Davida M Schiff1, Erin C Work2, Serra Muftu2, Shayla Partridge2, Kathryn Dee L MacMillan3, Jessica R Gray4, Bettina B Hoeppner5, John F Kelly5, Shelly F Greenfield6, Hendrée E Jones7, Timothy E Wilens8, Mishka Terplan9, Judith Bernstein10. 1. Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, MA, 02114, United States of America. Electronic address: Davida.schiff@mgh.harvard.edu. 2. Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, MA, 02114, United States of America. 3. Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, 02115, United States of America. 4. Division General of Internal Medicine, MassGeneral Hospital for Children, Boston, MA, 02114, United States of America; Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, 02114, United States of America. 5. Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, United States of America. 6. Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, 115 Mill St, Belmont, MA 02478, United States of America; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States of America. 7. UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, 410 North Greensboro St., Carrboro, NC, United States of America. 8. Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States of America. 9. Friends Research Institute, 1040 Park Ave, Suite 103, Baltimore, MD 21202, United States of America. 10. Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States of America.
Abstract
INTRODUCTION: Medications to treat opioid use disorder (MOUD) during pregnancy and in the postpartum period remain underutilized. A need exists to enhance our understanding of modifiable factors, facilitators, and barriers to MOUD utilization and adherence in the perinatal period to improve maternal and child outcomes. METHODS: The study conducted semi-structured qualitative interviews with recently pregnant people with opioid use disorder (OUD) to explore experiences as a pregnant and/or parenting person with OUD, perceptions of enabling factors and barriers to treatment utilization, incentivizing factors for maintaining adherence, and acceptability of ongoing supports to sustain treatment adherence. The study team used constant comparative methods to analyze transcripts and develop the codebook. The team double coded the transcripts, with an overall kappa coefficient of 0.88. RESULTS: The study team interviewed twenty-six women on average 10.1 months after delivery. All women had some prior experience using MOUD. Four unique themes emerged as barriers to medication utilization and adherence in the perinatal period: 1) Lack of agency and autonomy surrounding medication decisions because pregnancy or parenting status affected treatment adherence; 2) Hesitancy to use MOUD to minimize risk of newborn withdrawal; 3) Concern about increased scrutiny and potential loss of custody due to mandated child protective services reporting for opioid-exposure at delivery in Massachusetts; and 4) Perception that treatment environments, particularly methadone clinics, did not provide gender-responsive or equitable care, and standardized, inflexible visit regulations were particularly difficult to comply with in the early postpartum period. CONCLUSIONS: Women with OUD experienced a double bind when making perinatal treatment decisions, describing pressure to use MOUD with negative consequences after delivery. Key areas for possible intervention emerged from interviews. These areas include improving uptake of shared decision-making to increase patient autonomy and agency, particularly among those in the earliest stages of recovery during pregnancy; ongoing education around perinatal MOUD safety and efficacy; detangling MOUD and neonatal withdrawal signs from mandated child protective services reporting; and improving gender-responsive and equitable care in substance use disorder treatment programs, including incorporating the utilization of home visiting services for dosing assessments and administration in the early postpartum period.
INTRODUCTION: Medications to treat opioid use disorder (MOUD) during pregnancy and in the postpartum period remain underutilized. A need exists to enhance our understanding of modifiable factors, facilitators, and barriers to MOUD utilization and adherence in the perinatal period to improve maternal and child outcomes. METHODS: The study conducted semi-structured qualitative interviews with recently pregnant people with opioid use disorder (OUD) to explore experiences as a pregnant and/or parenting person with OUD, perceptions of enabling factors and barriers to treatment utilization, incentivizing factors for maintaining adherence, and acceptability of ongoing supports to sustain treatment adherence. The study team used constant comparative methods to analyze transcripts and develop the codebook. The team double coded the transcripts, with an overall kappa coefficient of 0.88. RESULTS: The study team interviewed twenty-six women on average 10.1 months after delivery. All women had some prior experience using MOUD. Four unique themes emerged as barriers to medication utilization and adherence in the perinatal period: 1) Lack of agency and autonomy surrounding medication decisions because pregnancy or parenting status affected treatment adherence; 2) Hesitancy to use MOUD to minimize risk of newborn withdrawal; 3) Concern about increased scrutiny and potential loss of custody due to mandated child protective services reporting for opioid-exposure at delivery in Massachusetts; and 4) Perception that treatment environments, particularly methadone clinics, did not provide gender-responsive or equitable care, and standardized, inflexible visit regulations were particularly difficult to comply with in the early postpartum period. CONCLUSIONS: Women with OUD experienced a double bind when making perinatal treatment decisions, describing pressure to use MOUD with negative consequences after delivery. Key areas for possible intervention emerged from interviews. These areas include improving uptake of shared decision-making to increase patient autonomy and agency, particularly among those in the earliest stages of recovery during pregnancy; ongoing education around perinatal MOUD safety and efficacy; detangling MOUD and neonatal withdrawal signs from mandated child protective services reporting; and improving gender-responsive and equitable care in substance use disorder treatment programs, including incorporating the utilization of home visiting services for dosing assessments and administration in the early postpartum period.
Authors: Mary Beth Howard; Elisha Wachman; Emily M Levesque; Davida M Schiff; Caroline J Kistin; Margaret G Parker Journal: Hosp Pediatr Date: 2018-11-06
Authors: Wei-Hsuan Lo-Ciganic; Julie M Donohue; Joo Yeon Kim; Elizabeth E Krans; Bobby L Jones; David Kelley; Alton E James; Marian P Jarlenski Journal: Pharmacoepidemiol Drug Saf Date: 2018-09-07 Impact factor: 2.890
Authors: Davida M Schiff; Timothy C Nielsen; Bettina B Hoeppner; Mishka Terplan; Scott E Hadland; Dana Bernson; Shelly F Greenfield; Judith Bernstein; Monica Bharel; Julia Reddy; Elsie M Taveras; John F Kelly; Timothy E Wilens Journal: Am J Obstet Gynecol Date: 2021-04-15 Impact factor: 10.693
Authors: Julia C Phillippi; Rebecca Schulte; Kemberlee Bonnet; David D Schlundt; William O Cooper; Peter R Martin; Katy B Kozhimannil; Stephen W Patrick Journal: Womens Health Issues Date: 2021-06-02