Addressing opioid use disorder among rural pregnant and postpartum women: a study protocol

Abstract

Background Opioid use disorder (OUD) among women delivering at a hospital has increased 400% from 1999–2014 in the United States. From the years 2007 to 2016, opioid-related mortality during pregnancy increased over 200%, and drug-overdose deaths made up nearly 10% of all pregnancy-associated mortality in 2016 in the US. Disproportionately higher rates of neonatal opioid withdrawal syndrome (NOWS) have been reported in rural areas of the country, suggesting that perinatal OUD is a pressing issue among these communities. There is an urgent need for comprehensive, evidence-based treatment services for pregnant women experiencing OUD. The purpose of this article is to describe a study protocol aimed at developing and evaluating a perinatal OUD curriculum, enhancing evidence-based perinatal OUD treatment in a rural setting, and evaluating the implementation of such collaborative care for perinatal OUD. Methods This two-year study employed a one group, repeated measures, hybrid type-1 effectiveness-implementation design. This study delivered interventions at 2 levels, both targeting improvement of care for pregnant women with OUD. The first area of focus was at the community healthcare provider-level, which aimed to evaluate the acceptability and feasibility of perinatal OUD education across time and to improve provider education by increasing knowledge specific to: MOUD provision; screening, brief intervention, and referral to treatment (SBIRT) utilization; and NOWS treatment. The second area of intervention focus was at the patient-level, which assessed the preliminary effect of perinatal OUD provider education in promoting illicit opioid abstinence and treatment engagement among pregnant women with OUD. We adopted constructs from the Consolidated Framework for Implementation Research (CFIR) to assess contextual factors that may influence implementation, and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model to comprehensively evaluate implementation outcomes. Discussion This article presents the protocol of an implementation study that is employing the CFIR and RE-AIM frameworks to implement and evaluate a perinatal OUD education and service coordination program in two rural counties. This protocol could serve as a model for clinicians and researchers seeking to implement improvements in perinatal care for women with OUD in other rural communities. Trial registration NCT04448015 clinicaltrials.gov.

Postpartum Treatment for Substance Use Disorder Among Mothers of Infants with Neonatal Abstinence Syndrome and Prenatal Substance Exposure

“…, Project ECHO, or Extension for Community Healthcare Outcomes) 45 and interventions to strengthen rural perinatal care for women with OUD. 46 …”

“…Others include efforts to expand provider capacity to manage addiction in pregnancy through telementoring initiatives (e.g., Project ECHO, or Extension for Community Healthcare Outcomes) 45 and interventions to strengthen rural perinatal care for women with OUD. 46 Conclusions Multipronged approaches at patient, provider, programmatic, and policy levels are needed to overcome the persistent structural barriers to delivering evidencebased SUD treatment in the postpartum period.…”

Attitudes, Self-Efficacy, and Practices Related to Opioid Risk Assessment and Mitigation: A Comparison of Health Care Professionals in Rural Communities

“…The purpose of the intervention was to target care improvement for pregnant and other persons with opioid misuse/OUD by supporting outpatient clinicians to adopt evidence-based practices (EBPs) for substance use screening, brief advice, and referral to treatment (SBIRT) ( NCT04448015 ). Implementation of the intervention, which has been previously described elsewhere, involved multiple components that included pre-implementation work, such as stakeholder engagement, development of intervention materials, a series of webinar training, and post-implementation activities aimed at increasing the sustainability of adopted EBPs 14 . Data were collected during the formative months of intervention activities to provide an initial understanding of HCPs’ attitudes toward patients with opioid misuse/OUD and competency around opioid risk assessment and mitigation.…”

Intersectional stigma and infant feeding in childbearing women with opioid use disorder.

“…Consistently, childbearing women with OUD report feeling that they are viewed as “bad mothers” due to their substance use histories and the influence that in-utero substance exposure has on the health of their infants (Nichols et al, 2021; Recto et al, 2020). The internalization of this perceived stigma may heighten the vulnerability felt by childbearing women with OUD and threaten both their recovery progression (Bryan et al, 2020; Lee & Boeri, 2017; Recto et al, 2020; Shadowen et al, 2022) and parenting-related health behaviors, including infant feeding (McGlothen et al, 2018; Stangl et al, 2019).…”