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Schiff DM, Li WZM, Work EC, Goullaud L, Vazquez J, Paulet T, Dorfman S, Selk S, Hoeppner BB, Wilens T, Bernstein JA, Diop H. Multiple marginalized identities: A qualitative exploration of intersectional perinatal experiences of birthing people of color with substance use disorder in Massachusetts. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209346. [PMID: 38789329 DOI: 10.1016/j.josat.2024.209346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/29/2024] [Accepted: 03/01/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Racial and ethnic inequities persist in receipt of prenatal care, mental health services, and addiction treatment for pregnant and postpartum individuals with substance use disorder (SUD). Further qualitative work is needed to understand the intersectionality of racial and ethnic discrimination, stigma related to substance use, and gender bias on perinatal SUD care from the perspectives of affected individuals. METHODS Peer interviewers conducted semi-structured qualitative interviews with recently pregnant people of color with SUD in Massachusetts to explore the impact of internalized, interpersonal, and structural racism on prenatal, birthing, and postpartum experiences. The study used a thematic analysis to generate the codebook and double coded transcripts, with an overall kappa coefficient of 0.89. Preliminary themes were triangulated with five participants to inform final theme development. RESULTS The study includes 23 participants of diverse racial/ethnic backgrounds: 39% mixed race/ethnicity (including 9% with Native American ancestry), 30% Hispanic or Latinx, 26% Black/African American, 4% Asian. While participants frequently names racial and ethnic discrimination, both interpersonal and structural, as barriers to care, some participants attributed poor experiences to other marginalized identities and experiences, such as having a SUD. Three unique themes emerged from the participants' experiences: 1) Participants of color faced increased scrutiny and mistrust from clinicians and treatment programs; 2) Greater self-advocacy was required from individuals of color to counteract stereotypes and stigma; 3) Experiences related to SUD history and pregnancy status intersected with racism and gender bias to create distinct forms of discrimination. CONCLUSION Pregnant and postpartum people of color affected by perinatal SUD faced pervasive mistrust and unequal standards of care from mostly white healthcare staff and treatment spaces, which negatively impacted their treatment access, addiction medication receipt, postpartum pain management, and ability to retain custody of their children. Key clinical interventions and policy changes identified by participants for antiracist action include personalizing anesthetic plans for adequate peripartum pain control, minimizing reproductive injustices in contraceptive counseling, and addressing misuse of toxicology testing to mitigate inequitable Child Protective Services (CPS) involvement and custody loss.
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Affiliation(s)
- Davida M Schiff
- Division of General Academic Pediatrics, MassGeneral for Children, 125 Nashua St. Suite 860, Boston, MA 02114, United States of America; Division of Newborn Medicine, MassGeneral for Children, Boston, MA, 02114, United States of America.
| | - William Z M Li
- Harvard Medical School, Boston, MA, United States of America
| | - Erin C Work
- University of California, Schools of Public Health and Social Welfare, Los Angeles, CA, United States of America
| | - Latisha Goullaud
- Institute for Health and Recovery, Watertown, MA, United States of America
| | | | - Tabhata Paulet
- Rutgers New Jersey Medical School, Newark, NJ, United States of America
| | - Sarah Dorfman
- Division of General Academic Pediatrics, MassGeneral for Children, 125 Nashua St. Suite 860, Boston, MA 02114, United States of America
| | - Sabrina Selk
- National Network of Public Health Initiatives, Washington, DC, United States of America
| | - Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Timothy Wilens
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, United States of America
| | - Judith A Bernstein
- Division of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States of America
| | - Hafsatou Diop
- Massachusetts Department of Public Health, Boston, MA, 02108, United States of America
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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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Feld H, Elswick A, Goodin A, Fallin-Bennett A. Partnering with recovery community centers to build recovery capital by improving access to reproductive health. J Nurs Scholarsh 2023; 55:692-700. [PMID: 36345125 DOI: 10.1111/jnu.12836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/19/2022] [Accepted: 10/08/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND People with substance use disorders (SUD), especially opioid use disorder (OUD) have the highest rates of unintended pregnancies (80-95%) and report unmet reproductive health needs. Women of childbearing age have some of the highest death rates from opioids and are notably rising the most rapidly, and when pregnancy does occur overdose is one of the leading causes of maternal mortality. There are numerous gender-based health disparities and social determinants of health shaped by the distribution of power and privilege that influence the risk trajectories of people who can get pregnant or are pregnant with a substance use disorder (SUD). PURPOSE The purpose of this paper is to describe how reproductive health is essential to recovery and building recovery capital for people who can get pregnant, (1) introduce a pilot implementation science study working with trained peer support coaches to promote reproductive autonomy in the community, and (2) make policy and advocacy recommendations relevant to the new reproductive health landscape in the United States. We will also describe the adaptation and feasibility of the initial pilot study where we partnered with a recovery community center to train peer recovery coaches to provide low barrier resources (contraception, pregnancy tests and prenatal vitamins) and referrals to health care. METHODS This initiative is the merging of best practices in recovery and community-based global reproductive health, to empower people with SUD who can get pregnant in an implementation science framework. The pilot study will last 3 months in each city and aims to (1) assess and describe the effectiveness of the training of local peer recovery coaches on the link between recovery capital and reproductive health, and (2) assess the feasibility, acceptability, appropriateness, scalability, sustainability, and uptake and reach of low barrier reproductive health resources (pregnancy tests, prenatal vitamins, and emergency contraception). In this paper we are only reporting the initial findings regarding adaptation and feasibility. FINDINGS Informed by qualitative interviews with stakeholders and participants, the method of contraception was adapted from injectable to emergency to meet the needs and context of the community with SUD. Early outcomes such as uptake and acceptability indicate that this is a feasible model with peer recovery coaches and recovery community centers, with the greatest uptake of emergency contraception and pregnancy tests. CONCLUSION Considering recent policies limiting access to reproductive health, innovative community-based solutions are needed to engage and empower people who can get pregnant or are pregnant while in active drug use and in recovery. Providing low barrier reproductive health items by people with lived experience with SUD can serve as a valuable harm reduction model and improve recovery capital. CLINICAL RELEVANCE This is the first study to propose a methodology and context to implement a community-based study merging best practices in recovery with those in reproductive health with the potential to improve recovery capital and maternal/child health trajectories for people with SUD.
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Affiliation(s)
- Hartley Feld
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Alex Elswick
- Family Sciences, University of Kentucky, Lexington, Kentucky, USA
- Voices of Hope, Lexington, Kentucky, USA
| | - Amie Goodin
- Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida, USA
| | - Amanda Fallin-Bennett
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
- Voices of Hope, Lexington, Kentucky, USA
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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] [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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Hurley EA, Goggin K, Piña-Brugman K, Noel-MacDonnell JR, Allen A, Finocchario-Kessler S, Miller MK. Contraception use among individuals with substance use disorder increases tenfold with patient-centered, mobile services: a quasi-experimental study. Harm Reduct J 2023; 20:28. [PMID: 36879314 PMCID: PMC9986654 DOI: 10.1186/s12954-023-00760-7] [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: 10/28/2022] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Individuals with substance use disorders (SUD) have disproportionately high rates of unintended pregnancy. Reducing harm associated with this risk and its biopsychosocial consequences requires evidence-based, non-coercive interventions that ensure access to contraception for individuals who choose to prevent pregnancy. We examined feasibility and impact of SexHealth Mobile, a mobile unit-based intervention that aimed to increase access to patient-centered contraceptive care for individuals in SUD recovery programs. METHODS We conducted a quasi-experimental study (enhanced usual care [EUC] followed by intervention) at three recovery centers with participants (n = 98) at risk for unintended pregnancy. EUC participants were offered printed information on community locations where they could access contraception care. SexHealth Mobile participants were offered same-day, onsite clinical consultation on a medical mobile unit and contraception if desired. The primary outcome was use of contraception (hormonal or intrauterine device) at one-month post-enrollment. Secondary outcomes were at two-weeks and three-months. Confidence in preventing unintended pregnancy, reasons for non-use of contraception at follow-up, and intervention feasibility were also assessed. RESULTS Participants (median age = 31, range 19-40) enrolled in the intervention period were almost 10 times more likely to be using contraception at one-month (51.5%) versus the those enrolled in the EUC period (5.4%) (unadjusted relative risk [URR] = 9.3 [95%CI: 2.3-37.1]; adjusted relative risk [ARR] = 9.8 [95%CI: 2.4-39.2]). Intervention participants were also more likely to be using contraception at 2-weeks (38.7% vs. 2.6%; URR = 14.3 [95%CI: 2.0-104.1]) and three-months (40.9% vs. 13.9%; URR = 2.9 [95% CI: 1.1-7.4]). EUC participants reported more barriers (cost, time) and less confidence in preventing unintended pregnancies. Mixed-methods feasibility data indicated high acceptability and feasible integration into recovery settings. CONCLUSIONS Mobile contraceptive care based on principles of reproductive justice and harm reduction reduces access barriers, is feasible to implement in SUD recovery settings, and increases contraception use. Expanding interventions like SexHealth Mobile may help reduce harm from unintended pregnancies among individuals in SUD recovery. Trial Registration NCT04227145.
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Affiliation(s)
- Emily A Hurley
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, 2401 Gillham Rd., Kansas City, MO, 64108, USA. .,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA. .,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Kathy Goggin
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, 2401 Gillham Rd., Kansas City, MO, 64108, USA.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,University of Missouri - Kansas City School of Pharmacy, Kansas City, MO, USA
| | - Kimberly Piña-Brugman
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, 2401 Gillham Rd., Kansas City, MO, 64108, USA
| | - Janelle R Noel-MacDonnell
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, 2401 Gillham Rd., Kansas City, MO, 64108, USA.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | | | | | - Melissa K Miller
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Division of Emergency Medicine, Children's Mercy Kansas City, Kansas City, MO, USA
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Crawford CA, Taylor JA, Park GI, Rios JW, Bunch J, Greenwood CJ, Lopez Sanchez DY, Gonzales DJ. Effects of neonatal fentanyl on late adolescent opioid-mediated behavior. Front Neurosci 2023; 17:1094241. [PMID: 36866335 PMCID: PMC9971583 DOI: 10.3389/fnins.2023.1094241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/16/2023] [Indexed: 02/16/2023] Open
Abstract
Introduction Because of the steady increase in the use of synthetic opioids in women of childbearing age, a large number of children are at risk of exposure to these drugs prenatally or postnatally through breast milk. While there is older literature looking at the effects of morphine and heroin, there are relatively few studies looking at the long-term effects of high-potency synthetic opioid compounds like fentanyl. Thus, in the present study, we assessed whether brief exposure to fentanyl in male and female rat pups during a period roughly equivalent to the third trimester of CNS development altered adolescent oral fentanyl self-administration and opioid-mediated thermal antinociception. Methods We treated the rats with fentanyl (0, 10, or 100 μg/kg sc) from postnatal day (PD) 4 to PD 9. The fentanyl was administered daily in two injections given 6 h apart. After the last injection on PD 9, the rat pups were left alone until either PD 40 where they began fentanyl self-administration training or PD 60 where they were tested for morphine- (0, 1.25, 2.5, 5, or 10 mg/kg) or U50,488- (0, 2.5, 5, 10, or 20 mg/kg) induced thermal antinociception. Results In the self-administration study, we found that female rats had more active nose pokes than male rats when receiving a fentanyl reward but not sucrose alone solution. Early neonatal fentanyl exposure did not significantly alter fentanyl intake or nose-poke response. In contrast, early fentanyl exposure did alter thermal antinociception in both male and female rats. Specifically, fentanyl (10 μg/kg) pre-treatment increased baseline paw-lick latencies, and the higher dose of fentanyl (100 μg/kg) reduced morphine-induced paw-lick latencies. Fentanyl pre-treatment did not alter U50,488-mediated thermal antinociception. Conclusions Although our exposure model is not reflective of typical human fentanyl use during pregnancy, our study does illustrate that even brief exposure to fentanyl during early development can have long-lasting effects on mu-opioid-mediated behavior. Moreover, our data suggest that females may be more susceptible to fentanyl abuse than males.
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Affiliation(s)
| | - Jordan A. Taylor
- Department of Psychology, California State University, San Bernardino, San Bernardino, CA, United States
| | - Ginny I. Park
- Department of Psychology, California State University, San Bernardino, San Bernardino, CA, United States
| | - Jasmine W. Rios
- Department of Psychology, California State University, San Bernardino, San Bernardino, CA, United States
| | - Joseph Bunch
- Department of Psychology, California State University, San Bernardino, San Bernardino, CA, United States
| | - Constance J. Greenwood
- Department of Psychology, California State University, San Bernardino, San Bernardino, CA, United States
| | - David Y. Lopez Sanchez
- Department of Psychology, California State University, San Bernardino, San Bernardino, CA, United States
| | - Diego J. Gonzales
- Department of Psychology, California State University, San Bernardino, San Bernardino, CA, United States
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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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Stancil SL, Miller MK, Duello A, Finocchario-Kessler S, Goggin K, Winograd RP, Hurley EA. Long-acting reversible contraceptives (LARCs) as harm reduction: a qualitative study exploring views of women with histories of opioid misuse. Harm Reduct J 2021; 18:83. [PMID: 34348734 PMCID: PMC8335991 DOI: 10.1186/s12954-021-00532-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/28/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The sharp rise in opioid use disorder (OUD) among women coupled with disproportionally high rates of unintended pregnancy have led to a four-fold increase in the number of pregnant women with OUD in the United States over the past decade. Supporting intentional family planning can have multiple health benefits and reduce harms related to OUD but requires a comprehensive understanding of women's perspectives of preventing unintended pregnancies. The purpose of this study was to comprehensively evaluate the knowledge, attitudes and experiences as they relate to seeking contraception, particularly LARCs, among women with active or recovered opioid misuse. METHODS In-depth interviews and focus group discussions with 36 women with current or past opioid misuse were recorded and transcribed. Transcripts were coded by ≥ 2 investigators. Themes related to contraceptive care seeking were identified and contextualized within the Health Belief Model. RESULTS Our analysis revealed seven interwoven themes that describe individual level factors associated with contraceptive care seeking in women with current or past opioid misuse: relationship with drugs, reproductive experiences and self-perceptions, sexual partner dynamics, access, awareness of options, healthcare attitudes/experiences, and perceptions of contraception efficacy/ side effects. Overall, perceived susceptibility and severity to unintended pregnancy varied, but most women perceived high benefits of contraception, particularly LARC. However, perceived barriers were too high for most to obtain desired contraception to support family planning intentions. CONCLUSIONS The individual-level factors identified should inform the design of integrated services to promote patient-centered contraceptive counseling as a form of harm reduction. Interventions should reduce barriers to contraceptive access, particularly LARCs, and establish counseling strategies that use open, non-judgmental communication, acknowledge the continuum of reproductive needs, explore perceived susceptibility to pregnancy, and utilize peer educators.
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Affiliation(s)
- Stephani L Stancil
- Division of Adolescent Medicine, Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO, 64108, USA.
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Kansas City, Kansas City, MO, USA.
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA.
| | - Melissa K Miller
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Alex Duello
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, MO, USA
| | | | - Kathy Goggin
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
- School of Pharmacy, University of Missouri - Kansas City, Kansas City, MO, USA
| | - Rachel P Winograd
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Emily A Hurley
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
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Sobel L, Lee YW, White KO, Woodhams E, Patton E. Contraceptive decision making among pregnancy-capable individuals with opioid use disorder at a tertiary care center in Massachusetts. Contraception 2021; 104:355-360. [PMID: 34118268 DOI: 10.1016/j.contraception.2021.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To explore contraceptive decision making among recently pregnant patients with a history of opioid use disorder. STUDY DESIGN We conducted semi-structured qualitative interviews, based on principles of the Ottawa Decision Support Framework, with 20 recently pregnant individuals diagnosed with opioid use disorder at a tertiary care medical center in Massachusetts. We audio-recorded the interviews and they were transcribed verbatim. We analyzed our interview data using inductive and deductive coding. RESULTS Participants value the availability of barrier methods as a means of preventing both sexually transmitted infections and pregnancy. For some participants, housing instability makes storing contraceptive methods and managing personal hygiene related to bleeding patterns difficult. For others, housing instability impacts their overall fertility goals. Side effects including weight gain, interactions with mood stabilizing medications, concern regarding post-operative opioids, or intrinsic aspects of a method that serve as reminders of opioid use may be unacceptable given the risk of relapse. The relapsing and remitting arc of recovery make remembering important aspects of both short- and long-acting contraceptive method use difficult, yet participants offer strategies to aid in doing so. CONCLUSION When choosing a contraceptive method participants in our study exhibit similarities to individuals with other chronic medical conditions as well as motivations specific to opioid use disorder. Their contraceptive decisions are grounded in integrating a method into a chaotic life, preventing relapse, and protecting future fertility. IMPLICATIONS Our data highlight how lived experiences at the intersection of active opioid use disorder and recovery fundamentally shape the lens through which pregnancy-capable individuals with opioid use disorder view their contraceptive decisions.
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Affiliation(s)
- Lauren Sobel
- Department of Obstetrics, Gynecology, Boston Medical Center, Boston, MA.
| | - Yeon Woo Lee
- Department of Obstetrics, Gynecology, Boston Medical Center, Boston, MA
| | | | | | - Elizabeth Patton
- Department of Obstetrics, Gynecology, Boston Medical Center, Boston, MA
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Gipson JD, Bornstein M, Berger A, Rocca CH. Desire to avoid pregnancy and contraceptive use among female methadone patients in Los Angeles. Contraception 2021; 103:322-327. [PMID: 33567322 DOI: 10.1016/j.contraception.2021.01.019] [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] [Received: 09/14/2020] [Revised: 01/27/2021] [Accepted: 01/31/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Opioid use disorder (OUD) is increasing among U.S. women. Research indicates higher levels of unintended pregnancy among women with OUD as compared to the general population. Following formative in-depth research documenting the complexity of considerations around pregnancy in this population, we collected information on pregnancy preferences and contraceptive use among women attending methadone treatment. STUDY DESIGN We surveyed women attending methadone clinics in Los Angeles in 2018. We used the Desire to Avoid Pregnancy (DAP) Scale, a 14-item instrument (0-4; 4 = highest desire to avoid pregnancy) to capture pregnancy preferences across 3 domains: cognitive desires, affective feelings, and anticipated consequences. We conducted factor analysis, descriptive analyses, and linear and logistic regressions to assess the DAP scale and to examine relationships between pregnancy preferences, sociodemographic characteristics, and contraceptive use. RESULTS Women (n = 46) expressed the full range of pregnancy preferences (DAP score range: 0.4-4.0; mean: 2.24, standard deviation: 1.02; Cronbach's α = 0.92). Overall, 40% used contraception at last sex. Women who reported a greater preference to avoid pregnancy were marginally more likely to use contraception at last sex as compared to women who were more open to pregnancy (odds ratio = 1.73; p = 0.09). CONCLUSIONS Similar to findings from other populations, responses to the Desire to Avoid Pregnancy scale among a sample of women with OUD revealed a broad range of pregnancy preferences. Pregnancy preferences were marginally associated with contraceptive use in this sample suggesting that the DAP may provide useful insights on pregnancy preferences that may facilitate contraceptive and preconception counseling in this population. IMPLICATIONS Given the complexity of considerations around pregnancy for women with opioid use disorder, the DAP scale may be a valuable tool to identify women's pregnancy and childbearing preferences and to facilitate alignment of women's sexual and reproductive health desires with appropriate services.
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Affiliation(s)
- Jessica D Gipson
- University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA, United States.
| | - Marta Bornstein
- University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA, United States
| | - Agatha Berger
- Department of Obstetrics and Gynecology, Christiana Care Health System, Center for Women's OB-Gyn and Reproductive Health, Newark, DE, United States
| | - Corinne H Rocca
- University of California, San Francisco Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, Advancing New Standards in Reproductive Health (ANSIRH), Oakland, CA, United States
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Neeki MM, Dong F, Archambeau B, Cerda M, Ratliff S, Goff A, Roloff K, Tran L. San Bernardino County Youth Opioid Response: Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder. Cureus 2020; 12:e9781. [PMID: 32821635 PMCID: PMC7431298 DOI: 10.7759/cureus.9781] [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: 11/10/2022] Open
Abstract
Opioid use disorder (OUD) and related overdose deaths have become a crisis of epidemic proportions in the United States. In 2018, over 10 million people age 12 years or older misused opioids.Substance use is also correlated with increased physical and mental health disorders, and developmental challenges among youths. Medication-assisted treatment (MAT) has been reported to reduce mortality, opioid use, and human immunodeficiency virus and hepatitis C virus transmission while increasing treatment retention in adults. The San Bernardino County Youth Opioid Response (SBCYOR) program was formed to explore best practices for youths at risk of opioid use disorders and/or overdose. SBCYOR is a coalition of professionals in healthcare, behavioral health, public education, law enforcement, emergency medical services (EMS) agencies, and juvenile detention centers throughout San Bernardino County, California. SBCYOR focuses on high-risk and addicted individuals between the ages of 12 to 24 years in San Bernardino County’s correctional system. It utilizes a strategy of collaboration, prevention, risk mitigation, medication, psychological treatment, and community outreach. This study aimed to evaluate the implementation and progress of SBCYOR.
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Affiliation(s)
- Michael M Neeki
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA.,Probation Department, San Bernardino County Department of Probation, San Bernardino, USA.,Emergency Medicine, California University of Science and Medicine, Colton, USA
| | - Fanglong Dong
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | | | - Melinda Cerda
- Probation Department, San Bernardino County Department of Probation, San Bernardino, USA
| | - Sireyia Ratliff
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Alan Goff
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Kristina Roloff
- Obstetrics and Gynecology, Arrowhead Regional Medical Center, Colton, USA.,Obstetrics and Gynecology, California University of Science and Medicine, Colton, USA
| | - Louis Tran
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA.,Emergency Medicine, California University of Science and Medicine, Colton, USA
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