Contextual risk and psychosocial profiles of opioid-using mothers: A mixed-methods study

Abstract

Introduction: There is an increase in cases of mothers using opioids during pregnancy in the United States but research investigating mothers’ psychosocial environments along with individual variability among this high-risk group of women is scarce. Methods: This mixed-methods study aims to examine the complex interplay of contextual risks and experiences of opioid-using mothers. A sample of 50 opioid-using biological mothers of infants diagnosed with neonatal opioid withdrawal syndrome (NOWS) were studied using a set of standardized and open-ended questions, along with medical records extraction. Results: A high-risk subgroup of 36 mothers was identified using cluster analysis, characterized by a distinct profile of psychosocial risk. Thematic content analysis revealed four themes: (1) barriers to communication and mistrust of health professionals, (2) limitations of access to health care and the amplification of disadvantages related to COVID-19, (3) lifelong consequences of adverse childhood experiences (ACEs), and (4) intimate partner violence and its influence on drug use. Conclusion: Our findings highlight important information toward health services provision for opioid-using women of childbearing age. Efforts to reduce opioid usage in mothers need to consider psychosocial and contextual risks.

Association Between Adverse Childhood Experiences and Opioid Use-Related Behaviors: A Systematic Review

“…ACEs Among People with Current Opioid Use-Related Behaviors. Five studies measured current opioid use-related behaviors (Beltran-Arzate et al, 2021;Guarino et al, 2021;Sansone et al, 2009;Stein et al, 2017;Swedo et al, 2020). Three of these studies conducted statistical analyses, and the results revealed significant associations between ACEs and opioid use-related behaviors.…”

“…The nine treatment centers in the selected studies also represented different settings: five studies were from urban clinics (Carr et al, 2021; Conroy et al, 2009; Gannon et al, 2017; Heffernan et al, 2000; Stein et al, 2017); two studies were from rural clinics (Derefinko et al, 2019; Winstanley et al, 2020); one study was conducted among homeless people receiving care from a mobile treatment facility (O’Gurek et al, 2021); and one study did not specify the treatment setting (Sansone et al, 2009). One article was a case-control study (Conroy et al, 2009), whereas all other articles ( n = 19) were cross-sectional studies, including one mixed method study (Beltran-Arzate et al, 2021). The majority of the studies ( n = 17) were conducted in the United States; one study was from China (Lei et al, 2018), one was from Australia (Conroy et al, 2009), and one was from Nigeria (Onu et al, 2020).…”

“…The majority of the studies ( n = 17) were conducted in the United States; one study was from China (Lei et al, 2018), one was from Australia (Conroy et al, 2009), and one was from Nigeria (Onu et al, 2020). Most of the studies ( n = 18) had a sample size of more than a hundred participants, with the exception of Derefinko et al (2019) and Beltran-Arzate et al (2021) studies, which included 87 and 50 participants, respectively. The sample sizes in the included studies ranged from 50 to 1,427 (see Tables 1 and 2).…”

“…The other two studies provided descriptive findings that supported the association between ACEs and opioid use-related behaviors. All specific types of ACEs were significantly associated with increased adjusted odds of recent opioid misuse (the range of aOR varied between 1.7 and 6.8 across different individual categories of ACEs) (Beltran-Arzate et al, 2021; Guarino et al, 2021; Sansone et al, 2009; Stein et al, 2017; Swedo et al, 2020). Similar to the association between ACEs and lifetime opioid use-related behaviors, a strong relationship between ACEs and current opioid use-related behaviors was observed.…”

“…This systematic review included studies across different settings and locations. Of the 20 studies included in this review, half (n = 9) were among clients from opioid use treatment clinics (Carr et al, 2021;Conroy et al, 2009;Derefinko et al, 2019;Gannon et al, 2017;Heffernan et al, 2000;O'Gurek et al, 2021;Sansone et al, 2009;Stein et al, 2017;Winstanley et al, 2020); five studies were conducted among the general population (Evans et al, 2020;Merrick et al, 2020;Tang et al, 2020;Z.Wang et al, 2021;Williams et al, 2020); three studies comprised respondents from student populations (Lei et al, 2018;Onu et al, 2020;Swedo et al, 2020); one study was conducted among biological mothers of neonates diagnosed with neonatal opioid withdrawal syndrome (Beltran-Arzate et al, 2021); and one study was conducted among people involved in the criminal justice system (Eaves et al, 2021). The nine treatment centers in the selected studies also represented different settings: five studies were from urban clinics (Carr et al, 2021;Conroy et al, 2009;Gannon et al, 2017;Heffernan et al, 2000;Stein et al, 2017); two studies were from rural clinics (Derefinko et al, 2019;Winstanley et al, 2020); one study was conducted among homeless people receiving care from a mobile treatment facility (O'Gurek et al, 2021); and one study did not specify the treatment setting (Sansone et al, 2009).…”