 10.1016/j.ijoa.2019.01.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/24/2018] [Accepted: 01/18/2019] [Indexed: 12/26/2022]
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Clark RRS. Breastfeeding in Women on Opioid Maintenance Therapy: A Review of Policy and Practice. J Midwifery Womens Health 2019; 64:545-558. [PMID: 31294522 DOI: 10.1111/jmwh.12982] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/24/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Opioid use is epidemic in the United States. Opioid use disorder (OUD) in pregnancy, as well as neonatal abstinence syndrome, has quadrupled in the last decade, and opioid maintenance therapy is recommended for pregnant women with OUD. Breastfeeding is an important means of improving outcomes for these vulnerable women and newborns. The purpose of this study was to review current policy on breastfeeding and opioid maintenance therapy, the rates of breastfeeding among women in this population, and facilitators and barriers to implementing policy recommendations. METHODS CINAHL, PubMed, the Cochrane Database of Systematic Reviews, Embase, and Web of Science were searched. Inclusion criteria included publication between 2013 and 2018, English language, human only, and original data (except for policy statements). Studies were excluded if they did not report original data and did not examine breastfeeding for women on opioid maintenance therapy. RESULTS Eight policy statements and 17 original research studies were identified that met the search criteria. All the policy statements support breastfeeding for women who are stable on opioid maintenance therapy and do not have HIV. Despite this, rates of breastfeeding among women receiving opioid maintenance therapy remain low compared with women in the general population. Results of qualitative research indicates that women on opioid maintenance therapy face numerous barriers to breastfeeding, including misinformation from health care professionals. Quantitative research has only begun to identify interventions to improve breastfeeding outcomes in this population. Research was conducted primarily with white women receiving care at urban health care centers. DISCUSSION Practice lags behind policy in terms of supporting breastfeeding in women receiving opioid maintenance therapy. There is a need for more research that includes African American and rural women on opioid maintenance therapy, as well as quantitative research that uses findings from qualitative research to identify the best possible interventions for improving breastfeeding outcomes for women on opioid maintenance therapy and their newborns. One significant need is for health care provider education regarding these policies as well as best practices for providing breastfeeding education and support to this population.
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Affiliation(s)
- Rebecca R S Clark
- Department of Community and Public Health, Johns Hopkins University, Baltimore, Maryland
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Short VL, Cambareri K, Gannon M, Alexander K, Abatemarco DJ. A Pilot Study to Assess Breastfeeding Knowledge, Attitudes, and Perceptions of Individuals Who Work in Perinatal Opioid Use Disorder Treatment Settings. Breastfeed Med 2019; 14:307-312. [PMID: 30888210 DOI: 10.1089/bfm.2018.0257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Although current evidence suggests that there are unique benefits of breastfeeding for mothers receiving comprehensive treatment, including counseling and pharmacotherapy, for opioid use disorder (OUD) and their infants, breastfeeding rates in this population are low. Support and counseling about breastfeeding are key predictors of infant feeding behaviors. Thus, identifying knowledge and attitudes regarding breastfeeding of individuals who work in OUD treatment facilities could offer insight into targets for breastfeeding-promotion interventions in such settings. Materials and Methods: Individuals who work at two urban perinatal OUD treatment centers were e-mailed a link to complete a questionnaire electronically. Breastfeeding knowledge, attitudes, and perceptions of those who completed the questionnaire were described using descriptive statistics. Results: Among the 24 survey respondents, most correctly identified the health benefits of breastfeeding for infants with neonatal abstinence syndrome, whereas less than half correctly identified the health benefits of breastfeeding for all infants. Only 16% reported receiving work-related breastfeeding education. The leading perceived breastfeeding challenges for women in treatment for OUD were (1) concern with transfer of medication (e.g., methadone) through breast milk, (2) daily commutes for treatment, and (3) beliefs that formula is better than breastfeeding. Conclusions: Professionals who work in perinatal OUD treatment centers could benefit from education regarding breastfeeding in mothers in treatment for OUD.
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Affiliation(s)
- Vanessa L Short
- 1 Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Katherine Cambareri
- 2 School of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Meghan Gannon
- 1 Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Karen Alexander
- 3 College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Diane J Abatemarco
- 1 Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Phillips KA, Preston KL. Prevention and Treatment of Opioid Overdose and Opioid-Use Disorders. Addict Behav 2018; 86:1-3. [PMID: 30080480 DOI: 10.1016/j.addbeh.2018.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Karran A Phillips
- National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Blvd., BRC Bldg Suite 200, Baltimore, MD 21224, USA.
| | - Kenzie L Preston
- National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Blvd., BRC Bldg Suite 200, Baltimore, MD 21224, USA.
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