Factors Affecting Contraception Access and Use in Patients With Opioid Use Disorder

Abstract

Maternal opioid use disorder increased > 4‐fold from 1999 to 2014 and is associated with poor maternal and fetal outcomes. Women with opioid use disorder are at 2 to 3 times greater risk for unintended pregnancy than the general population and may face additional barriers to accessing and effectively using contraception compared to women without opioid use disorder, particularly highly effective long‐acting reversible contraception. Additionally, women with opioid use disorder tend to use less effective forms of contraception such as condoms alone. Barriers to contraceptive access include patient misconceptions or knowledge gaps regarding reproductive health and family planning, cost, intimate partner violence, fear of criminalization, difficulty accessing care, comorbid health conditions, and health care provider misconceptions or practice limitations. Strategies that may assist women with opioid use disorder in achieving their family planning goals include colocation of family planning services within opioid treatment facilities, optimization of patient care services to minimize the need for costly and/or time consuming follow‐up, increasing provider education and awareness of best practices in family planning and opioid use disorder treatment, and providing patient‐centered family planning education and counseling. Additional research is needed to identify and develop strategies that empower women who use opioids to effectively access and use their preferred contraceptive method.

Barriers to and facilitators of hormonal and long-acting reversible contraception access and use in the US among reproductive-aged women who use opioids: A scoping review

“…Since that time, additional studies have documented that reproductive-aged WWUO and are at risk of unintended pregnancy do not use hormonal contraception and LARC (HC-LARC) 2 because of barriers related to accessing and using those methods. Two such studies were narrative reviews: one published in 2016 and the other in 2020 ( Black and Day, 2016 , Stone et al, 2020 ). The 2016 review by Black and Day focused on barriers to contraceptive access and uptake among women with any SUD.…”

“…The more recent review by Stone and colleagues specifically documented barriers to contraceptive access and uptake among women with OUD. In that study, barriers included but were not limited to “patient misconception or lack of reproductive health knowledge, cost, poor access to care, partner violence, fear of criminalization, comorbid conditions, and healthcare provider misconceptions or practice limitations” ( Stone et al, 2020 ). Although both reviews were comprehensive in nature, neither used a systematic methodological approach to map and synthesize the literature, nor did they identify facilitators to HC-LARC access and use.…”

Contraception and Healthcare Utilization by Reproductive-Age Women Who Use Drugs in Rural Communities: a Cross-Sectional Survey

“…Contraceptive use and reproductive choice by WWUD is further influenced by high rates of intimate partner violence and sexual and reproductive coercion. 13,14 While not all WWUD want or need highly or moderately effective contraception, the notable differences in unintended pregnancy rates may indicate a gap in reproductive health access and utilization and necessitates further investigation and interventions. Pregnant and parenting WWUD also face considerable stigma, 15 frequently delaying or avoiding prenatal care, citing concerns around child protective service involvement and potential custodial loss.…”

“It Just Depends on Their Stability”: A Qualitative Examination of Patient Factors Influencing Providers’ Contraceptive Counseling Approaches for Persons With Substance Use Disorders

“…While there is relatively little research examining providers’ contraceptive counseling approaches for patients with SUDs, it is plausible that provider-held biases about addiction could lead to nonpatient-centered care with regard to contraceptive recommendations or content of counseling. Moreover, individuals with SUDs experience numerous vulnerabilities, such as housing instability, unemployment, and a high prevalence of psychiatric comorbidities, that can impede contraceptive access and use 16 . Because providers perceive that such vulnerabilities may result in contraceptive nonadherence, 17 it is important to understand whether and to what extent patient-related factors influence providers’ contraceptive counseling approaches, communication strategies, and methods recommendations.…”

“…Moreover, individuals with SUDs experience numerous vulnerabilities, such as housing instability, unemployment, and a high prevalence of psychiatric comorbidities, that can impede contraceptive access and use. 16 Because providers perceive that such vulnerabilities may result in contraceptive nonadherence, 17 it is important to understand whether and to what extent patient-related factors influence providers' contraceptive counseling approaches, communication strategies, and methods recommendations. The goals of this study are to explore individual behavior and social factors that contribute to providers modifying their contraceptive counseling approaches and to describe how providers alter their counseling recommendations and communication strategies in the presence of such factors.…”