Society of Family Planning clinical recommendations: Contraception and abortion care for persons who use substances

Woodhams, Elisabeth; Samura, Tirah; White, Katharine O.; Patton, Elizabeth W.; Terplan, Mishka

doi:10.1016/j.contraception.2022.05.010

Cited by 5 publications

(12 citation statements)

References 71 publications

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“…There are growing concerns regarding the risks to pregnant women using methamphetamine and to neonates exposed in utero [20]. Efforts are urgently needed to remove barriers to and improve delivery of patient‐centered reproductive services to this highly marginalized and stigmatized population [47,48].…”

Section: Discussionmentioning

confidence: 99%

A gender‐based secondary analysis of the ADAPT‐2 combination naltrexone and bupropion treatment for methamphetamine use disorder trial

et al. 2023

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Background and Aims Socio‐cultural (gender) and biological (sex)‐based differences contribute to psychostimulant susceptibility, potentially affecting treatment responsiveness among women with methamphetamine use disorder (MUD). The aims were to measure (i) how women with MUD independently and compared with men respond to treatment versus placebo and (ii) among women, how the hormonal method of contraception (HMC) affects treatment responsiveness. Design This was a secondary analysis of ADAPT‐2, a randomized, double‐blind, placebo‐controlled, multicenter, two‐stage sequential parallel comparison design trial. Setting United States. Participants This study comprised 126 women (403 total participants); average age = 40.1 years (standard deviation = 9.6) with moderate to severe MUD. Interventions Interventions were combination intramuscular naltrexone (380 mg/3 weeks) and oral bupropion (450 mg daily) versus placebo. Measurements Treatment response was measured using a minimum of three of four negative methamphetamine urine drug tests during the last 2 weeks of each stage; treatment effect was the difference between weighted treatment responses of each stage. Findings At baseline, women used methamphetamine intravenously fewer days than men [15.4 versus 23.1% days, P = 0.050, difference = −7.7, 95% confidence interval (CI) = −15.0 to −0.3] and more women than men had anxiety (59.5 versus 47.6%, P = 0.027, difference = 11.9%, 95% CI = 1.5 to 22.3%). Of 113 (89.7%) women capable of pregnancy, 31 (27.4%) used HMC. In Stage 1 29% and Stage 2 5.6% of women on treatment had a response compared with 3.2% and 0% on placebo, respectively. A treatment effect was found independently for females and males (P < 0.001); with no between‐gender treatment effect (0.144 females versus 0.100 males; P = 0.363, difference = 0.044, 95% CI = −0.050 to 0.137). Treatment effect did not differ by HMC use (0.156 HMC versus 0.128 none; P = 0.769, difference = 0.028, 95% CI −0.157 to 0.212). Conclusions Women with methamphetamine use disorder receiving combined intramuscular naltrexone and oral bupropion treatment achieve greater treatment response than placebo. Treatment effect does not differ by HMC.

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Section: Discussionmentioning

confidence: 99%

A gender‐based secondary analysis of the ADAPT‐2 combination naltrexone and bupropion treatment for methamphetamine use disorder trial

et al. 2023

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“…Our data highlight that regardless of specialty, the development of a trusting contraception counseling relationship is predicated on the clinician providing contraceptive information in the context of this chronic disease, as well as demonstrating the knowledge of pertinent reproductive health topics specific to OUD. To our knowledge, there is only one contraception information resource developed by professional societies specific to individuals with OUD 26 . A focus on developing both clinician‐facing and patient‐facing evidence‐based contraception resources would allow for clinician engagement in a more informed dialogue with individuals with OUD and allow them to empower patients to gather evidence‐based contraception information in the context of their chronic disease.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, there is only one contraception information resource developed by professional societies specific to individuals with OUD. 26 A focus on developing both clinician-facing and patient-facing evidence-based contraception resources would allow for clinician engagement in a more informed dialogue with individuals with OUD and allow them to empower patients to gather evidence-based contraception information in the context of their chronic disease.…”

Section: Trusted Information Source 2: Recovery Home Peersmentioning

confidence: 99%

Trusted contraception information sources for individuals with opioid use disorder

Sobel

Lee

White

et al. 2022

Health Services Research

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“…Reproductive-aged persons with substance use disorder experience high rates of unintended or unplanned pregnancies. 56 Persons with a history of dependence may be on a maintenance treatment medication or actively using illicit substances. Common treatments for opioid use disorder include opioid agonists (methadone and buprenorphine) or antagonists (naltrexone).…”

Section: Persons With Substance Usementioning

confidence: 99%

“…Common treatments for opioid use disorder include opioid agonists (methadone and buprenorphine) or antagonists (naltrexone). 56 These medications do not provide pain control when additional stimuli are present, such as cramping associated with medication abortion. Routinely prescribed pain regimens for medication abortion should not be withheld in this subpopulation.…”

Section: Persons With Substance Usementioning

confidence: 99%

Medication Abortion: A Comprehensive Review

Fleurant,

McCloskey

2023

Clinical Obstetrics &Amp; Gynecology

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This chapter provides an overview of evidence-based guidelines for medication abortion in the first trimester. We discuss regimens, both FDA-approved and other clinical-based protocols, and will briefly discuss novel self-managed abortion techniques taking place outside the formal health care system. Overview of patient counseling and pain management are presented with care to include guidance on “no touch” regimens that have proven both feasible and effective. We hope that this comprehensive review helps the health care community make strides to increase access to abortion in a time when reproductive health care is continuously restricted.

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Society of Family Planning clinical recommendations: Contraception and abortion care for persons who use substances

Cited by 5 publications

References 71 publications

A gender‐based secondary analysis of the ADAPT‐2 combination naltrexone and bupropion treatment for methamphetamine use disorder trial

A gender‐based secondary analysis of the ADAPT‐2 combination naltrexone and bupropion treatment for methamphetamine use disorder trial

Trusted contraception information sources for individuals with opioid use disorder

Medication Abortion: A Comprehensive Review

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