“I didn’t want to be on Suboxone at first…” – Ambivalence in Perinatal Substance Use Treatment

Abstract

Objectives: The objectives of this article are to present findings from recent qualitative research with patients in a combined perinatal substance use treatment program in Central Appalachia, and to describe and analyze participants' ambivalence about medicationassisted treatment for opioid use disorder (OUD), in the context of widespread societal stigma and judgement. Methods: We conducted research in a comprehensive outpatient perinatal substance use treatment program housed in a larger obstetric practice serving a large rural, Central Appalachian region. The program serves patients across the spectrum of substance use disorders but specifically offers medication-assisted treatment to perinatal patients with OUD. We purposively and opportunistically sampled patients receiving prescriptions for buprenorphine or buprenorphine-naloxone dual product, along with prenatal care and other services. Through participant-observation and semi-structured interviews, we gathered qualitative data from 27 participants, in a total of 31 interviews. We analyzed transcripts of interviews and fieldnotes using modified Grounded Theory. Results: Participants in a combined perinatal substance use treatment program value supportive, non-judgmental care but report ambivalence about medication, within structural and institutional contexts of criminalized, stigmatized substance use and close scrutiny of their pregnancies. Women are keenly aware of the social and public consequences for themselves and their parenting, if they begin or continue medication treatment for OUD. Conclusions: Substance use treatment providers should consider the social consequences of medication treatment, as well as the clinical benefits, when presenting treatment options and recommendations to patients. Patient-centered care must include an understanding of larger social and structural contexts.

Predicting longitudinal service use for individuals with substance use disorders: A latent profile analysis

“…The relapsing and remitting nature of SUDs means individuals often require multiple treatment episodes before they are able to abstain from using substances (McLellan et al, 2014). Individuals' motivation to engage in treatment shifts along a continuum (Oser et al, 2010;Ostrach & Leiner, 2019). However, SUD treatment is frequently measured as a binary outcome, where individuals either receive or do not receive care following the immediate treatment seeking event (Mark et al, 2003;Naeger et al, 2016;Trowbridge et al, 2017).…”

Perspectives About Emergency Department Care Encounters Among Adults With Opioid Use Disorder

“… 13 , 14 The treatment gap between people with OUD and those engaged in treatment 15 , 16 is associated with stigma, limited patient knowledge about and motivation for treatment, socioeconomic barriers to treatment, and racial and ethnic disparities in access to treatment. 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 These patient-related factors should be considered when designing interventions to engage patients in the ED. We aimed to explore patients’ perspectives on receiving OUD-related care in the ED to inform future implementation efforts to promote OUD treatment initiation and improve patient-centered care in the ED for those with OUD.…”

Revisiting the Fetal Assault Law in Tennessee: Implications and the Way Forward

“…Despite the recommendation for MAT in pregnant women, some women choose detoxification during pregnancy due to the uncertainty of the long-term effects of NAS and to avoid the distress of watching their newborns suffer from withdrawal (Howard, 2016; Ostrach & Leiner, 2019). Also favoring detoxification, TN mandates reporting of NAS regardless of cause and an evaluation from the Department of Child Services of the woman’s ability to care for her child (Howard, 2016; Warren et al., 2015).…”

“…Mistrust of providers due to prior mistreatment in a care setting, the social stigma of substance use in pregnancy, and the common cultural misperception that recovery (i.e., being "clean") is only achieved through detoxification further complicates treatment decisions (Cockroft et al, 2019;Ostrach & Leiner, 2019). While counties in TN lacking access to mental health services are associated with higher rates of NAS (Patrick et al, 2019), comprehensive psychosocial and behavioral support services are limited for these women due to the lack of coordinated funding and limited number of health organizations accepting Medicaid coverage for these services, which are often deemed medically unnecessary (Division of TennCare, 2018).…”

“…While counties in TN lacking access to mental health services are associated with higher rates of NAS (Patrick et al, 2019), comprehensive psychosocial and behavioral support services are limited for these women due to the lack of coordinated funding and limited number of health organizations accepting Medicaid coverage for these services, which are often deemed medically unnecessary (Division of TennCare, 2018). This limited access to mental health services and lack of training among buprenorphine-prescribing providers in resource-poor regions of TN can lead to the phenomenon of clinical abandonment, or continually prescribing MAT medication without providing the appropriate psychosocial component of treatment (Ostrach & Leiner, 2019). This can exacerbate cultural resistance to MAT and, in turn, lead to poorer long-term treatment outcomes for these women.…”