Background Pregnancy and the delivery of an infant mark a unique time of engagement in healthcare for women in treatment for opioid use disorder (OUD). The American College of Obstetrics and Gynecology calls for a comprehensive approach to perinatal healthcare delivery for pregnant women with OUD in order to facilitate improved health outcomes and increase patient-provider collaboration. Yet, there is little knowledge regarding the perceptions of women with OUD regarding the current delivery of healthcare which could inform a personalized, tailored approach to perinatal healthcare delivery. Methods Four focus groups consisting of 22 women with OUD were conducted, transcribed, and analysed using qualitative thematic analysis methodology. Results Women reported an overall lack of preparation for the birth and neonatal healthcare experiences and identified opportunities for greater support by the healthcare team. Women emphasized the desire for evidence-based preparation from trusted sources about delivery, neonatal abstinence syndrome, breastfeeding, and how their medications affect their pregnancy and baby. Women reported receiving a varied amount of support from healthcare providers in their transition to motherhood, but women predominantly reported receiving emotional and informational support from their mothers and partners. Conclusions The knowledge obtained in this study points to gaps in perinatal healthcare delivery for women with OUD. Improving the delivery of perinatal healthcare may contribute to increased engagement by women with OUD, and ultimately improve outcomes for a vulnerable population.

Research objective The COVID-19 pandemic disrupted healthcare delivery worldwide with likely negative effects on people who use opioids (PWUO). This scoping review of the original research literature describes the impact of the COVID-19 pandemic on healthcare delivery for PWUO and identifies gaps in the literature. Methods This scoping review of the original research literature maps the available knowledge regarding the impact of the COVID-19 pandemic on healthcare delivery for PWUO. We utilized the methodology developed by the Joanna Briggs Institute for scoping reviews, and content analyses methodology to characterize the current state of the literature. Results Of the 14 included studies, administrative database (n = 11), cross-sectional (n = 1) or qualitative (n = 2) studies demonstrated service gaps (n = 7), patient/provider experiences (n = 3), and patient outcomes for PWUO (n = 4). In March 2020, healthcare utilization dropped quickly, sharply increasing only for reasons of opioid overdose by May 2020. Service gaps existed in accessing treatment for new patients during the pandemic due to capacity and infrastructure limits. Physicians reported difficulty referring patients to begin an outpatient opioid treatment program due to increased restrictions in capacity and infrastructure. Patients also reported uncertainty about accessing outpatient treatment, but that telehealth initiation of buprenorphine increased access to treatment from home. Disproportionate increases in overdose rates among African Americans were reported in two studies, with differences by race and gender not examined in most studies. Fatal overdoses increased 60% in African Americans during the pandemic, while fatal overdoses in Non-Hispanic White individuals decreased. Conclusions In summary, this beginning evidence demonstrates that despite early reluctance to use the healthcare system, opioid overdose-related use of healthcare increased throughout the pandemic. Service delivery for medications to treat OUD remained at or above pre-pandemic levels, indicating the ability of telehealth to meet demand. Yet, racial disparities that existed pre-pandemic for PWUO are intensifying, and targeted intervention for high-risk groups is warranted to prevent further mortality. As the pandemic progresses, future research must focus on identifying and supporting subgroups of PWUO who are at heightened risk for experiencing negative outcomes and lack of access to care.

Background: Preventive paediatric healthcare is essential for infant and child health. Current research, however, suggests that the delivery of routine well child care (WCC) for children affected by maternal opioid use disorder (OUD) could be improved. How mothers perceive interactions with healthcare providers may help identify ways to modify the experience of WCC, which could ultimately improve healthcare utilization, patient satisfaction and clinical outcomes. The objective of this qualitative study was to assess perceptions of WCC among mothers in treatment for OUD. Methods: Four focus group sessions of 4-8 participants each (N = 22) were conducted. All study participants were receiving comprehensive behavioural and physical health support and care plus pharmacotherapy for OUD from a single outpatient treatment centre. Focus groups were semi-structured, with a standardized set of open-ended questions and follow-up prompts to engage participants in a fluid discussion. Participants were asked to identify and discuss important aspects of their youngest child's WCC and what they liked and disliked about their child's WCC. Grounded theory analysis was used to identify themes. Results: Several aspects of WCC were identified as important to the mothers. Main themes identified included (1) mother-provider relationship, (2) communication with healthcare team and (3) support for mother's OUD treatment. Participants discussed their desire to be heard and understood and wanted the entire healthcare team and clinic staff to see them as mothers first and foremost, not merely as individuals with OUD. Conclusion: Future attempts to refine care may consider healthcare models that highlight open communication and personalized care and offer strong support and ongoing encouragement for the mother's OUD treatment and recovery process.

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The Substance Abuse and Mental Health Services Administration (2014) reported that 1.1% of pregnant women used nonprescription opiates (either heroin or prescription pills) in the last 30 days. Methadone and buprenorphine are the most common treatments for opiate addiction in pregnant women. Reasons for seeking opiate maintenance treatment (OMT) include keeping custody of one's children and the hope of developing a healthy parenting relationship. Yet, healthcare organizations and professionals have mixed opinions regarding health promotion within the maternal OMT population. Proper education regarding the growing and complex opiate epidemic continues to remain a void for many healthcare professionals. It is imperative that nurses who regularly interact with women in OMT show compassion and competence. It is important to highlight the universality of the challenges and needs of caring for the OMT population. This Perspectives column will explore and describe the context of maternal nonprescription opiate use and the care mothers in OMT should receive based on established nursing ethical standards.

Mothering and methadone can occur together with the right resources and support. Methadone mothers need to be seen in the context of their social risks and environment. Societal attitudes, social capital, and other contextual variables can be changed through policy. The purpose of this article is to describe the contextual risks experienced by drug abusing mothers in order to direct further research and policy changes that protect their children. Research has focused on biological or genetic determinants, but now social risks and environmental factors are shaping current literature about substance abuse in pregnancy. Significant risk factors, taken from the literature, are detailed, such as intimate partner violence and mental health co-morbidities. Racial differences and the effect of place on pregnant substance abusers are also discussed. Policy recommendations address the barriers substance abusing women face in their journey toward a healthy pregnancy.

Healthcare reform and changing population health demographics call for a radical transformation in healthcare delivery and the education of healthcare providers. Nurses comprise the largest proportion of healthcare providers making it necessary to ensure that they are prepared to address the challenges that arise from the evolving healthcare delivery system. A key message of The Institute of Medicine's The Future of Nursing: Leading Change, Advancing Health, is that nurses must lead healthcare change. To accomplish this, nurses must recognize their role in educating the new nursing workforce about creating a culture of health. Specifically, nurse educators must act as stewards for promoting health and wellness, and reducing health disparities and inequities. They must also recognize their role in forming partnerships with community organizations to improve primary care and population health by addressing social determinants of health. The purpose of this paper is to describe the structure for developing an innovative baccalaureate nursing curriculum and lessons learned that can inform the efforts of others interested in accelerating design of new curriculum.

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