Abstract
BackgroundDiagnoses of perinatal opioid use disorder (OUD) continue to rise in the United States. Patients and providers report obstacles to OUD treatment access. Difficulties include legal ambiguity related to Social Services notification requirements following a birth to people using opioids or in medication-assisted treatment for OUD.MethodsThrough semi-structured interviews, participant-observation, and a focus group conducted in a mostly rural, region of the Southern United States (where perinatal OUD is more prevalent), patients’ and providers’ perspectives about perinatal substance use treatment were initially sought for a larger study. The findings presented here are from a subset analysis of patients’ experiences and perspectives. Following ethics review and exemption determination, a total of 27 patient participants were opportunistically, convenience, and/or purposively sampled and recruited to participate in interviews and/or a focus group. Data were analyzed using modified Grounded Theory.ResultsWhen asked about overall experiences with and barriers to accessing perinatal substance use treatment, 11 of 27 participants reported concerns about Social Services involvement resulting from disclosure of their substance use during pregnancy. In the subset analysis, prevalent themes were Fears of Social Services Involvement, Preparation for Delivery, and Providers Addressing Fears.ConclusionsPerinatal OUD patients may seek substance use treatment with existing fears of Social Services involvement. Patients appreciate providers’ efforts to prepare them for this potential reality. Providers should become aware of how their own hospital systems, counties, states, and countries interpret laws governing notification requirements. By becoming aware of patients’ fears, providers can be ready to discuss the implications of Social Services involvement, promote patient-centered decision-making, and increase trust.
Highlights
Diagnoses of perinatal opioid use disorder (OUD) continue to rise in the United States
Rates of opioid use disorder (OUD) detected at delivery increased fourfold in the United States over the past decade [4] and pose significant perinatal health risks for the dyad composed of the neonate and the person that delivered it [3, 5, 6]
A pregnant person with OUD is often reluctant to seek prenatal care according to recommended guidelines [9,10,11], in part because of the stigmatized nature of substance use during pregnancy and stigma associated with medication-assisted treatment (MAT), [9, 10, 12]
Summary
Diagnoses of perinatal opioid use disorder (OUD) continue to rise in the United States. A pregnant person with OUD is often reluctant to seek prenatal care according to recommended guidelines [9,10,11], in part because of the stigmatized nature of substance use during pregnancy and stigma associated with medication-assisted treatment (MAT), [9, 10, 12]. Laws are increasingly in place throughout the United States that penalize substance use during pregnancy [11, 13] These include mandatory notifications or reporting requirements that are shown to deter pregnant people from seeking either prenatal care or substance use treatment [11, 14, 15]. As noted by O’Rourke-Suchoff et al [16] and others [17,18,19], such laws and requirements threaten perinatal OUD patients’ trust in care providers
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