Contraceptive decision making among pregnancy-capable individuals with opioid use disorder at a tertiary care center in Massachusetts

Lauren Sobel,Yeon Woo Lee,Katharine O'Connell White,Elisabeth Woodhams,Elizabeth Patton

doi:10.1016/j.contraception.2021.06.002

Abstract

ObjectiveTo explore contraceptive decision making among recently pregnant patients with a history of opioid use disorder. Study DesignWe conducted semi-structured qualitative interviews, based on principles of the Ottawa Decision Support Framework, with 20 recently pregnant individuals diagnosed with opioid use disorder at a tertiary care medical center in Massachusetts. We audio-recorded the interviews and they were transcribed verbatim. We analyzed our interview data using inductive and deductive coding. ResultsParticipants value the availability of barrier methods as a means of preventing both sexually transmitted infections and pregnancy. For some participants, housing instability makes storing contraceptive methods and managing personal hygiene related to bleeding patterns difficult. For others, housing instability impacts their overall fertility goals. Side effects including weight gain, interactions with mood stabilizing medications, concern regarding post-operative opioids, or intrinsic aspects of a method that serve as reminders of opioid use may be unacceptable given the risk of relapse. The relapsing and remitting arc of recovery make remembering important aspects of both short- and long-acting contraceptive method use difficult, yet participants offer strategies to aid in doing so. ConclusionWhen choosing a contraceptive method participants in our study exhibit similarities to individuals with other chronic medical conditions as well as motivations specific to opioid use disorder. Their contraceptive decisions are grounded in integrating a method into a chaotic life, preventing relapse, and protecting future fertility. ImplicationsOur data highlight how lived experiences at the intersection of active opioid use disorder and recovery fundamentally shape the lens through which pregnancy-capable individuals with opioid use disorder view their contraceptive decisions.

Highlights

In the United States, 4.6 million women report misuse of opioids and over 700,000 women report meeting criteria for opioid use disorder (OUD) [1]
While some contraceptive considerations are not unique to individuals with OUD, others are significant in the context of their disease [21,22]
The motivations behind many contraceptive decisions made by pregnancy-capable individuals with OUD include prioritizing relapse prevention, integrating a method into a chaotic life, and protecting fertility in a way that emulates patients with other chronic medical conditions [23,24,25,26]

Summary

Introduction

In the United States, 4.6 million women report misuse of opioids and over 700,000 women report meeting criteria for opioid use disorder (OUD) [1]. Another study found 54% of women with OUD reported 4 or more lifetime pregnancies, compared to 14% of a nationally representative sample of women in the United States [4]. While women with OUD both desire and plan pregnancies, unintended pregnancies may impact OUD treatment outcomes [5]. Use of contraception ranges widely among women with substance use disorder (SUD). A retrospective cohort study concluded the prevalence of contraception use among women receiving treatment for opioid addiction may be even lower at 30% [7]. OUD is associated with decreased uptake of postpartum contraception [8]

Methods

Results

Conclusion