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Martinez NG, Seidman DL, Briscoe H, Hayes CM, Ojukwu EI, Paltin D, Roberts SCM. Patients, colleagues, systems, and self: Exploring layers of physician emotions in caring for pregnant people who use substances and their newborns. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209432. [PMID: 38857826 DOI: 10.1016/j.josat.2024.209432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/24/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Pregnant people who use substances experience significant stigma, including in healthcare settings, where physicians make high-stakes decisions about treatment plans, resource allocation, and even a person's ability to parent. Previous psychology research has demonstrated the influence of emotions on decision-making, as well as on the development and expression of stigma. Yet the specific content of physician emotions, as well as approaches to processing these emotions, has been relatively under-examined. We sought to better understand the emotional experiences of physicians who practice in safety-net labor and delivery/inpatient settings to inform strategies to facilitate more humanizing, equitable care. METHODS From March 2021 to June 2022, the study team conducted semi-structured interviews with 24 San Francisco Bay Area-based physicians (obstetrics-gynecology, pediatrics, family medicine) caring for pregnant people who use substances and/or their newborns. We used deductive and inductive coding and identified themes regarding the nature, etiology, and processing of physician emotions. RESULTS Physicians described experiencing a range of emotions related to interpersonal (patients, colleagues), systems-level, and internal dynamics. Emotions such as anger, sadness, frustration, and helplessness resulted from their deep care and empathy for patients, witnessing stigmatizing colleague behaviors, disagreement with punitive systems, and recognition of their own limitations in effecting change. Few participants identified strategies for processing these emotions, and several described efforts to disengage from their emotional experience to preserve their sense of well-being and professionalism. CONCLUSIONS Physicians caring for pregnant people who use substances and their newborns experienced intense, multi-layered emotions. This study posits that additional efforts to support physician emotional processing and structural competency could improve healthcare experiences and outcomes for pregnant people who use substances.
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Affiliation(s)
- Noelle G Martinez
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, La Jolla, CA 92161, United States of America; Department of Family and Community Medicine, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, United States of America.
| | - Dominika L Seidman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, United States of America
| | - Heather Briscoe
- Department of Pediatrics, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, United States of America
| | - Crystal M Hayes
- School of Social Work, Sacred Heart University, 5151 Park Avenue, Fairfield, CT 06825, United States of America
| | - Ekene I Ojukwu
- San Quentin Rehabilitation Center, 100 Main Street, San Quentin, CA 94964, United States of America
| | - Dafna Paltin
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 102/103, San Diego, CA 92120, United States of America
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway Street, Suite 1100, Oakland, CA 94612, United States of America
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Bello JK, Xu KY, Salas J, Kelly J, Grucza RA. Contraceptive uptake in postpartum people with and without opioid use disorder and opioid use with co-occurring substance use. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 12:100248. [PMID: 39040479 PMCID: PMC11261297 DOI: 10.1016/j.dadr.2024.100248] [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: 03/22/2024] [Revised: 05/22/2024] [Accepted: 06/14/2024] [Indexed: 07/24/2024]
Abstract
Background Using contraception to delay pregnancy allows people with opioid use disorder (OUD) to choose when they are ready to continue their families. Yet, postpartum contraceptive uptake among people with OUD has not been well characterized. Methods Analyses used 73,811 pregnancy episodes among 61,221 people (2016-2021) from the St. Louis University-SSM Virtual Data Warehouse. OUD was defined from the year prior and through pregnancy. Contraceptive uptake was defined within 90-days after delivery. We used Generalized Estimating Equations-type multinomial logit models to assess association of OUD +/- co-occurring substance use disorders (SUDs) with any contraception (yes/no) and type of contraception (effective - pills, patch, ring, injection; or highly effective - long-acting reversible, LARC methods [intrauterine device, implant] and sterilization). Results The sample was 66.0 % white and average age was 27.7 years (±5.6). 32.5 % of pregnancies were followed by contraception initiation, 2.3 % had an OUD diagnosis, and 1.3 % OUD with co-occurring SUD. There was no association between OUD and postpartum contraception receipt, but OUD was associated with decreased highly effective compared to effective method initiation (aOR=0.76; 95 % CI: [0.64-0.91]). OUD plus co-occurring SUD was associated with decreased uptake across all contraception types (aOR=0.81[0.70-0.93]), specifically, highly-effective methods (aOR=0.48[0.38-0.61]). Conclusions Overall postpartum contraception uptake among people with OUD is comparable to uptake in the non-OUD population. People with OUD plus co-occurring SUDs are particularly unlikely to receive contraception. The reasons people choose contraceptive methods are complex and may differ by SUD severity. More information is needed to understand factors that impact postpartum contraception initiation.
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Affiliation(s)
- Jennifer K. Bello
- Department of Family and Community Medicine, Saint Louis University School of Medicine, SLUCare Academic Pavilion, 1008 S. Spring Ave. 3rd Floor, Saint Louis, MO 63110, USA
| | - Kevin Y. Xu
- Health and Behavior Research Center, Division of Addiction Science, Prevention and Treatment, Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Joanne Salas
- Advanced Health Data Institute, Department of Health and Outcomes Research, Saint Louis University, 3545 Lafayette Ave., St. Louis, MO 63104, USA
| | - Jeannie Kelly
- Division of Maternal-Fetal Medicine & Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine, 4901 Forest Park Ave. Suite 710, St. Louis, MO 63108, USA
| | - Richard A. Grucza
- Department of Family and Community Medicine, Saint Louis University School of Medicine, SLUCare Academic Pavilion, 1008 S. Spring Ave. 3rd Floor, Saint Louis, MO 63110, USA
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Hackett C. "I Was Treated Differently": Reproductive Health Care Experiences Among Women With Recent Experiences of Incarceration, Homelessness, And/Or Substance Use in a Medically Underserved Area in the Southwestern US. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024:2752535X241277352. [PMID: 39168483 DOI: 10.1177/2752535x241277352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Background: Women with upstream social determinants of health, particularly those with recent experiences of incarceration, homelessness, and/or substance use, encounter a series of barriers in accessing health care services and consequently face poor sexual and reproductive health outcomes. Driven by a community concern for increasing rates of syphilis and congenital syphilis among women who are structurally disadvantaged, this study focuses on their experiences with reproductive healthcare access across healthcare settings.Research Design and Study Sample: This community-based pláticas (conversational) research project gathered 12 in-depth interviews and testimonios (testimonies) with women who reported a criminalized upstream barrier (incarceration, homelessness, and/or substance use) in a small city in the southwestern U.S. - most of whom identified as Latina/Hispanic.Analysis and Results: Using a grounded analysis and drawing upon Chicana feminist methodologies, this study identifies four major themes: (1) homelessness and economic vulnerabilities, (2) incarceration and health care, (3) drug use, provider stigma, and motherhood, and (4) desired changes to the healthcare experience.Conclusion: Results highlight the need for economic and transportation supports, community-based preventive services as alternatives to incarcerated healthcare, along with more compassionate and structurally competent provider-patient dialogue.
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Affiliation(s)
- Colleen Hackett
- Criminology and Criminal Justice, Northern Arizona University, Flagstaff, AZ, USA
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McGlothen-Bell K, Cartagena D, Malin KJ, Vittner D, McGrath JM, Koerner RL, Vance AJ, Crawford AD. Reimagining Supportive Approaches at the Intersection of Mandatory Reporting Policies for the Mother-Infant Dyad Affected by Substance Use. Adv Neonatal Care 2024:00149525-990000000-00142. [PMID: 39133542 DOI: 10.1097/anc.0000000000001188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
BACKGROUND As rates of substance use during pregnancy persist, the health and optimal development of infants with prenatal substance exposure remain a key priority. Nurses are tasked with identifying and reporting suspected cases of child maltreatment, including abuse and neglect, which is often assumed to be synonymous with substance use during pregnancy. While policies aimed at protecting infants from child abuse and neglect are well intentioned, literature regarding the short- and long-term social and legal implications of mandatory reporting policies is emerging. PURPOSE In this article, we explore the intersections between the condition of substance use in pregnancy and policies related to mandatory reporting. METHODS We provide an overview of historical and current trends in mandatory reporting policies for nurses related to substance use in pregnancy and related ethical and social implications for mother-infant dyads. RESULTS Nurses often function at the intersection of healthcare and social services, underscoring the important role they play in advocating for ethical and equitable care for both members of the mother-infant dyad affected by substance use. IMPLICATIONS FOR PRACTICE AND RESEARCH We offer recommendations for practice including the integration of respectful care and family-centered support for the mother-infant dyad affected by substance use. Cross-sectoral collaborations, inclusive of the family, are important to the advancement of evidence-based and equity-focused research, advocacy, and policy initiatives to support familial preservation and reduce mother-infant separation.
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Affiliation(s)
- Kelly McGlothen-Bell
- Author Affiliations: School of Nursing, UT Health San Antonio, San Antonio, Texas (Drs McGlothen-Bell, McGrath, and Crawford); School of Nursing, Old Dominion University, Norfolk, Virginia (Dr Cartagena); College of Nursing, Marquette University, Milwaukee, Wisconsin (Dr Malin); Egan School of Nursing and Health Studies, Fairfield University, Fairfield, Connecticut (Dr Vittner); Neonatal Intensive Care Unit, Connecticut Children's, Hartford, Connecticut (Dr Vittner); College of Nursing, University of South Florida, Tampa, Florida (Dr Koerner); and Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan (Dr Vance)
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D'Aquino S, Kumar A, Riordan B, Callinan S. Long-term effects of alcohol consumption on anxiety in adults: A systematic review. Addict Behav 2024; 155:108047. [PMID: 38692070 DOI: 10.1016/j.addbeh.2024.108047] [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] [Received: 02/18/2024] [Revised: 04/21/2024] [Accepted: 04/27/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Despite the high prevalence and comorbidity of alcohol consumption and anxiety, it is unclear whether alcohol consumption influences long-term anxiety. This study aimed to systematically review the literature on the long-term longitudinal effects of alcohol consumption on anxiety in adults. METHODS EMBASE, PsychInfo, Medline, and Web of Science databases were systematically searched from inception to April 12th, 2024. Articles analysing the relationship between alcohol consumption and anxiety symptoms or anxiety disorder diagnosis at least three-months later in adults were eligible. Articles were screened and extracted by two independent reviewers with study quality assessed using the Mixed Methods Appraisal Tool. RESULTS From 884 records, eight studies of mixed quality met inclusion criteria. One study using a sample representative of the USA population found low volume consumption was associated with lower long-term anxiety. All other studies used a convenience sample or a specific medical population sample. The significance and direction of the relationship between alcohol consumption and long-term anxiety in these studies varied, likely due to differences in alcohol consumption thresholds used and populations studied. CONCLUSIONS A paucity of research on the longitudinal effects of alcohol consumption on anxiety was found, highlighting a significant gap in the research literature. Furthermore, existing research, primarily focussed on clinical subpopulations, has yielded mixed results. Further research is needed to explore the longitudinal dose dependent impact of alcohol consumption on anxiety using samples representative of national populations.
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Affiliation(s)
- Simon D'Aquino
- Department of Psychology, La Trobe University, Australia.
| | - Akaash Kumar
- Department of Psychology, La Trobe University, Australia
| | - Benjamin Riordan
- Centre for Alcohol Policy Research, La Trobe University, Australia
| | - Sarah Callinan
- Centre for Alcohol Policy Research, La Trobe University, Australia
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Jones CM, Zhang K, Han B, Guy GP, Losby J, Einstein EB, Delphin-Rittmon M, Volkow ND, Compton WM. Estimated Number of Children Who Lost a Parent to Drug Overdose in the US From 2011 to 2021. JAMA Psychiatry 2024; 81:789-796. [PMID: 38717781 PMCID: PMC11079787 DOI: 10.1001/jamapsychiatry.2024.0810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/01/2024] [Indexed: 05/12/2024]
Abstract
Importance Parents' overdose death can have a profound short- and long-term impact on their children, yet little is known about the number of children who have lost a parent to drug overdose in the US. Objective To estimate the number and rate of children who have lost a parent to drug overdose from 2011 to 2021 overall and by parental age, sex, and race and ethnicity. Design, Setting, and Participants This was a cross-sectional study of US community-dwelling persons using data from the National Survey on Drug Use and Health (2010-2014 and 2015-2019) and the National Vital Statistics System (2011-2021). Data were analyzed from January to June 2023. Exposure Parental drug overdose death, stratified by age group, sex, and race and ethnicity. Main Outcomes and Measures Numbers, rates, and average annual percentage change (AAPC) in rates of children losing a parent aged 18 to 64 years to drug overdose, overall and by age, sex, and race and ethnicity. Results From 2011 to 2021, 649 599 adults aged 18 to 64 years died from a drug overdose (mean [SD] age, 41.7 [12.0] years; 430 050 [66.2%] male and 219 549 [33.8%] female; 62 606 [9.6%] Hispanic, 6899 [1.1%] non-Hispanic American Indian or Alaska Native, 6133 [0.9%] non-Hispanic Asian or Pacific Islander, 82 313 [12.7%] non-Hispanic Black, 485 623 [74.8%] non-Hispanic White, and 6025 [0.9%] non-Hispanic with more than 1 race). Among these decedents, from 2011 to 2021, an estimated 321 566 (95% CI, 276 592-366 662) community-dwelling children lost a parent aged 18 to 64 years to drug overdose. The rate of community-dwelling children who lost a parent to drug overdose per 100 000 children increased from 27.0 per 100 000 in 2011 to 63.1 per 100 000 in 2021. The highest rates were found among children of non-Hispanic American Indian or Alaska Native individuals, who had a rate of 187.1 per 100 000 in 2021, more than double the rate among children of non-Hispanic White individuals (76.5 per 100 000) and non-Hispanic Black individuals (73.2 per 100 000). While rates increased consistently each year for all parental age, sex, and race and ethnicity groups, non-Hispanic Black parents aged 18 to 25 years had the largest AAPC (23.8%; 95% CI, 16.5-31.6). Rates increased for both fathers and mothers; however, more children overall lost fathers (estimated 192 459; 95% CI, 164 081-220 838) than mothers (estimated 129 107; 95% CI, 112 510-145 824). Conclusions and Relevance An estimated 321 566 children lost a parent to drug overdose in the US from 2011 to 2021, with significant disparities evident across racial and ethnic groups. Given the potential short- and long-term negative impact of parental loss, program and policy planning should ensure that responses to the overdose crisis account for the full burden of drug overdose on families and children, including addressing the economic, social, educational, and health care needs of children who have lost parents to overdose.
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Affiliation(s)
| | - Kun Zhang
- National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Beth Han
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Gery P. Guy
- National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jan Losby
- National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily B. Einstein
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | | | - Nora D. Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
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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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Shank TM, Tjahaja S, Rutter TM, Mackiewicz Seghete KL. Substance use during pregnancy: the role of mindfulness in reducing stigma. Front Psychol 2024; 15:1432926. [PMID: 38984277 PMCID: PMC11231397 DOI: 10.3389/fpsyg.2024.1432926] [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: 05/15/2024] [Accepted: 06/11/2024] [Indexed: 07/11/2024] Open
Abstract
Stigmatization is a significant healthcare barrier among individuals who utilize substances during pregnancy. Of the 3.6 million U.S. births each year, approximately 10% are affected by perinatal substance use, an estimate which is likely underestimated due to fear of stigma and prosecution. Of those experiencing perinatal substance use, less than 11% receive treatment, while maternal deaths due to overdose during the postpartum period have increased by 81% from 2017 to 2020. Societal perception of non-pregnant individuals experiencing substance use disorders recognizes the biological basis of addiction, whereas for pregnant individuals, societal perception slides into moral failing as the basis of addiction. Many recommendations and guidelines for decreasing substance use stigmatization among non-pregnant and pregnant individuals exist. We focus on the use of mindfulness in recognizing and addressing structural and social stigma within healthcare systems. Mindfulness has been extracted from its roots as an essential element of the Eightfold Path in Buddhism, which largely centers on living ethically to reduce suffering of self and others. By acknowledging the roots of mindfulness, providers can engage mindfully in practices that help identify one's overarching personal values and encourage one to lead healthcare encounters compassion and willingness to support help-seeking community members who are experiencing suffering. A deeper awareness of mindfulness practices within the context of ethical conduct can support healthcare shifts away from criminalization toward more patient- and family-centered approaches.
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Affiliation(s)
- Taylor M Shank
- Department of Psychiatry and Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Surja Tjahaja
- MindfulnessMeditation.us, Portland, OR, United States
| | - Tara M Rutter
- Department of Psychiatry and Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Kristen L Mackiewicz Seghete
- Department of Psychiatry, Department of Obstetrics and Gynecology, and Center for Mental Health Innovation, Oregon Health and Science University, Portland, OR, United States
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Rivera D, Henwood BF, Sussman S, Wenzel S, Dasgupta A, Campbell ANC, Wu E, Amaro H. Characterizing Multisystem Barriers to Women's Residential SUD Treatment: A Multisite Qualitative Analysis in Los Angeles. J Urban Health 2024; 101:653-667. [PMID: 38632159 PMCID: PMC11190110 DOI: 10.1007/s11524-024-00857-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 04/19/2024]
Abstract
Residential substance use disorder (SUD) treatment programs are challenged by the differing values of the problem-solving court (PSC) and child welfare (CW) systems, along with communication barriers between staff. This study aimed to understand, from the viewpoints of SUD treatment providers, how divergent values and communication barriers adversely affect women's residential SUD treatment. We conducted qualitative semistructured interviews with 18 SUD treatment clinicians and six directors from four women's residential SUD treatment programs. Using a thematic analysis framework, we identified salient themes across specified codes. Analysis revealed six main themes, suggesting differing values and communication barriers across the SUD, PSC, and CW systems adversely affect the provision of SUD treatment. For differing values, three main themes emerged: (a) unaddressed trauma and fear of mental health treatment seeking; (b) perceptions of mothers with a SUD; and (c) the Adoption and Safe Families Act (ASFA) timeline as a barrier to SUD treatment provision. For communication barriers, three themes emerged: (a) inadequate communication and responsiveness with PSC and CW systems adversely affect treatment coordination, induce patient stress, and treatment disengagement; (b) lack of PSC and CW communication regarding child visitation planning adversely affects treatment motivation and retention; and (c) competing ASFA, PSC, and CW priorities and inadequate cross-system communication adversely affect treatment planning. Treatment providers face significant barriers in providing effective treatment to women simultaneously involved in the CW and PSC systems. Aligning values and addressing communication barriers, changes in policy, and enhanced cross-system training are crucial. Additionally, it is essential to reevaluate the ASFA timeline to align with the long-term treatment needs of mothers with a SUD. Further research should explore the viewpoints of patients, CW, and PSC staff to gain deeper insights into these SUD treatment barriers.
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Affiliation(s)
- Dean Rivera
- Columbia School of Social Work, Columbia University, 1225 Amsterdam Ave., New York, NY, 10027, USA.
| | - Benjamin F Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34 Street, MRF 214, Los Angeles, CA, 90089, USA
| | - Steve Sussman
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA, 90033, USA
| | - Suzanne Wenzel
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34 Street, MRF 214, Los Angeles, CA, 90089, USA
| | - Anindita Dasgupta
- Columbia School of Social Work, Columbia University, 1225 Amsterdam Ave., New York, NY, 10027, USA
| | - Aimee N C Campbell
- Columbia University Irving Medical Center Department of Psychiatry and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, Room 3719, New York, NY, 10032, USA
| | - Elwin Wu
- Columbia School of Social Work, Columbia University, 1225 Amsterdam Ave., New York, NY, 10027, USA
| | - Hortensia Amaro
- Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8Th Street, Miami, FL, 33199, USA
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Combellick JL, Esmaeili A, Johnson AM, Haskell SG, Phibbs CS, Manzo L, Miller LJ. Perinatal mental health and pregnancy-associated mortality: opportunities for change. Arch Womens Ment Health 2024; 27:417-424. [PMID: 38172275 DOI: 10.1007/s00737-023-01404-2] [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] [Received: 09/18/2023] [Accepted: 11/17/2023] [Indexed: 01/05/2024]
Abstract
Perinatal mental health conditions have been associated with adverse pregnancy outcomes, including maternal death. This quality improvement project analyzed pregnancy-associated death among veterans with mental health conditions in order to identify opportunities to improve healthcare and reduce maternal deaths. Pregnancy-associated deaths among veterans using Veterans Health Administration (VHA) maternity care benefits between fiscal year 2011 and 2020 were identified from national VHA databases. Deaths among individuals with active mental health conditions underwent individual chart review using a standardized abstraction template adapted from the Centers for Disease Control and Prevention (CDC). Thirty-two pregnancy-associated deaths were identified among 39,720 paid deliveries with 81% (n = 26) occurring among individuals with an active perinatal mental health condition. In the perinatal mental health cohort, most deaths (n = 16, 62%) occurred in the late postpartum period and 42% (n = 11) were due to suicide, homicide, or overdose. Opportunities to improve care included addressing (1) racial disparities, (2) mental health effects of perinatal loss, (3) late postpartum vulnerability, (4) lack of psychotropic medication continuity, (5) mental health conditions in intimate partners, (6) child custody loss, (7) lack of patient education or stigmatizing patient education, and (8) missed opportunities for addressing reproductive health concerns in mental health contexts. Pregnancy-associated deaths related to active perinatal mental health conditions can be reduced. Mental healthcare clinicians, clinical teams, and healthcare systems have opportunities to improve care for individuals with perinatal mental health conditions.
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Affiliation(s)
- Joan L Combellick
- Department of Veterans Affairs, Veterans Health Administration, Office of Women's Health, 810 Vermont Ave NW, Washington, DC, 20420, USA.
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA.
- School of Nursing, Yale University, 400 West Campus Drive, Orange, CT, 06477, USA.
| | - Aryan Esmaeili
- Health Economics Resource Center (HERC), Palo Alto VA Medical Center, 795 Willow Road, Menlo Park, Palo Alto, CA, 94025, USA
| | - Amanda M Johnson
- Department of Veterans Affairs, Veterans Health Administration, Office of Women's Health, 810 Vermont Ave NW, Washington, DC, 20420, USA
| | - Sally G Haskell
- Department of Veterans Affairs, Veterans Health Administration, Office of Women's Health, 810 Vermont Ave NW, Washington, DC, 20420, USA
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA
- School of Medicine, Yale University, 333 Cedar St, New Haven, CT, 06510, USA
| | - Ciaran S Phibbs
- Health Economics Resource Center (HERC), Palo Alto VA Medical Center, 795 Willow Road, Menlo Park, Palo Alto, CA, 94025, USA
- Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Laura Manzo
- School of Nursing, Yale University, 400 West Campus Drive, Orange, CT, 06477, USA
- US Army, AMEDD Student Detachment, 187th Medical Battalion, Joint Base San Antonio, San Antonio, TX, 78234, USA
| | - Laura J Miller
- Department of Veterans Affairs, Veterans Health Administration, Women's Mental Health, Office of Mental Health and Suicide Prevention, 810 Vermont Ave NW, Washington, DC, 20420, USA
- Department of Psychiatry and Behavioral Sciences, Stritch School of Medicine, Loyola University, 2160 South First Avenue, Maywood, IL, 60153, USA
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11
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Bogdan R, Leverett SD, Constantino-Petit AM, Lashley-Simms N, Liss DB, Johnson EC, Lenze SN, Lean RE, Smyser TA, Carter EB, Smyser CD, Rogers CE, Agrawal A. Characteristics of women concordant and discordant for urine drug screens for cannabis exposure and self-reported cannabis use during pregnancy. Neurotoxicol Teratol 2024; 103:107351. [PMID: 38604316 DOI: 10.1016/j.ntt.2024.107351] [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] [Received: 10/17/2023] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Increasing cannabis use among pregnant people and equivocal evidence linking prenatal cannabis exposure to adverse outcomes in offspring highlights the need to understand its potential impact on pregnancy and child outcomes. Assessing cannabis use during pregnancy remains a major challenge with potential influences of stigma on self-report as well as detection limitations of easily collected biological matrices. OBJECTIVE This descriptive study examined the concordance between self-reported (SR) cannabis use and urine drug screen (UDS) detection of cannabis exposure during the first trimester of pregnancy and characterized concordant and discordant groups for sociodemographic factors, modes of use, secondhand exposure to cannabis and tobacco, and alcohol use and cotinine positivity. STUDY DESIGN The Cannabis Use During Development and Early Life (CUDDEL) Study is an ongoing longitudinal study that recruits pregnant individuals presenting for obstetric care, who report lifetime cannabis use as well as using (n = 289) or not using cannabis (n = 169) during pregnancy. During the first trimester pregnancy visit, SR of cannabis use and a UDS for cannabis, other illicit drugs and nicotine are acquired from eligible participants, of whom 333 as of 05/01/2023 had both. RESULTS Using available CUDDEL Study data on both SR and UDS (n = 333; age 26.6 ± 4.7; 88.6% Black; 45.4% below federal poverty threshold; 56.5% with paid employment; 89% with high school education; 22% first pregnancy; 12.3 ± 3.6 weeks gestation), we classified pregnant individuals with SR and UDS data into 4 groups based on concordance (k = 0.49 [95% C.I. 0.40-0.58]) between SR cannabis use and UDS cannabis detection during the first trimester: 1) SR+/UDS+ (n = 107); 2) SR-/UDS- (n = 142); 3) SR+/UDS- (n = 44); 4) SR-/UDS+ (n = 40). Those who were SR+/UDS- reported less frequent cannabis use and fewer hours under the influence of cannabis during their pregnancy. Those who were SR-/UDS+ were more likely to have joined the study at a lower gestational age with 62.5% reporting cannabis use during their pregnancy prior to being aware that they were pregnant. Of the 40 SR-/UDS+ women, 14 (i.e., 35%) reported past month secondhand exposure, or blunt usage. In the subset of individuals with SR and UDS available at trimester 2 (N = 160) and 3 (N = 140), concordant groups were mostly stable and > 50% of those in the discordant groups became concordant by the second trimester. Classifying individuals as exposed or not exposed who were SR+ and/or UDS+ resulted in minor changes in group status based on self-report at screening. CONCLUSION Overall, there was moderate concordance between SR and UDS for cannabis use/exposure during pregnancy. Instances of SR+/UDS- discordancy may partially be attributable to lower levels of use that are not detected on UDS. SR-/UDS+ discordancy may arise from recent use prior to knowledge of pregnancy, extreme secondhand exposure, deception, and challenges with completing questionnaires. Acquiring both self-report and biological detection of cannabis use/exposure allows for the examination of convergent evidence. Classifying those who are SR+ and/or UDS+ as individuals who used cannabis during their first trimester after being aware of their pregnancy resulted in only a minor change in exposure status; thus, relying on self-report screening, at least in this population and within this sociocultural context likely provides an adequate approximation of cannabis use during pregnancy.
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Affiliation(s)
- Ryan Bogdan
- Psychological & Brain Sciences, Washington University in Saint Louis, United States.
| | - Shelby D Leverett
- Division of Biology & Biomedical Sciences, Neurosciences Program, Washington University in Saint Louis, United States; Department of Psychiatry, Washington University in Saint Louis, United States
| | | | | | - David B Liss
- Department of Emergency Medicine, Washington University in Saint Louis, United States
| | - Emma C Johnson
- Department of Psychiatry, Washington University in Saint Louis, United States
| | - Shannon N Lenze
- Department of Psychiatry, Washington University in Saint Louis, United States
| | - Rachel E Lean
- Department of Psychiatry, Washington University in Saint Louis, United States
| | - Tara A Smyser
- Department of Psychiatry, Washington University in Saint Louis, United States
| | - Ebony B Carter
- Department of Obstetrics & Gynecology, Washington University in Saint Louis, United States
| | | | - Cynthia E Rogers
- Department of Psychiatry, Washington University in Saint Louis, United States
| | - Arpana Agrawal
- Department of Psychiatry, Washington University in Saint Louis, United States
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12
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Valerio H, Marshall AD, Conway A, Treloar C, Carter L, Martinello M, Henderson C, Amin J, Read P, Silk D, Degenhardt L, Prain B, Alavi M, Dore GJ, Grebely J. Factors associated with hepatitis C testing, treatment, and current hepatitis C infection among men and women who inject drugs: The ETHOS engage study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 127:104394. [PMID: 38608357 DOI: 10.1016/j.drugpo.2024.104394] [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] [Received: 11/29/2023] [Revised: 02/26/2024] [Accepted: 03/13/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Evaluating gender-specific trends in hepatitis C virus (HCV) treatment uptake among men and women who inject drugs is crucial for ensuring equitable progress towards HCV elimination. This study aimed to quantify differences in testing, treatment, and current HCV infection between men and women who inject drugs. METHOD ETHOS Engage is an observational cohort study of people who inject drugs attending drug treatment clinics and needle and syringe programs in Australia recruited from May 2018-September 2019 (wave 1) and November 2019-April 2021 (wave 2). Participants completed a questionnaire including self-reported HCV testing and treatment history and underwent point-of-care HCV RNA testing (Xpert® HCV Viral Load Fingerstick). Logistic regression was used to compare the factors associated with self-reported HCV testing and treatment and current HCV infection for men and women who inject drugs. RESULTS Among 2,395 participants enrolled in ETHOS Engage, 66% (n = 1,591) were men, 33% (n = 786) women, and <1% (n = 18) did not identify as a man or woman. HCV testing history and current infection were similar among men and women. Among men or women ever eligible for HCV treatment (ever chronic HCV) (n = 1,242), women were less likely to report a history of HCV treatment compared to men (227/352, 64% vs. 631/890, 71%; p = 0.03). Among women, those aged <45 were less likely to report HCV testing (aOR: 0.57, 95%CI: 0.36, 0.90), treatment (aOR: 0.47, 95%CI: 0.29, 0.77), and more likely to have HCV infection (aOR: 1.48, 95%CI: 1.00, 2.20) CONCLUSION: Among women, those of childbearing age (<45) were less likely to report testing and treatment and were more likely to have current HCV infection. Women <45 years old should be a priority population for HCV care. Services that interface with these women should be optimised to enhance HCV testing and treatment.
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Affiliation(s)
- Heather Valerio
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
| | - Alison D Marshall
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia; Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anna Conway
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia; Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lisa Carter
- Hepatitis SA, Hackney, South Australia, Australia
| | - Marianne Martinello
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Janaki Amin
- Macquarie University, Sydney, New South Wales, Australia
| | - Phillip Read
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia; Kirketon Road Centre, Sydney, New South Wales, Australia
| | - David Silk
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Bianca Prain
- Population Health Strategy & Performance, NSW Health, New South Wales, Australia
| | - Maryam Alavi
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Jason Grebely
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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13
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Le AB, Urban-Wojcik E, Seewald M, Mezuk BR. The Relationship Between Workplace Drug Policies, Opioid Misuse, and Psychological Distress: Evidence From the 2020 National Survey on Drug Use and Health. New Solut 2024; 34:22-37. [PMID: 38332622 PMCID: PMC11003197 DOI: 10.1177/10482911241231523] [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: 02/10/2024]
Abstract
Background: This study, using a nationally representative dataset of the U.S. workforce, examines how punitive workplace drug policies relate to opioid use/misuse and psychological distress. Methods: The sample included adults aged ≥18 years who participated in the National Survey on Drug Use and Health and were employed in 2020. Hierarchical multivariate logistical models were constructed to address the research questions. Results: The weighted, design-based estimates indicate that of 147 831 081 workers, 3.38% reported misusing opioids in the last 12 months. Having a punitive workplace policy was associated with higher rates of opioid use/misuse among workers aged ≤ 34 compared to their same-aged counterparts in nonpunitive workplaces, and among workers identifying as Black, Indigenous, or Person of Color who also experienced severe psychological distress the past year. Conclusion: Some employers may think drug testing policies are net-beneficial to worker well-being; these findings indicate such policies may interact in harmful ways with psychological distress.
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Affiliation(s)
- Aurora B. Le
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Emily Urban-Wojcik
- Eisenberg Family Depression Center, University of Michigan, Ann Arbor, MI, USA
| | - Meghan Seewald
- Eisenberg Family Depression Center, University of Michigan, Ann Arbor, MI, USA
| | - Briana R. Mezuk
- Eisenberg Family Depression Center, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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14
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Witcraft SM, Johnson E, Eitel AE, Moreland AD, King C, Terplan M, Guille C. Listening to Black Pregnant and Postpartum People: Using Technology to Enhance Equity in Screening and Treatment of Perinatal Mental Health and Substance Use Disorders. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01989-z. [PMID: 38605223 DOI: 10.1007/s40615-024-01989-z] [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: 01/08/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024]
Abstract
Perinatal mood and anxiety disorders (PMADs), perinatal substance use disorders (PSUDs), and intimate partner violence (IPV) are leading causes of pregnancy-related deaths in the United States. Screening and referral for PMADs, PSUDs and IPV is recommended, however, racial disparities are prominent: Black pregnant and postpartum people (PPP) are less likely to be screened and attend treatment compared to White PPP. We conducted qualitative interviews to better understand the experience of Black PPP who used a text/phone-based screening and referral program for PMADs/PSUDs and IPV-Listening to Women and Pregnant and Postpartum People (LTWP). We previously demonstrated that LTWP led to a significant reduction in racial disparities compared to in-person screening and referral, and through the current study, sought to identify facilitators of PMAD/PSUD symptom endorsement and treatment attendance. Semi-structured interviews were conducted with 68 Black PPP who were or had been pregnant within the last 24 months, and who either had or did not have a PMAD or PSUD. Participants were enrolled in LTWP and provided feedback on their experience. Using a grounded theory approach, four themes emerged: usability, comfort, necessity, and recommendations. Ease of use, brevity, convenience, and comfort in discussing mental health and substance use via text were highlighted. Need for a program like LTWP in Black communities was discussed, given the reduction in perceived judgement and access to trusted information and resources for PMADs/PSUDs, which may lessen stigma. These qualitative findings illuminate how technology-based adaptations to behavioral health screening and referral can reduce perceived negative judgment and facilitate identification and referral to treatment, thereby more adequately meeting needs of Black PPP.
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Affiliation(s)
- Sara M Witcraft
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 67 President Street, MSC 861, 29425, Charleston, SC, USA.
| | - Emily Johnson
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, MSC 160, 29425, Charleston, SC, USA
| | - Anna E Eitel
- College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 617, 29425, Charleston, SC, USA
| | - Angela D Moreland
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 67 President Street, MSC 861, 29425, Charleston, SC, USA
| | - Courtney King
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 67 President Street, MSC 861, 29425, Charleston, SC, USA
| | - Mishka Terplan
- Friends Research Institute, 1040 Park Avenue, Ste. 103, 21201, Baltimore, MD, USA
| | - Constance Guille
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 67 President Street, MSC 861, 29425, Charleston, SC, USA
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston South Carolina, 171 Ashley Ave, 29425, Charleston, SC, USA
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15
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Bann CM, Okoniewski KC, Clarke L, Wilson-Costello D, Merhar S, DeMauro S, Lorch S, Ambalavanan N, Peralta-Carcelen M, Limperopoulos C, Poindexter B, Davis JM, Walsh M, Newman J. Psychological distress among postpartum women who took opioids during pregnancy: the role of perceived stigma in healthcare settings. Arch Womens Ment Health 2024; 27:275-283. [PMID: 37955711 PMCID: PMC10933137 DOI: 10.1007/s00737-023-01390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/24/2023] [Indexed: 11/14/2023]
Abstract
This study examined the relationship between perceived stigma in healthcare settings during pregnancy and psychological distress and well-being in the postpartum period among individuals who took opioids while pregnant. Analyses included 134 birth mothers of opioid-exposed infants. At 0-1 months postpartum, perceived stigma and psychological distress were measured using the Prenatal Opioid use Perceived Stigma scale and measures from the Patient-Reported Outcome Measurement Information System (PROMIS). Food insecurity, housing instability, and Adverse Childhood Experiences (ACEs) were also assessed. Linear and generalized linear mixed-effect models were conducted to compare PROMIS scale scores and unmet needs by stigma, adjusting for site/location, age, race/ethnicity, marital status, education, public insurance, and parity. More than half of participants (54%) perceived stigma in healthcare settings. Individuals reporting stigma had higher depression, anxiety, and anger scores (p < 0.001) indicating greater psychological distress in the postpartum period compared to those reporting no stigma, after controlling for demographic characteristics. In addition, they scored significantly lower on the PROMIS meaning and purpose scale, an indicator of well-being (p = 0.002). Those reporting stigma were more likely to have food insecurity (p = 0.003), three or more ACEs (p = 0.040), verbal or physical abuse during pregnancy (p < 0.001), and less emotional support (p = 0.006) than those who did not. An association was observed between perceived stigma in the prenatal period and psychological distress in the postpartum period, providing support for stigma reduction interventions and education for healthcare providers on trauma-informed care.
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Affiliation(s)
- Carla M Bann
- Analytics Division, RTI International, Research Triangle Park, NC, USA.
| | - Katherine C Okoniewski
- Genomics, Ethics, and Translational Research Center, RTI International, Research Triangle Park, NC, USA
| | - Leslie Clarke
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | | | - Stephanie Merhar
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sara DeMauro
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott Lorch
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | - Brenda Poindexter
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Michele Walsh
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Jamie Newman
- Analytics Division, RTI International, Research Triangle Park, NC, USA
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16
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Gulbransen K, Thiessen K, Ford N, Phillips Beck W, Watson H, Gregory P. Interprofessional Care Models for Pregnant and Early-Parenting Persons Who Use Substances: A Scoping Review. Int J Integr Care 2024; 24:24. [PMID: 38855026 PMCID: PMC11160395 DOI: 10.5334/ijic.7589] [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: 02/10/2023] [Accepted: 05/21/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Use of substances during pregnancy is a global health concern. Interprofessional care teams can provide an optimal care approach to engage individuals who use substances during the perinatal period. The purpose of this scoping review is to provide a comprehensive summation of published literature reporting on interprofessional care models for perinatal individuals who use substances. Methods We conducted a systematic search for articles from health-related databases. The Preferred Reporting Items for Systematic Reviews for Scoping Reviews (PRISMA-ScR) was followed. Data were extracted and synthesized to identify the interprofessional care team roles, program and/or provider characteristics, and care outcomes of these models. Results We screened 645 publications for full text eligibility. Eleven articles met full inclusion criteria and were summarized. Programs were built on co-location of services, partnership with other agencies, available group/peer support and approaches inclusive of cultural care, trauma informed care, and harm reduction principles. Discussion There is growing evidence supporting integrated care models that are inclusive of relational care providers from multiple health care professions to achieve wraparound care. Conclusions Many of the interprofessional care models studied have successfully blended social, primary, pregnancy, and addictions care. The success and sustainability of programs varies, and more work is needed to evaluate program and patient outcomes.
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Affiliation(s)
| | | | | | | | - Heather Watson
- Max Rady College of Medicine, University of Manitoba, CA
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17
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Guille C, King C, King K, Kruis R, Ford D, Maldonado L, Nietert PJ, Brady KT, Newman RB. Text And Telephone Screening And Referral Improved Detection And Treatment Of Maternal Mental Health Conditions. Health Aff (Millwood) 2024; 43:548-556. [PMID: 38560794 DOI: 10.1377/hlthaff.2023.01432] [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: 04/04/2024]
Abstract
Effective screening and referral practices for perinatal mental health disorders, perinatal substance use disorders (SUDs), and intimate partner violence are greatly needed to reduce maternal morbidity and mortality. We conducted a randomized controlled trial from January 2021 to April 2023 comparing outcomes between Listening to Women and Pregnant and Postpartum People (LTWP), a text- and telephone-based screening and referral program, and usual care in-person screening and referral within the perinatal care setting. Participants assigned to LTWP were three times more likely to be screened compared with those assigned to usual care. Among participants completing a screen, those assigned to LTWP were 3.1 times more likely to screen positive, 4.4 times more likely to be referred to treatment, and 5.7 times more likely to attend treatment compared with those assigned to usual care. This study demonstrates that text- and telephone-based screening and referral systems may improve rates of screening, identification, and attendance to treatment for perinatal mental health disorders and perinatal SUDs compared with traditional in-person screening and referral systems. System-level changes and complementary policies and insurance payments to support adoption of effective text- and telephone-based screening and referral programs are needed.
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Affiliation(s)
- Constance Guille
- Constance Guille , Medical University of South Carolina, Charleston, South Carolina
| | | | - Kathryn King
- Kathryn King, Medical University of South Carolina
| | - Ryan Kruis
- Ryan Kruis, Medical University of South Carolina
| | - Dee Ford
- Dee Ford, Medical University of South Carolina
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18
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Miller-Matero LR, Joseph-Mofford G, Abdole L, Loree AM, Vanderziel A, Vagnini KM, Hecht LM. Alcohol and cannabis use among women with infertility: associations with psychiatric symptoms, attempts to conceive, and engagement in fertility treatment. Arch Womens Ment Health 2024; 27:259-264. [PMID: 38082004 DOI: 10.1007/s00737-023-01408-y] [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] [Received: 08/28/2023] [Accepted: 11/30/2023] [Indexed: 03/13/2024]
Abstract
Little is known about substance use among women with infertility, yet substance use has implications for fertility and pregnancy. The purpose was to estimate the prevalence of substance use among women with infertility and examine whether substance use was associated with psychiatric symptoms, active attempts to conceive, and engagement in fertility treatments. Eligible patients were from a single healthcare system who received a female infertility diagnosis within the past 2 years. Participants (n = 188) completed an online questionnaire regarding substance use, psychiatric symptoms, attempts to conceive, and fertility treatments. The prevalence of hazardous alcohol use, any cannabis use, and hazardous cannabis use were 30.3%, 30.9%, and 8.5%, respectively. Hazardous alcohol use was not associated with psychiatric symptoms (p > .05). Those with any cannabis use were more likely to have higher depression scores than those without (p = .02). Those with hazardous cannabis use were more likely to have higher depression scores (p = .001) and higher anxiety scores (p = .03). Substance use was not associated with actively trying to conceive. Those pursuing fertility treatments had a lower percentage engaging in hazardous alcohol use compared to those not pursuing fertility treatments (19.0% vs. 36.3%, p = .02). Substance use among women with infertility is common. Hazardous cannabis use was associated with greater psychiatric symptoms, suggesting that cannabis may be used to cope with distress. Pursuing fertility treatments may serve as a protective factor for hazardous alcohol use. Clinicians treating patients with infertility may want to screen for substance use.
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Affiliation(s)
- Lisa R Miller-Matero
- Henry Ford Health, Behavioral Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA.
- Henry Ford Health, Center for Health Policy and Health Services Research, Detroit, MI, USA.
| | | | - Lana Abdole
- Henry Ford Health, Behavioral Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
| | - Amy M Loree
- Henry Ford Health, Center for Health Policy and Health Services Research, Detroit, MI, USA
| | - Alyssa Vanderziel
- Henry Ford Health, Center for Health Policy and Health Services Research, Detroit, MI, USA
| | - Kaitlyn M Vagnini
- Henry Ford Health, Behavioral Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
- Henry Ford Health, Center for Health Policy and Health Services Research, Detroit, MI, USA
| | - Leah M Hecht
- Henry Ford Health, Center for Health Policy and Health Services Research, Detroit, MI, USA
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19
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Lijewski VA, Aldrich H, Straub HL. The Impact of Social Vulnerability on Substance Use Detection Practices in Pregnancy. Am J Perinatol 2024. [PMID: 38503303 DOI: 10.1055/s-0044-1782686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
This study aimed to synthesize current literature regarding the impact of social vulnerability on pregnancy-related substance use detection in the United States and highlight disparities in substance use detection practices. Clinicaltrials.gov, Google Scholar, PubMed (includes MEDLINE), and Cochrane Library databases were searched using the following Medical Subject Headings (MeSH): (["pregnancy" or "prenatal"] AND ["substance use screening" or "urine toxicology testing" or "toxicology testing" or "urine drug screening" or "CRAFFT" or "4P's" or "4P's Plus" or "NIDA Quick Screen" or "DAST-10" or "SURP-P" or "WIDUS"], AND ("bias" or "disparities" or "social vulnerability"]). The search included systematic reviews, prospective and retrospective studies, randomized controlled trials, case studies, and qualitative and quantitative research from January 2014 through November 2023. Selected literature was limited to studies published in English, which included a study population of either pregnant individuals or pregnancy health care providers in the United States, and that were focused on inequities in pregnancy substance use detection. Using Covidence, three authors screened abstracts, and two screened full articles for inclusion. The included studies were evaluated for quality of evidence using the mixed methods appraisal tool. The search yielded 4,188 manuscripts; 37 were eligible for full review. A total of 18 manuscripts were included based on the relevancy of the topic. The most common social vulnerability domain identified was minority status (17/18), followed by socioeconomic status (11/18), household characteristics (8/18), and housing type (1/18). Social vulnerability plays a role in substance use detection among pregnant individuals. Most notably, race and ethnicity, age, and public insurance lead to increased rates of detection, though most individual factors need to be studied in greater depth. This study was registered with PROSPERO (PROSPERO ID CRD42022352598), the International Prospective Register of Systematic Reviews. KEY POINTS: · Socially vulnerable pregnant individuals are more likely to receive substance use screening or urine toxicology testing.. · Race, ethnicity, age, and insurance influence substance use detection disparities.. · More research is needed to understand how other characteristics influence disparities in substance use detection..
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Affiliation(s)
- Virginia A Lijewski
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado
| | - Heather Aldrich
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado
| | - Heather L Straub
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado
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20
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Beatty JR, Zelenak L, Gillon S, McGoron L, Goyert G, Ondersma SJ. Risk Identification in Perinatal Health Care Settings via Technology-Based Recruitment Methods: Comparative Study. JMIR Form Res 2024; 8:e48823. [PMID: 38437004 PMCID: PMC10949130 DOI: 10.2196/48823] [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: 05/08/2023] [Revised: 12/01/2023] [Accepted: 01/25/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Digital screening and intervention tools have shown promise in the identification and reduction of substance use in health care settings. However, research in this area is impeded by challenges in integrating recruitment efforts into ongoing clinical workflows or staffing multiple study clinics with full-time research assistants, as well as by the underreporting of substance use. OBJECTIVE The aim of the study is to evaluate pragmatic methods for facilitating study recruitment in health care settings by examining recruitment rates and participant characteristics using in-person-based versus flyer approaches. METHODS This study compared recruitment rates at a Women's Health clinic in the Midwest under 2 different recruitment strategies: in person versus via a flyer with a QR code. We also examined the disclosure of substance use and risk screener positivity for the 2 strategies. We also obtained information about the current use of technology and willingness to use it for study participation. RESULTS A greater percentage of patients recruited in person participated than those recruited via flyers (57/63, 91% vs 64/377, 17%). However, the final number recruited in each group was roughly equal (n=57 vs n=64). Additionally, participants recruited via flyers were more likely to screen positive for alcohol use risk on the Tolerance, Annoyed, Cut Down, Eye-Opener alcohol screen than those recruited at the clinic (24/64, 38% vs 11/57, 19%; χ21=4.9; P=.03). Participants recruited via flyers were also more likely to screen positive for drug use risk on the Wayne Indirect Drug Use Screener than those recruited at the clinic (20/64, 31% vs 9/57, 16%; χ21=4.0; P=.05). Furthermore, of the 121 pregnant women, 117 (96.7%) reported owning a smartphone, 111 (91.7%) had an SMS text message plan on their phone, and 94 (77.7%) reported being willing to receive SMS text messages or participate in a study if sent a link to their phone. CONCLUSIONS The distribution of flyers with a QR code by medical staff appears to be an efficient and cost-effective method of recruitment that also facilitates disclosure while reducing the impact on clinic workflows. This method of recruitment can be useful for data collection at multiple locations and lead to larger samples across and between health systems. Participant recruitment via technology in perinatal health care appears to facilitate disclosure, particularly when participants can learn about the research and complete screening using their own device at a place and time convenient for them. Pregnant women in an urban Midwestern hospital had access to and were comfortable using technology.
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Affiliation(s)
- Jessica R Beatty
- Merrill Palmer Skillman Institute for Child & Family Development, Wayne State University, Detroit, MI, United States
| | - Logan Zelenak
- Merrill Palmer Skillman Institute for Child & Family Development, Wayne State University, Detroit, MI, United States
| | - Spencer Gillon
- Merrill Palmer Skillman Institute for Child & Family Development, Wayne State University, Detroit, MI, United States
| | - Lucy McGoron
- Merrill Palmer Skillman Institute for Child & Family Development, Wayne State University, Detroit, MI, United States
| | - Gregory Goyert
- Maternal Fetal Medicine, Women's Health Services, Henry Ford Health, Detroit, MI, United States
| | - Steven J Ondersma
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, Flint, MI, United States
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, United States
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Cleveland LM, McGlothen-Bell K. Drug Testing of Pregnant Patients. J Obstet Gynecol Neonatal Nurs 2024; 53:93-95. [PMID: 38331389 DOI: 10.1016/j.jogn.2024.01.007] [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: 02/10/2024] Open
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Micalizzi L, Aston ER, Nesi J, Price D, Gunn RL. A Descriptive Analysis of a Popular Pregnancy Forum: Comments on the Developmental Consequences of Cannabis Use on Offspring. J Stud Alcohol Drugs 2024; 85:210-217. [PMID: 38095172 PMCID: PMC10941825 DOI: 10.15288/jsad.23-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 11/21/2023] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVE Pregnant and postpartum people want more and higher quality information about the effects of perinatal cannabis use (PCU) on child health, and they turn to anonymous sources of information, such as online pregnancy forums, to make decisions about its use. This study characterized perceptions of the developmental impact of PCU on children via a narrative evaluation of a public forum on which people discuss a range of issues around cannabis use. METHOD A random sample of 10 threads per month from June 2020 to May 2021 were scraped from the "Ganja Mamas" forum on Whattoexpect.com. Posts were analyzed if they discussed use of cannabis during pregnancy or lactation and children. A qualitative coding structure was developed from a literature review on PCU and was refined for inclusion of emergent topics. Posts were evaluated by two coders using applied thematic analysis and were assessed using an open coding process to identify key topics. Associated codes were grouped into themes. RESULTS Posters (a) discussed the negative and positive impact of PCU on child physical, cognitive, and socioemotional development; (b) garnered information about PCU from sources other than medical providers; and (c) discussed harm-reduction approaches to reduce impacts of PCU on child health. CONCLUSIONS There is a need for stigma-free support around PCU decision-making for people who select into discussion forums designed for communication and support around parental cannabis use. This forum presents a fruitful opportunity for intervention to encourage health-promoting behaviors through the provision of evidence-based information.
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Affiliation(s)
- Lauren Micalizzi
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island
| | - Elizabeth R. Aston
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island
| | - Jacqueline Nesi
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
- Rhode Island Hospital, Providence, Rhode Island
| | - Dayna Price
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island
| | - Rachel L. Gunn
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island
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23
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Chan J, Ward B, Maher L, Crawford S, Stoové M, Dietze P. Parents who inject drugs: Demographics, care arrangements and correlates for child placement in out-of-home care. Drug Alcohol Rev 2024; 43:775-786. [PMID: 38147397 DOI: 10.1111/dar.13798] [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] [Received: 05/03/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Children in families affected by substance use disorders are at high risk of being placed in out-of-home care (OOHC). We aimed to describe the characteristics of parents who inject drugs and identify correlates associated with child placement in OOHC. METHODS We used baseline data from a community-based cohort of parents who inject drugs (SuperMIX) from Melbourne, Australia. Participants were recruited via convenience, respondent-driven and snowball sampling from April 2008 to November 2020, with follow-up until March 2021. To explore correlates associated with child placement to OOHC, we used multivariable logistic regression and assessed for potential interactions between gender and a range of relevant covariates. RESULTS Of the 1067 participants, 611 (57%) reported being parents. Fifty-six percent of parents reported child protection involvement. Almost half (49%) had children in OOHC. Nearly half of the parents lived in unstable accommodation (44%) and many of them experienced moderate-severe levels of anxiety (48%) and depression (53%). Female or non-binary gender, identifying as Aboriginal or Torres Strait Islander, experiencing assault and having more children were associated with child removal to OOHC. Of the 563 participants who reported their own childhood care status, 135 (24%) reported they had been removed to OOHC. DISCUSSION AND CONCLUSIONS We identified high rates of child placement in OOHC among parents who inject drugs. There is a need for targeted health and social services, that are gender and culturally responsive, in addition to systems-level interventions addressing social inequities, such as housing, to support parents to care for their children.
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Affiliation(s)
| | - Bernadette Ward
- Burnet Institute, Melbourne, Australia
- School of Rural Health, Monash University, Melbourne, Australia
| | - Lisa Maher
- Burnet Institute, Melbourne, Australia
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Sione Crawford
- Burnet Institute, Melbourne, Australia
- Harm Reduction Victoria, Melbourne, Australia
| | - Mark Stoové
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Paul Dietze
- Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Curtin University, Melbourne, Australia
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Burgos L, Gelband M. Addressing substance use disorder in a hospital prenatal setting. SOCIAL WORK IN HEALTH CARE 2024; 63:230-236. [PMID: 38372152 DOI: 10.1080/00981389.2024.2316695] [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: 07/31/2023] [Accepted: 01/19/2024] [Indexed: 02/20/2024]
Abstract
Pregnancy can be a time of joy and hope but, for birthing parents struggling with a substance use disorder (SUD), it can be challenging. Social stigma, shame, and the potential legal ramifications present barriers to individuals seeking the care they need. Marginalized groups, in particular, face challenges that put them at even greater risk for substance misuse. Substance use during pregnancy can further impair the individual's level of functioning, and it has also been associated with problems in the social, emotional, and cognitive development of their children. Pregnancy and addiction each require guidance and good medical care. By integrating substance misuse treatment services under the umbrella of their medical care, clinics facilitate timely access to care, as well as help break the stigma associated with substance misuse. Our program offers a comprehensive and multidisciplinary approach to support pregnant individuals with SUDs. Interventions include support, education, case management, and mental health counseling. By providing optimal prenatal care early on, individuals can receive the treatment that they need so that they can achieve physical and emotional stability once the baby arrives, which ultimately has better outcomes for the parent and child's health and wellbeing.
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Affiliation(s)
- Laudy Burgos
- Social Work, Mount Sinai Hospital Department of Social Work Services, New York, USA
| | - Michelle Gelband
- Social Work, Mount Sinai Hospital Department of Social Work Services, New York, USA
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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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Raifman S, Biggs MA, Rocca C, Roberts SCM. Is legal recreational cannabis associated with cannabis use during pregnancy, beliefs about safety, and perceived community stigma? Drug Alcohol Depend 2024; 255:111079. [PMID: 38183831 DOI: 10.1016/j.drugalcdep.2023.111079] [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] [Received: 09/15/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Among pregnant and recently pregnant people we investigated whether legal recreational cannabis is associated with pregnancy-related cannabis use, safety beliefs, and perceived community stigma. METHODS In 2022, we surveyed 3571 currently and recently pregnant English- or Spanish-speaking adults in 37 states. Primary outcomes included cannabis use during pregnancy and two continuous scale measures of beliefs about safety and perceived community stigma. Using generalized linear models and mixed effects ordinal logistic regression with random effects for state, we assessed associations between legal recreational cannabis and outcomes of interest, controlling for state-level and individual-level covariates and specifying appropriate functional form. RESULTS Those who reported cannabis use during pregnancy were more likely to believe it is safe and to perceive community stigma compared to those who did not report use during pregnancy. Legal recreational cannabis was not associated with cannabis use during pregnancy, continuation or increase in use, frequency of use, or safety beliefs. Legal recreational cannabis was associated with lower perceived community stigma (coefficient: -0.07, 95% CI: -0.13, -0.01), including among those who reported use during (coefficient = -0.22, 95% CI: -0.40, -0.04) and prior to but not during (coefficient = -0.19, 95% CI: -0.37, -0.01) pregnancy. CONCLUSION Findings do not support concerns that legal recreational cannabis is associated with cannabis use during pregnancy or beliefs about safety. Legal recreational cannabis may be associated with lower community stigma around cannabis use during pregnancy, which could have implications for pregnant people's disclosure of use and care-seeking behavior.
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Affiliation(s)
- Sarah Raifman
- Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Oakland, CA 94612, USA.
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Oakland, CA 94612, USA
| | - Corinne Rocca
- Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Oakland, CA 94612, USA
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Oakland, CA 94612, USA
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Gilmour L, Honeybul L, Lewis S, Smith E, Cheyne H, Aladangady N, Featherstone B, Maxwell M, Neale J, Radcliffe P. Scoping review: mapping clinical guidelines and policy documents that address the needs of women who are dependent on drugs during the perinatal period. BMC Pregnancy Childbirth 2024; 24:84. [PMID: 38273236 PMCID: PMC10809451 DOI: 10.1186/s12884-023-06172-6] [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] [Received: 06/01/2023] [Accepted: 12/03/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Women who use or are in treatment for drug use during the perinatal period often have complex needs and presenting comorbidity. Women who use opioids during pregnancy, and their infants, experience poor outcomes. Drug use by women during pregnancy is a public health priority. This scoping review aimed to (1) map clinical guidelines, treatment protocols and good practice guidance across the UK for women who use or are in treatment for drug use during the perinatal period, (2) identify recommended best practice across health and social care for optimising outcomes and reducing inequalities for these women and (3) identify potential gaps within guidance. METHODS We followed the Joanna Briggs International (JBI) guidance on scoping reviews and PRISMA Scr extension. A registered protocol, containing a clear search strategy, inclusion, and exclusion criteria was adhered to. Reviewers double screened 25%, discussing disagreements. Data were extracted using a predefined template and charted in tables. Recommendations for best practice were organised around agreed categories. RESULTS Of 968 documents screened, 111 met the inclusion criteria. The documents included UK-wide, national, regional, and organisational policy documents. They varied in the degree they were relevant to women who use or are in treatment for drug use during the perinatal period, the settings to which they applied, and their intended users. Most were created without patient or public involvement and lacked any clear evidence base. Overall, documents recommended an integrated model of care with a lead professional, clear referral pathways and information sharing between agencies. Guidance suggested referrals should be made to specialist midwives, drug, and social care services. A holistic assessment, inclusive of fathers / partners was suggested. Recent documents advocated a trauma-informed care approach. Opioid substitution therapy (OST) was recommended throughout pregnancy where required. Potential gaps were identified around provision of support for women postnatally, especially when their baby is removed from their care. CONCLUSIONS This synthesis of recommended practice provides key information for practitioners, service providers and policy makers. It also highlights the need for guidelines to be evidence-based, informed by the experiences of women who use or are in treatment for drug use during the perinatal period, and to address the support needs of postnatal women who have their babies removed from their care.
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Affiliation(s)
- Lynne Gilmour
- Nursing, Midwifery and Allied Health Professions Research Unit, Pathfoot Building, University of Stirling, Stirling, FK9 4LA, Scotland.
| | - Louise Honeybul
- Nursing, Midwifery and Allied Health Professions Research Unit, Pathfoot Building, University of Stirling, Stirling, FK9 4LA, Scotland
| | - Shirley Lewis
- Department of Behavioural and Social Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - Emma Smith
- National Addiction Centre, Kings College London, Denmark Hill, London, SE5 8BB, UK
| | - Helen Cheyne
- Nursing, Midwifery and Allied Health Professions Research Unit, Pathfoot Building, University of Stirling, Stirling, FK9 4LA, Scotland
| | | | - Brid Featherstone
- Department of Behavioural and Social Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, Pathfoot Building, University of Stirling, Stirling, FK9 4LA, Scotland
| | - Joanne Neale
- National Addiction Centre, Kings College London, Denmark Hill, London, SE5 8BB, UK
| | - Polly Radcliffe
- National Addiction Centre, Kings College London, Denmark Hill, London, SE5 8BB, UK
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Austin AE, Naumann RB, DiPrete BL, Geary S, Proescholdbell SK, Jones-Vessey K. Pregnancy-associated homicide, suicide and unintentional opioid-involved overdose deaths, North Carolina 2018-2019. Inj Prev 2024:ip-2023-045112. [PMID: 38195655 PMCID: PMC11231051 DOI: 10.1136/ip-2023-045112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Rates of death due to homicide, suicide and overdose during pregnancy and the first year postpartum have increased substantially in the USA in recent years. The aims of this study were to use 2018-2019 data on deaths identified for review by the North Carolina Maternal Mortality Review Committee (NC-MMRC), data from the North Carolina Violent Death Reporting System (NC-VDRS) and data from the Statewide Unintentional Drug Overdose Reporting System (NC-SUDORS) to examine homicide, suicide and unintentional opioid-involved overdose deaths during pregnancy and the first year postpartum. METHODS We linked data from the 2018-2019 NC-MMRC to suicide and homicide deaths among women ages 10-50 years from the 2018-2019 NC-VDRS and to unintentional opioid-involved overdose deaths among women ages 10-50 years from the 2018-2019 NC-SUDORS. We conducted descriptive analyses to examine the prevalence of demographic characteristics and the circumstances surrounding each cause of death. RESULTS From 2018 to 2019 in North Carolina, there were 23 homicides, nine suicides and 36 unintentional opioid-involved overdose deaths (9.7, 3.8 and 15.1 per 100 000 live births, respectively) during pregnancy and the first year postpartum. Most homicide deaths (87.0%) were by firearm, and more than half (52.5%) were related to intimate partner violence. More than two-thirds of women who died by suicide had a current mental health problem (77.8%). Less than one-fourth (22.2%) of those who died by unintentional opioid-involved overdose had a known history of substance use disorder treatment. CONCLUSION Our approach to quantifying and describing these causes of pregnancy-associated death can serve as a framework for other states to inform data-driven prevention.
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Affiliation(s)
- Anna E Austin
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebecca B Naumann
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bethany L DiPrete
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shana Geary
- Injury and Violence Prevention Branch, North Carolina Division of Public Health, Raleigh, North Carolina, USA
| | - Scott K Proescholdbell
- Injury and Violence Prevention Branch, North Carolina Division of Public Health, Raleigh, North Carolina, USA
| | - Kathleen Jones-Vessey
- North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
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Campbell AG, Naz S, Gharbi S, Chambers J, Denne S, Litzelman DK, Wiehe SE. The Concordance of Electronic Health Record Diagnoses and Substance use Self-Reports Among Reproductive Aged Women Enrolled in a Community-Based Addiction Reduction Program. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241237051. [PMID: 38528783 DOI: 10.1177/00469580241237051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Substance use disorders among reproductive aged women are a major public health issue. There is little work investigating the validity and reliability of electronic health record (EHR) data for measuring substance use in this population. This study examined the concordance of self-reported substance use with clinical diagnoses of substance use, substance abuse and substance use disorder in EHR data. Reproductive age women enrolled in the Community-Based Addiction Reduction (CARE) program were interviewed by peer recovery coaches (PRC) at enrollment. That survey data was linked with EHR data (n = 102). Concordance between self-reported substance use and clinical diagnoses in the EHR was examined for opioids, cannabis/THC, and cocaine. Cohen's kappa, sensitivity, and specificity were calculated. The survey captured a higher number of women who use substances compared to the EHR. The concordance of self-report with EHR diagnosis varied by substance and was higher for opioids (17.6%) relative to cannabis/THC (8.8%), and cocaine (3.0%). Additionally, opioids had higher sensitivity (46.2%) and lower specificity (76.2%) relative to cannabis/THC and cocaine. Survey data collected by PRCs captured more substance use than EHRs, suggesting that EHRs underestimate substance use prevalence. The higher sensitivity and lower specificity of opioids was due to a larger number of women who had a diagnosis of opioid use in the EHR who did not self-report opioid use in the self-report survey relative to cannabis/THC and cocaine. Opioid self-report and diagnosis may be influenced by research setting, question wording, or receipt of medication for opioid use disorder.
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Affiliation(s)
| | - Saman Naz
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sami Gharbi
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joanna Chambers
- Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Clinical Translational Sciences Institute, Indianapolis, IN, USA
| | - Scott Denne
- Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Clinical Translational Sciences Institute, Indianapolis, IN, USA
| | - Debra K Litzelman
- Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Clinical Translational Sciences Institute, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Sarah E Wiehe
- Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Clinical Translational Sciences Institute, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
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Taylor KJ. A Different Vision: Centering Love Not Punishment for Families Affected by Substance Use. Matern Child Health J 2023; 27:182-186. [PMID: 37955838 PMCID: PMC10691986 DOI: 10.1007/s10995-023-03843-w] [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: 11/03/2023] [Indexed: 11/14/2023]
Abstract
Improving maternal and child outcomes requires us to understand and deconstruct our country's historically punitive policies toward pregnant and parenting people who use drugs. We also must build a new system that centers wellness in partnership with individuals directly affected by these policies. From a maternal and child health (MCH) perspective, wellness is defined as parent-infant dyads living in supportive, preserved, and loving families with access to the resources needed for optimal health. To achieve wellness and positive outcomes, all individuals must have equitable access to a full continuum of culturally and linguistically effective, geographically available, evidence-informed, non-punitive, and welcoming health and social services that prioritize family preservation. In addition, to attain transformative and equitable outcomes, advocates for families affected by substance use must focus on implementing and evaluating services and continuously monitoring disaggregated data to ensure inequities are eliminated.
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Reddy J, Palmer L, Putnam-Hornstein E. Three-Year Custody Outcomes Among Infants Investigated by Child Protection Systems for Prenatal Substance Exposure in California. Matern Child Health J 2023; 27:94-103. [PMID: 37256517 PMCID: PMC10692263 DOI: 10.1007/s10995-023-03690-9] [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: 05/16/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Infants affected by prenatal alcohol and drug use are more likely to be removed from parental custody than those in the general population, although it is unclear whether their custody outcomes differ from infants investigated by child protection systems (CPS) for other reasons. This analysis seeks to compare trajectories of involvement and custody outcomes among infants investigated by CPS with and without documentation of prenatal substance exposure (PSE). METHOD We used vital birth records linked to administrative CPS records to examine the timing of system involvement and 3-year custodial outcomes among investigated infants with and without identified PSE. We defined PSE according to documentation on the state's standardized hotline screening form, which CPS completes upon referral for alleged maltreatment. We estimated the likelihood a child was in nonparental custody at age 3 by specifying multivariable generalized linear models, adjusted for covariates available in the birth record. RESULTS In our sample of 22,855 infants investigated by CPS in 2017 in California, more than 26% had documentation of PSE. These infants experienced an accelerated timeline of system penetration and were 2.2 times as likely to be in nonparental placement at age 3. DISCUSSION PSE confers an independent risk of custody interruption among infants investigated by CPS. The younger age of these infants, complexity of parental substance use, and potential misalignment of administrative permanency timelines with parental recovery all suggest the need for increased research, policy, and programmatic interventions to serve this vulnerable population.
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Affiliation(s)
- Julia Reddy
- Gillings School of Global Public Health, University of North Carolina, 412 Rosenau Hall, Chapel Hill, NC, 27599, USA.
| | - Lindsey Palmer
- The Pennsylvania State University, 133 Health and Human Development Building, University Park, PA, 16802, USA
| | - Emily Putnam-Hornstein
- School of Social Work, University of North Carolina at Chapel Hill, Tate-Turner-Kuralt Building, 325 Pittsboro St, Chapel Hill, NC, 27599-3550, USA
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Martinez NG, Roberts SCM, Achu-Lopes RA, Samura TL, Seidman DL, Woodhams EJ. Reconsidering the use of urine drug testing in reproductive settings. Am J Obstet Gynecol MFM 2023; 5:101206. [PMID: 37871695 DOI: 10.1016/j.ajogmf.2023.101206] [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] [Received: 08/02/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
The urine drug test is ubiquitous within reproductive healthcare settings. Although the test can have evidence-based use for a patient and clinician, in practice, it is often applied in ways that are driven by bias and stigma, do not correctly inform decisions about clinical aspects of patient care, and cause devastating ripple effects through social and legal systems. This paper proposes a framework of guiding questions to prompt reflection on (1) the question the clinical team is trying to answer, (2) whether a urine drug test answers the question at hand, (3) how testing benefits compare with the associated risks, (4) a more effective tool for clinical decision-making if the urine drug test does not meet the standards for use, and (5) individual and institutional biases affecting decision-making. We demonstrate the use of this framework using 3 common uses of the urine drug test within abortion care and labor and delivery settings.
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Affiliation(s)
- Noelle G Martinez
- Division of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Martinez).
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, CA (Dr Roberts)
| | - Rachel A Achu-Lopes
- Department of Anesthesia, Boston Medical Center, Boston University School of Medicine, Boston, MA (Dr Achu-Lopes)
| | - Tirah L Samura
- Los Angeles County Department of Health Services, Harbor-University of California Los Angeles Medical Center, Los Angeles, CA (Dr Samura); Los Angeles County Department of Health Services, Martin Luther King, Jr. Outpatient Center, Los Angeles, CA (Dr Samura)
| | - Dominika L Seidman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA (Dr Seidman)
| | - Elisabeth J Woodhams
- Department of Obstetrics & Gynecology, Boston Medical Center, Boston University School of Medicine, Boston, MA (Dr Woodhams)
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Bormann NL, Miskle B, Holdefer P, Arndt S, Lynch AC, Weber AN. Evidence of telescoping in females across two decades of US treatment admissions for injection drug use: 2000-2020. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 9:100204. [PMID: 38045494 PMCID: PMC10690569 DOI: 10.1016/j.dadr.2023.100204] [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: 10/07/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023]
Abstract
Background People who inject drugs (PWID) have an increased risk of soft tissue infection, drug overdose and death. Females may be particularly vulnerable due to barriers to substance use disorder (SUD) treatment entry, stigma, and telescoping, or the greater severity in substance use-related comorbidity and consequences despite a shorter history of use. We set out to identify sex differences in United States injection drug use (IDU). Methods The Treatment Episode Dataset-Admission (2000-2020) provided data to identify PWID undergoing their initial SUD treatment admission. Mann-Whitney U test, chi-square, and Spearman correlations were used for ordinal variables, categorical variables, and to assess similarity of male/female trends over the 21 years, respectively. The probabilistic index (PI) and Cramer's V provided effect sizes for Mann-Whitney U tests and chi-square tests, respectively. Results A total of 13,612,978 records existed for cases entering their initial treatment. Mapping to a history of IDU left 1,458,695 (561,793 females). Females had a higher prevalence among PWID across all 21 years; IDU trends were essentially identical between males and females (r = 0.97). Females endorsed beginning their primary substance later in life (PI = 0.47, p < 0.0001) and entered treatment after a shorter period of substance use (PI = 0.57, p < 0.0001). Conclusions We saw evidence of telescoping among PWID with a SUD entering their initial episode of treatment. Interventions should be implemented prior to the transition to IDU, and this window of opportunity is shortened in females. Utilizing gender-responsive treatment options may be a way to increase treatment-seeking earlier in the disease course.
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Affiliation(s)
- Nicholas L. Bormann
- Department of Psychiatry and Psychology, Mayo Clinic, 404 W Fountain St, Albert Lea, Rochester, MN 56007, USA
| | - Benjamin Miskle
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Pharmacy, University of Iowa, Iowa City, IA, USA
| | - Paul Holdefer
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Stephan Arndt
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Alison C. Lynch
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, University of Iowa, Iowa City, IA, USA
| | - Andrea N. Weber
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
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34
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Townsel C, Irani S, Buis C, Lasser S, Menke N, Preston Y, Kountanis JA, Skoczylas M, Menke R, Getty B, Stout M, Muzik M. Partnering for the future clinic: A multidisciplinary perinatal substance use program. Gen Hosp Psychiatry 2023; 85:220-228. [PMID: 37992465 DOI: 10.1016/j.genhosppsych.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/29/2023] [Accepted: 10/13/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE The current model of obstetric care does not integrate multiple subspecialty services for high-risk pregnancies with substance use disorder (SUD), resulting in fragmented care. We describe the framework of our multidisciplinary and integrated perinatal substance use clinic and provide recent clinical outcomes. METHODS We detail the Partnering for the Future (PFF) clinic, which integrates numerous subspecialty and support services for patients with SUDs and complex mental health needs. Additionally, a retrospective chart review of patients receiving care in the PFF clinic from 2017 to 2021 was completed. RESULTS Seven integrated services are detailed with a focus on reducing stigma, providing trauma-informed care and mitigating harm. During the study period, 182 patients received care in PFF clinic, with opioid use disorder the most common indication for care. Co-occurring mental illness was common (81%). NICU admissions and severe NOWS diagnosis declined after the implementation of Eat-Sleep-Console. Social services identified care coordination, transportation assistance and adjustment counseling as the most common needs. A novel virtual behavioral health consultation service was successfully launched. CONCLUSIONS Our integrated care model supports the holistic care of pregnant people with SUD and mental health disease. Patient-centered care and co-located services have improved perinatal outcomes, particularly for opioid-exposed pregnancies.
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Affiliation(s)
- Courtney Townsel
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
| | - Sanaya Irani
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America; University of Michigan Medical School, United States of America
| | - Carol Buis
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
| | - Sheryl Lasser
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
| | - Nathan Menke
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Yolanda Preston
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Joanna A Kountanis
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States of America
| | - Maria Skoczylas
- University of Michigan Medical School, United States of America; Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States of America
| | - Rena Menke
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Barbara Getty
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
| | - Molly Stout
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
| | - Maria Muzik
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America; Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America.
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Morehouse E, Ingoldsby E, Newburg-Rinn S, Bertrand J, Usher K. Knowledge, Training, and Support Needs for Identification and Appropriate Care of Children with Prenatal Alcohol and Other Drug Exposures in the Child Welfare System. CHILD WELFARE 2023; 101:51-76. [PMID: 38415275 PMCID: PMC10896263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Increased awareness of the conditions associated with prenatal substance exposure may enhance care delivery among professionals working in child welfare. The ways in which prenatal substance exposure intersects with child welfare are critically important, yet prenatal substance exposure knowledge is uneven among these professionals. Also, caregivers may lack information that prepares them to care for children with prenatal substance exposure, particularly children with prenatal alcohol exposure. This study explores what professionals working in child welfare and caregivers know about prenatal substance exposure and prenatal alcohol exposure and their training and support needs.
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Affiliation(s)
| | | | - Sharon Newburg-Rinn
- Children's Bureau, Administration for Children and Families U.S. Department of Health and Human Services
| | - Jacquelyn Bertrand
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention
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36
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Darlington CK, Clark R, Jacoby SF, Terplan M, Alexander K, Compton P. Outcomes and experiences after child custody loss among mothers who use drugs: A mixed studies systematic review. Drug Alcohol Depend 2023; 251:110944. [PMID: 37713979 DOI: 10.1016/j.drugalcdep.2023.110944] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Mothers who use drugs are more likely to experience child custody loss than mothers who do not use drugs. The negative impact of removal on children has been well characterized in current literature while less is known about the impact of custody loss on mothers. The purpose of this mixed studies systematic review is to describe the state of science on the maternal outcomes and experiences after child custody loss among mothers who use drugs. METHODS PubMed, PsycINFO, CINAHL, and Social Work Abstract databases were systematically searched between June 2022 to January 2023. Article eligibility criteria centered on the outcomes and experiences of mothers who use drugs after losing child custody. Studies were analyzed using results-based convergent synthesis methodology for mixed studies reviews. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). A visual synthesis model was derived from combined results across all studies. RESULTS Of 2434 articles screened, 22 relevant scientific articles were selected for inclusion. Longitudinal, cohort studies (n=4) and a cross-sectional study (n=1) identified positive associations between custody loss and poorer mental health, increased drug use and overdose risk, less treatment engagement, and worsened social factors. Qualitative studies (n=17) identified themes that described re-traumatization after child custody loss and the development of coping mechanisms through identity negotiation. CONCLUSION Our findings indicate that child custody loss associated with drug use may exacerbate trauma and worsen maternal health. Immediate implications are provided for maternal health policy and practice in healthcare, child welfare, and legal professions.
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Affiliation(s)
- Caroline K Darlington
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States.
| | - Rebecca Clark
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States; Pennsylvania Hospital, Philadelphia, PA, United States
| | - Sara F Jacoby
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States
| | - Mishka Terplan
- Friends Research Institute, Baltimore, MD, United States
| | | | - Peggy Compton
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States
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37
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Khandelwal A, Lewey J, Mehta L. Improving Maternal Health Is a Team Sport. JACC. ADVANCES 2023; 2:100620. [PMID: 38938364 PMCID: PMC11198584 DOI: 10.1016/j.jacadv.2023.100620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Abha Khandelwal
- Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Jennifer Lewey
- Department of Medicine, University of Pennsylvania, Palo Alto, California, USA
| | - Laxmi Mehta
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
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38
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West BS, Choi S, Terplan M. In our responses to the overdose epidemic, we cannot forget pregnant and postpartum people. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104153. [PMID: 37572587 DOI: 10.1016/j.drugpo.2023.104153] [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: 04/02/2023] [Revised: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023]
Abstract
In 2021, there were over 100,000 drug overdose deaths in the United States (US). Death rates have increased faster among women than men, particularly among Black and Indigenous people. Although drug overdose is a leading cause of pregnancy-associated deaths, birthing people are rarely emphasized in discussions of overdose and research and services remain limited. Data show increases in drug use and deaths among women of child-bearing age, with risks continuing in the postpartum period. Harms experienced by birthing people who use drugs occur in the context of broader inequities in maternal morbidity and mortality that lead to disparate reproductive health outcomes. Shared structural antecedents (e.g. intersecting sexism and racism, stigma, and punitive policies) underlie overlapping epidemics of overdose and maternal morbidity and mortality. Here we discuss the unique challenges placed on birthing people who use drugs and make recommendations on how to mitigate harms by improving access to and delivery of quality care and addressing unjust policies and practices. We highlight the need for integrated health services, clearer guidelines rooted in equity, and the need for changes to policy and practice that support rather than punish. To better serve individuals and families impacted by substance use, we need multilevel solutions that advance gender equity and racial justice to reshape and/or dismantle the systems that undergird oppression.
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Affiliation(s)
- Brooke S West
- Columbia University School of Social Work, United States.
| | - Sugy Choi
- Department of Population Health, New York University Langone Health, United States
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39
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Bormann NL, Weber AN, Miskle B, Arndt S, Lynch AC. Sex Differences in Recovery Capital Gains Post-Incarceration. Subst Use Misuse 2023; 58:1839-1846. [PMID: 37702512 DOI: 10.1080/10826084.2023.2257303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND People with substance use disorders are highly prevalent in the carceral system. Recovery capital (RC) is the resources available to an individual to initiate or maintain substance use cessation. Sex differences have been identified in RC during both active substance use and recovery in the general population, however, less is known about these sex differences in the post-incarceration population. METHODS Participants (n = 136) were those with an opioid or stimulant use disorder with past year involvement with the Iowa criminal justice system (USA), who completed the Assessment of Recovery Capital (ARC) twice over a six-month cohort study. Participants were involved in an addiction clinic that utilized active case management. Analysis of covariance evaluated changes in ARC during the study. Separate models compared total ARC and individual ARC domains, with sex as the independent variable of interest. Model means were generated for interpretation based on sex, comparing baseline and study endpoint ARC scores. RESULTS There were no baseline sex differences in total ARC. ARC increased significantly for the group, however, males showed disproportionate growth. Females ended the study with a mean ARC of 37.8 (SD= 9.3) and males finished at 41.6 (SD= 9.3), which was a significant difference (p = 0.044); this significant difference was driven by ARC subdomains of 'Psychological Health' and 'Physical Health.' CONCLUSIONS People post-incarceration are at high risk for return to substance use. Treatment that is informed by sex-based differences may have the potential to decrease the differing rates of growth in RC between sexes.
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Affiliation(s)
| | - Andrea N Weber
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Benjamin Miskle
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Pharmacy, University of Iowa, Iowa City, IA, USA
| | - Stephan Arndt
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Alison C Lynch
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, University of Iowa, Iowa City, IA, USA
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40
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Pars E, VanDerNagel JEL, Dijkstra BAG, Schellekens AFA. Using the Recovery Capital Model to Explore Barriers to and Facilitators of Recovery in Individuals with Substance Use Disorder, Psychiatric Comorbidity and Mild-to-Borderline Intellectual Disability: A Case Series. J Clin Med 2023; 12:5914. [PMID: 37762855 PMCID: PMC10531644 DOI: 10.3390/jcm12185914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/04/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
Recovery capital (RC) encompasses the wide range of resources individuals can employ to recover from Substance Use Disorder (SUD). It consists of five subdomains: human, social, cultural, financial, and community RC. Negative recovery capital (NRC) represents the obstacles to recovery. Research on (N)RC in complex multimorbid populations is scarce. This study offers an initial exploration of the viability of (N)RC in three individuals with SUD, psychiatric comorbidities, and an intellectual disability (a triple diagnosis) in inpatient addiction treatment. We collected case file data, ranked recovery goals, and conducted follow-up interviews. The data were subjected to template analysis, using (N)RC domains as codes. All domains were prevalent and relevant, showing dynamic and reciprocal effects, influenced by critical life events acting as catalysts. Notably, during treatment, patients prioritized individual skill development despite challenges in other domains. RC emerges as a valuable concept for mapping recovery barriers and facilitators in individuals with a triple diagnosis, serving as an alternative to the medical model and complementing the biopsychosocial model. It provides a systematic framework to assess critical factors for recovery in complex cases and accordingly align interventions. Future studies should explore the intersections of NRC domains and the dynamic nature of (N)RC to enhance the understanding of the challenges faced by individuals with a triple diagnosis.
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Affiliation(s)
- Esther Pars
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), 6525 HR Nijmegen, The Netherlands; (J.E.L.V.); (B.A.G.D.)
- Department of Human Media Interaction (HMI), University of Twente, 7500 AE Enschede, The Netherlands
| | - Joanne E. L. VanDerNagel
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), 6525 HR Nijmegen, The Netherlands; (J.E.L.V.); (B.A.G.D.)
- Department of Human Media Interaction (HMI), University of Twente, 7500 AE Enschede, The Netherlands
- Tactus, Centre for Addiction and Intellectual Disability, 7400 AD Deventer, The Netherlands
- Aveleijn, 7622 GW Borne, The Netherlands
| | - Boukje A. G. Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), 6525 HR Nijmegen, The Netherlands; (J.E.L.V.); (B.A.G.D.)
- Behavioral Science Institute, Radboud University Nijmegen, 6525 GD Nijmegen, The Netherlands
- Novadic-Kentron, Addiction Care Centre, 5261 LX Vught, The Netherlands
| | - Arnt F. A. Schellekens
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), 6525 HR Nijmegen, The Netherlands; (J.E.L.V.); (B.A.G.D.)
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Kurtz T, Smid MC. Office-Based Management of Perinatal Substance Use and Substance Use Disorder for the General Obstetrician-Gynecologist. Obstet Gynecol Clin North Am 2023; 50:609-627. [PMID: 37500220 DOI: 10.1016/j.ogc.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
This is a review of substance use and substance use disorder in pregnancy, intended for the generalist obstetrician-gynecologist. Herein, the authors discuss legal considerations, outline definitions, review screening tools, introduce special considerations and harm reduction, caution the use of urinary toxicology testing, and touch on the screening, brief intervention, and referral to treatment model. Furthermore, the authors provide a brief overview of the prevalence, maternal and neonatal risks, and treatment approaches for commonly used substances.
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Affiliation(s)
- Theresa Kurtz
- Department of Obstetrics and Gynecology, University of Utah Health, 30 North 1900 East #2B200 SOM, Salt Lake City, UT 84132, USA.
| | - Marcela C Smid
- Department of Obstetrics and Gynecology, University of Utah Health, 30 North 1900 East #2B200 SOM, Salt Lake City, UT 84132, USA
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Natividad M, Seeman MV, Paolini JP, Balagué A, Román E, Bagué N, Izquierdo E, Salvador M, Vallet A, Pérez A, Monreal JA, González-Rodríguez A. Monitoring the Effectiveness of Treatment in Women with Schizophrenia: New Specialized Cooperative Approaches. Brain Sci 2023; 13:1238. [PMID: 37759839 PMCID: PMC10526759 DOI: 10.3390/brainsci13091238] [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: 07/19/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
Women with schizophrenia have specific health needs that differ from those of men and that change through successive life stages. We aimed to review the biopsychosocial literature on schizophrenia that addresses clinically important questions related to the treatment of women, including somatic morbi-mortality, hyperprolactinemia, comorbid substance use disorders, social risk factors, and medication effectiveness/safety. Data search terms were as follows: (Morbidity AND mortality) OR hyperprolactinemia OR ("substance use disorders" OR addictions) OR ("social risk factors") OR ("drug safety" OR prescription) AND women AND schizophrenia. A secondary aim was to describe a method of monitoring and interdisciplinary staff strategies. Schizophrenia patients show an increased risk of premature death from cardiovascular/respiratory disease and cancer compared to the general population. The literature suggests that close liaisons with primary care and the introduction of physical exercise groups reduce comorbidity. Various strategies for lowering prolactin levels diminish the negative long-term effects of hyperprolactinemia. Abstinence programs reduce the risk of victimization and trauma in women. Stigma associated with women who have serious psychiatric illness is often linked to reproductive functions. The safety and effectiveness of antipsychotic drug choice and dose differ between men and women and change over a woman's life cycle. Monitoring needs to be multidisciplinary, knowledgeable, and regular.
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Affiliation(s)
- Mentxu Natividad
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Mary V. Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON M5P 3L6, Canada;
| | - Jennipher Paola Paolini
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Ariadna Balagué
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Eloïsa Román
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Noelia Bagué
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Eduard Izquierdo
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Mireia Salvador
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Anna Vallet
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Anabel Pérez
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - José A. Monreal
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
- Institut de Neurociències, Universitat Autònoma de Barcelona (UAB), 08221 Terrassa, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
| | - Alexandre González-Rodríguez
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
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Marinelli S, Basile G, Manfredini R, Zaami S. Sex- and Gender-Specific Drug Abuse Dynamics: The Need for Tailored Therapeutic Approaches. J Pers Med 2023; 13:965. [PMID: 37373954 DOI: 10.3390/jpm13060965] [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: 04/06/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Sex and gender have been gaining ever greater attention due to their associated risks, dynamics, patterns and protective factors underlying substance abuse and addiction. Such differentiations and the clarification of complexities thereof take on even greater relevance in light of drug abuse scope worldwide. According to the 2022 World Drug Report released by the United Nations Office on Drugs and Crime (UNODC), in 2020 an estimated 284 million people worldwide aged 15-64 had used a drug within the last 12 months. The authors have set out to shed a light on determinants and contributing factors of drug abuse based on sex and gender and outline policy and medicolegal remarks aimed at delineating sex- and gender-based approaches towards drug abuse therapeutic interventions that are both therapeutically and ethically/legally viable and grounded in an evidence-based set of standards. Neurobiological data suggest that estrogen may facilitate drug taking by interacting with reward- and stress-related systems. In animal research, the administration of estrogen increases drug taking and facilitates the acquisition, escalation, and reinstatement of cocaine-seeking behavior. From a medicolegal perspective, it is of utmost importance to take into account the whole picture constituting each patient profile, which certainly includes gender factors and contributors, when outlining a therapeutic approach. Failure to do so could lead to negligence-based malpractice allegations, in light of the scientific findings representing best practices with which clinicians need to comply when caring for SUD patients.
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Affiliation(s)
- Susanna Marinelli
- School of Law, Università Politecnica delle Marche, 60121 Ancona, Italy
| | | | - Roberto Manfredini
- University Center for Studies on Gender Medicine, Department of Medical Sciences, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, "Sapienza" University of Rome, 00161 Rome, Italy
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Lipsett M, Wyant-Stein K, Mendes S, Berger E, Berkman ET, Terplan M, Cioffi CC. Addressing stigma within the dissemination of research products to improve quality of care for pregnant and parenting people affected by substance use disorder. Front Psychiatry 2023; 14:1199661. [PMID: 37351006 PMCID: PMC10282149 DOI: 10.3389/fpsyt.2023.1199661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/15/2023] [Indexed: 06/24/2023] Open
Abstract
Substance use disorders are a common and treatable condition among pregnant and parenting people. Social, self, and structural stigma experienced by this group represent a barrier to harm reduction, treatment utilization, and quality of care. We examine features of research dissemination that may generate or uphold stigmatization at every level for pregnant and parenting individuals affected by substance use disorder and their children. We explore stigma reduction practices within the research community that can increase uptake of evidence-based treatment programs and prevent potential harm related to substance use in pregnant and parenting people. The strategies we propose include: (1) address researcher stereotypes, prejudice, and misconceptions about pregnant and parenting people with substance use disorder; (2) engage in interdisciplinary and transdisciplinary collaborations that engage with researchers who have lived experience in substance use; (3) use community-based approaches and engage community partners, (4) address stigmatizing language in science communication; (5) provide contextualizing information about the social and environmental factors that influence substance use among pregnant and parenting people; and (6) advocate for stigma-reducing policies in research articles and other scholarly products.
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Affiliation(s)
- Megan Lipsett
- Department of Psychology, Center for Translational Neuroscience, University of Oregon, Eugene, OR, United States
| | - Katie Wyant-Stein
- Diamond Lab, Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Simone Mendes
- Department of Psychology, Center for Translational Neuroscience, University of Oregon, Eugene, OR, United States
| | - Estelle Berger
- Department of Psychology, Center for Translational Neuroscience, University of Oregon, Eugene, OR, United States
| | - Elliot T. Berkman
- Department of Psychology, Center for Translational Neuroscience, University of Oregon, Eugene, OR, United States
| | - Mishka Terplan
- Friends Research Institute, Baltimore, MD, United States
| | - Camille C. Cioffi
- Department of Psychology, Center for Translational Neuroscience, University of Oregon, Eugene, OR, United States
- Prevention Science Institute, University of Oregon, Eugene, OR, United States
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Forchuk C, Serrato J, Scott L. People with lived and living experience of methamphetamine use and admission to hospital: what harm reduction do they suggest needs to be addressed? Health Promot Chronic Dis Prev Can 2023; 43:338-347. [PMID: 37466399 PMCID: PMC10414816 DOI: 10.24095/hpcdp.43.7.04] [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: 07/20/2023]
Abstract
INTRODUCTION People who use substances may access hospital services for treatment of infections and injuries, substance use disorder, mental health issues and other reasons. Our aim was to identify the experiences, issues and recommendations of people who use methamphetamine and have accessed hospital services. METHODS Of the 114 people with lived and living experience of methamphetamine use recruited for a mixed-methods study conducted in southwestern Ontario, Canada, 104 completed the qualitative component. Interviews were conducted from October 2020 to April 2021. Participants were asked open-ended questions and the responses were analyzed using an ethnographic thematic approach. RESULTS Negative patient-staff interactions included stigma and a lack of understanding of addiction and methamphetamine use, leading to distrust, avoidance of hospital care and reduced help-seeking and health care engagement. The consequences can be infections, unsafe needle use, discharge against medical advice and withdrawal. Almost all participants were in favour of in-hospital harm reduction strategies including safe consumption services, provision of sterile equipment and sharps containers, and withdrawal support. Clinical implications include education to reduce knowledge gaps about methamphetamine use and addiction and address stigma, which could facilitate the introduction of harm reduction strategies. CONCLUSION Although the strategies identified by participants could promote a safer care environment, improving therapeutic relationships through education of health care providers and hospital staff is an essential first step. The addition of in-hospital harm reduction strategies requires attention as the approach remains uncommon in hospitals in Canada.
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Affiliation(s)
- Cheryl Forchuk
- Lawson Health Research Institute, London, Ontario, Canada
- Western University, London, Ontario, Canada
| | | | - Leanne Scott
- Lawson Health Research Institute, London, Ontario, Canada
- Western University, London, Ontario, Canada
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Gao Y(A, Krans EE, Chen Q, Rothenberger SD, Zivin K, Jarlenski MP. Sex-related differences in the prevalence of substance use disorders, treatment, and overdose among parents with young children. Addict Behav Rep 2023; 17:100492. [PMID: 37214425 PMCID: PMC10195847 DOI: 10.1016/j.abrep.2023.100492] [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: 12/05/2022] [Revised: 03/31/2023] [Accepted: 04/22/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Risk factors and treatment rates for substance use disorders (SUDs) differ by sex. Females often have greater childcare and household responsibilities than males, which may inhibit SUD treatment. We examined how SUD, medication for opioid use disorder (MOUD) receipt, and overdose rates differ by sex among parents with young children (<5 years). Methods Using deidentified national administrative healthcare data from Optum's Clinformatics® Data Mart Database version 8.1 (2007-2021), we identified parents aged 26-64 continuously enrolled in commercial insurance for ≥ 30 days and linked to ≥ 1 dependent child < 5 years from January 1, 2016-February 29, 2020. We used generalized estimating equations to estimate the average predicted prevalence of SUD diagnosis, MOUD receipt after opioid use disorder (OUD) diagnosis, and overdose by parent sex in any month, adjusting for age, race/ethnicity, state of residence, enrollment month, and mental health conditions. Results From 2016 to 2020, there were 2,241,795 parents with a dependent child < 5 years, including 1,155,252 (51.5%) females and 1,086,543 (48.5%) males. Male parents had a higher average predicted prevalence of an SUD diagnosis (11.1% [11, 11.16]) than female parents (5.5% [5.48, 5.58]). Among parents with OUD, the average predicted prevalence of receiving MOUD was 27.4% [26.1, 28.63] among male and 19.7% [18.34, 21.04] among female parents, with no difference in overdose rates by sex. Conclusion Female parents are less likely to be diagnosed with an SUD or receive MOUD than male parents. Removing policies that criminalize parental SUD and addressing childcare-related barriers may improve SUD identification and treatment.
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Affiliation(s)
- Yitong (Alice) Gao
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, United States
| | - Elizabeth E. Krans
- Department of Obstetrics, Gynecology & Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Qingwen Chen
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Scott D. Rothenberger
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Kara Zivin
- Department of Psychiatry, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Marian P. Jarlenski
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, United States
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Gräfe EL, Reid HMO, Shkolnikov I, Conway K, Kit A, Acosta C, Christie BR. Women are Taking the Hit: Examining the Unique Consequences of Cannabis Use Across the Female Lifespan. Front Neuroendocrinol 2023; 70:101076. [PMID: 37217080 DOI: 10.1016/j.yfrne.2023.101076] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/28/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023]
Abstract
Cannabis use has risen dramatically in recent years due to global decriminalization and a resurgence in the interest of potential therapeutic benefits. While emerging research is shaping our understanding of the benefits and harms of cannabis, there remains a paucity of data specifically focused on how cannabis affects the female population. The female experience of cannabis use is unique, both in the societal context and because of the biological ramifications. This is increasingly important given the rise in cannabis potency, as well as the implications this has for the prevalence of Cannabis Use Disorder (CUD). Therefore, this scoping review aims to discuss the prevalence of cannabis use and CUD in women throughout their lifespan and provide a balanced prospective on the positive and negative consequences of cannabis use. In doing so, this review will highlight the necessity for continued research that goes beyond sex differences.
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Affiliation(s)
- E L Gräfe
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - H M O Reid
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - I Shkolnikov
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - K Conway
- Island Medical Program, University of British Columbia, Victoria, British Columbia, Canada
| | - A Kit
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - C Acosta
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - B R Christie
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada; Island Medical Program, University of British Columbia, Victoria, British Columbia, Canada.
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Green C, George N, Park Y, Denny CH, Weber MK, Meaney-Delman D, Kim SY. Screening and Brief Interventions for Alcohol Use During Pregnancy: Practices Among US Primary Care Clinicians, DocStyles 2019. Prev Chronic Dis 2023; 20:E25. [PMID: 37055155 PMCID: PMC10109479 DOI: 10.5888/pcd20.220226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION Alcohol use during pregnancy can cause birth defects and developmental disabilities. From 2018 through 2020, 13.5% of pregnant women reported current drinking. The US Preventive Services Task Force recommends evidence-based tools (eg, AUDIT-C and SASQ) for implementing screening and brief interventions to reduce excessive alcohol use among adults, including pregnant people, for whom any alcohol use is considered excessive. METHODS We used DocStyles 2019 data to conduct a cross-sectional analysis to examine current screening and brief intervention practices that primary care clinicians conduct among pregnant patients; clinicians' confidence levels in conducting screening, brief interventions, and referral to treatment; and the documentation of brief interventions in the medical record. RESULTS A total of 1,500 US adult medicine clinicians completed the entire survey. Among the respondents who conduct screening (N = 1,373) and brief interventions (N = 1,357) in their practice, nearly all reported implementing screening (94.6%) and brief interventions (94.9%) with their pregnant patients for alcohol use, but fewer than half felt confident about conducting their screening practices (46.5%). Two-thirds (64%) reported using a tool that met the criteria recommended by the US Preventive Services Task Force (USPSTF). Over half documented brief interventions in electronic health record notes (51.7%) or designated space (50.7%). CONCLUSION Pregnancy presents a unique opportunity for clinicians to incorporate screening into routine obstetric care and encourage behavior change among patients. Most providers reported always screening their pregnant patients for alcohol use, but fewer used evidence-based USPSTF-recommended screening tools. Increased clinician confidence in screening and brief intervention, the use of standardized screening tools tailored to pregnant people, and maximal use of electronic health record technology may enhance the benefits of their application to alcohol use, which ultimately can reduce adverse outcomes associated with alcohol use during pregnancy.
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Affiliation(s)
- Caitlin Green
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia
- Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS S106-3, Atlanta, GA 30341
| | - Nisha George
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia
- Eagle Global Scientific, LLC, Atlanta, Georgia
| | - Youngjoo Park
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Clark H Denny
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary Kate Weber
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dana Meaney-Delman
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shin Y Kim
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia
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Smith C, Fatima H, McClain E, Bryant K, Verbiest S, Hassmiller Lich K. Supporting reproductive health among birthing persons with chronic conditions in the United States: A qualitative multilevel study using systems thinking to inform action. Health Serv Res 2023; 58:521-533. [PMID: 36632673 PMCID: PMC10012242 DOI: 10.1111/1475-6773.14131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE (STUDY QUESTION) To use systems thinking with diverse system actors to (a) characterize current problems at the intersection of chronic conditions (CCs) and reproductive health (RH) care and their determinants, (b) determine necessary system actors for change, and (c) document cross-system actions that can improve identified problems in the United States. DATA SOURCES/STUDY SETTING Data were collected from six groups of system actors via online focus groups. STUDY DESIGN This is a qualitative multilevel study using the iceberg systems thinking framework. DATA COLLECTION/EXTRACTION METHODS Data were collected by note-taking and recording six focus groups; analysis incorporated perspective triangulation using the systems thinking iceberg and system mapping to visualize interconnected system challenges, actors, and action ideas. PRINCIPAL FINDINGS Participants described eight necessary system actors: health care institutions, medical leaders, medical providers, patient advocates and foundations, patients and families, payors, policy makers, and research funders. Forty pain points were identified, spread across each of the four levels of the systems thinking iceberg: undesirable outcomes (6), concerning trends (9), system structure flaws (15), and problematic mental models (10). In response to these pain points, a set of 46 action ideas was generated by participants and mapped into nine action themes: (1) adjust QI metrics, incentives, and reimbursement, (2) bolster RH medical education and training, (3) break down medical silos, (4) enrich patient education, (5) expand the health care team, (6) improve holistic health care, (7) modify research and programmatic funding to prioritize RH and CC, (8) spur innovation for patient visits, and (9) support professional champions and leaders. CONCLUSIONS By embracing system complexity, creating visual maps, and pushing participants to identify actionable strategies for improvement, this study generates a set of specific actions that can be used to address pain points across the multiple system levels that make improving reproductive care for people with CCs so challenging.
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Affiliation(s)
- Cambray Smith
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hiba Fatima
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erin McClain
- Collaborative for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katherine Bryant
- Collaborative for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah Verbiest
- Collaborative for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Jordan Institute for Families, School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Bann CM, Newman JE, Okoniewski KC, Clarke L, Wilson-Costello D, Merhar S, Mack N, DeMauro S, Lorch S, Ambalavanan N, Limperopoulos C, Poindexter B, Walsh M, Davis JM. Psychometric Properties of the Prenatal Opioid Use Perceived Stigma Scale and Its Use in Prenatal Care. J Obstet Gynecol Neonatal Nurs 2023; 52:150-158. [PMID: 36696952 PMCID: PMC9992302 DOI: 10.1016/j.jogn.2022.12.002] [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] [Received: 09/16/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To examine the psychometric properties of the Prenatal Opioid Use Perceived Stigma (POPS) scale and to assess the relationship of POPS scores to adequate prenatal care. DESIGN Prospective cohort study. SETTING Medical centers in Alabama, Ohio, and Pennsylvania (N = 4). PARTICIPANTS Women (N = 127) who took opioids during pregnancy and whose infants participated in the Outcomes of Babies With Opioid Exposure Study. METHODS Participants reported their perceptions of stigma during pregnancy by responding to the eight items on the POPS scale. We evaluated the instrument's internal consistency reliability (Cronbach's alpha), structural validity (factor analysis), and convergent validity (relationship with measures of similar constructs). In addition, to assess construct validity, we used logistic regression to examine the relationship of POPS scores to the receipt of adequate prenatal care. RESULTS The internal consistency of the POPS scale was high (Cronbach's α = .88), and all item-total correlations were greater than 0.50. The factor analysis confirmed that the items cluster into one factor. Participants who reported greater perceived stigma toward substance users and everyday discrimination in medical settings had higher POPS scores, which supported the convergent validity of the scale. POPS scores were significantly associated with not receiving adequate prenatal care, adjusted OR = 1.47, 95% confidence interval [1.19, 1.83], p < .001. CONCLUSION The psychometric testing of the POPS scale provided initial support for the reliability and validity of the instrument. It may be a useful tool with which to assess perceived stigma among women who take opioids, a potential barrier to seeking health care during pregnancy.
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