Aim To systematically review the literature on contraceptive use by women with opioid and other substance use disorders in order to estimate overall contraceptive use and to examine method choice given the alarmingly high rate of unintended pregnancy in this population. Method Pubmed (1948–2014) and PsycINFO (1806–2014) databases were searched for peer-reviewed journal articles using a systematic search strategy. Only articles published in English and reporting contraceptive use within samples of women with opioid and other substance use disorders were eligible for inclusion. Results Out of 580 abstracts reviewed, 105 articles were given a full-text review, and 24 studies met the inclusion criteria. The majority (51%) of women in these studies reported using opioids, with much smaller percentages reporting alcohol and cocaine use. Across studies, contraceptive prevalence ranged widely, from 6%–77%, with a median of 55%. Results from a small subset of studies (N = 6) suggest that women with opioid and other substance use disorders used contraception less often than non-drug-using comparison populations (56% vs. 81%, respectively). Regarding method choice, condoms were the most prevalent method, accounting for a median of 62% of contraceptives used, while use of more effective methods, especially implants and intrauterine devices (IUDs), was far less prevalent 8%. Conclusions Women with opioid and other substance use disorders have an unmet need for contraception, especially for the most effective methods. Offering contraception services in conjunction with substance use treatment and promoting use of more effective methods could help meet this need and reduce unintended pregnancy in this population.

No abstract

OBJECTIVE To systematically review maternal and neonatal outcomes associated with opioid detoxification during pregnancy. DATA SOURCES PubMed, PsycINFO, EMBASE, Cochrane, and ClinicalTrials.gov databases were searched from January 1, 1966, to September 1, 2016. METHODS OF STUDY SELECTION English-language studies that reported outcomes associated with opioid detoxification among pregnant women with opioid use disorder were included. Nonoriginal research articles (case reports, editorials, reviews) and studies that failed to report outcomes for detoxification participants were excluded. Bias was assessed using the Cochrane Collaboration’s tool for assessing risk of bias and quality was assessed using the U.S. Preventive Service Task Force Quality of Evidence scale. TABULATION, INTEGRATION, AND RESULTS Of 1,315 unique abstracts identified, 15 met criteria for inclusion and included 1,997 participants, of whom 1,126 underwent detoxification. Study quality ranged from fair to poor as a result of the lack of a randomized control or comparison arm and high risk of bias across all studies. Only nine studies had a comparison arm. Detoxification completion (9–100%) and illicit drug relapse (0–100%) rates varied widely across studies depending on whether data from participants who did not complete detoxification or who were lost to follow-up were included in analyses. The reported rate of fetal loss was similar among women who did (14 [1.2%]) and did not undergo detoxification (17 [2.0%]). CONCLUSIONS Evidence does not support detoxification as a recommended treatment intervention as a result of low detoxification completion rates, high rates of relapse, and limited data regarding the effect of detoxification on maternal and neonatal outcomes beyond delivery.

No abstract

Background Opioid-dependent (OD) women tend to engage in unprotected sex with high-risk partners, placing themselves at elevated risk for sexually transmitted HIV infection. This behavior generally persists after completion of interventions that increase sexual HIV risk reduction knowledge and skills, suggesting that decision-making biases may influence HIV transmission among OD women. Methods The primary aim of this report is to examine delay discounting of condom-protected sex among OD women and non-drug-using control women using the novel Sexual Discounting Task (SDT; Johnson and Bruner, 2012). Data were collected from 27 OD women and 33 non-drug-using control women using the SDT, a monetary discounting task, and the Barratt Impulsiveness Scale (BIS-11). Results OD women discounted the value of delayed condom-protected sex more steeply than controls for hypothetical sexual partners in the two sets of paired partner conditions examined. Overall, women discounted condom protected sex more steeply for partners they perceived as being lowest STI risk vs. those they perceived as being highest risk. Steeper discounting of condomprotected sex was significantly associated with higher scores on the BIS-11, but not with discounting of money. Conclusions Delay discounting of condom-protected sex differs between OD women and non-drug-using women, is sensitive to perceived partner risk, and is correlated with a self-report measure of impulsivity, the BIS-11. The effect of delay on sexual decision-making is a critical but underappreciated dimension of HIV risk among women, and the SDT appears to be a promising measure of this domain. Further investigation of these relationships is warranted.