Fulfilling an Unmet Need: Integrating Family Planning into Office-Based Addiction Therapy

Introduction/Background: Women with opioid use disorder (OUD) have unique concerns related to reproductive health. Previous studies have found that women with OUD reported having unintended pregnancies at two to three times the rate of the general population, and use of very effective methods is less frequent. The high rate of unintended pregnancy coupled with the use of less effective forms of contraception suggests unmet reproductive healthcare needs for women with OUD. Given the structure of addiction treatment programs in which patients present at frequent and regular intervals to a health care provider, there is a possibility to address these disparities in family planning. This qualitative study aims to investigate the feasibility of and barriers to integrating family planning (FP) services into office-based opioid addiction treatment (OBAT) from the perspective of clinicians specializing in treatment of OUD.

Methods: After obtaining IRB approval, we conducted semi-structured interviews with clinicians working in OBAT clinics to better understand the unique strengths and barriers of providing FP services to women with OUD within OBAT clinics. Interviews were recorded, transcribed, and analyzed using a codebook based on the Promoting Action on Research Implementation (PARiHS) framework and the Ottawa Decision Support framework.

Results: Participant interviews (n=19) highlighted several key themes: 1) high relevance of FP counseling to the holistic care offered in OBAT clinics; 2) tension felt by patients and clinicians when considering outcomes of an unplanned pregnancy on recovery: concern about a destabilizing influence of an unplanned pregnancy versus the potentially motivating effect of parenthood; 3) complexity of including nuanced FP counseling into OBAT visits including need for additional education to provide effective patient-centered contraceptive counseling; 4) logistics of providing timely access to contraception requiring procedures; 5) conflicting priorities between ensuring patients have a contraceptive plan and varying clinician awareness of the potential for reproductive coercion.

Conclusion/Implications: OBAT programs involve frequent visits with consistent and trusted clinical teams, making them an optimal setting to provide high-quality FP care to women with OUD. Implementation will require thoughtful planning and incorporate clinical education, logistics, and broad engagement of clinical teams to effectively meet the reproductive health needs of patients with OUD.

References: Heil SH, Jones HE, Arria A, et al. Unintended pregnancy in opioid-abusing women. Journal of Substance Abuse Treatment. 2011;40(2):199-202. doi:10.1016/j.jsat.2010.08.011

Terplan M, Hand DJ, Hutchinson M, Salisbury-Afshar E, Heil SH. Contraceptive use and method choice among women with opioid and other substance use disorders: A systematic review. Preventive Medicine. 2015;80:23-31. doi:10.1016/j.ypmed.2015.04.008

Robinowitz N, Muqueeth S, Scheibler J, Salisbury-Afshar E, Terplan M. Family Planning in Substance Use Disorder Treatment Centers: Opportunities and Challenges. Substance Use and Misuse. 2016;51(11):1477-1483. doi:10.1080/10826084.2016.1188944