Women-Reported Barriers and Facilitators of Continued Engagement with Medications for Opioid Use Disorder

Abstract

Opioid-related fatalities increased exponentially during the COVID-19 pandemic and show little sign of abating. Despite decades of scientific evidence that sustained engagement with medications for opioid use disorders (MOUD) yields positive psychosocial outcomes, less than 30% of people with OUD engage in MOUD. Treatment rates are lowest for women. The aim of this project was to identify women-specific barriers and facilitators to treatment engagement, drawing from the lived experience of women in treatment. Data are provided from a parent study that used a community-partnered participatory research approach to adapt an evidence-based digital storytelling intervention for supporting continued MOUD treatment engagement. The parent study collected qualitative data between August and December 2018 from 20 women in Western Massachusetts who had received MOUD for at least 90 days. Using constructivist grounded theory, we identified major themes and selected illustrative quotations. Key barriers identified in this project include: (1) MOUD-specific discrimination encountered via social media, and in workplace and treatment/recovery settings; and (2) fear, perceptions, and experiences with MOUD, including mental health medication synergies, internalization of MOUD-related stigma, expectations of treatment duration, and opioid-specific mistrust of providers. Women identified two key facilitators to MOUD engagement: (1) feeling “safe” within treatment settings and (2) online communities as a source of positive reinforcement. We conclude with women-specific recommendations for research and interventions to improve MOUD engagement and provide human-centered care for this historically marginalized population.

The Lived Experiences of Pregnant and Parenting Women in Recovery Toward Medication Treatment for Opioid Use Disorder

“…[44][45][46][47] Negative perceptions of methadone were conflated by factors including lack of commitment and pursuance of concomitant use of drugs, reported in our study and others, and the belief that one could not become "clean" on methadone. [46][47][48][49][50] However, our study confirmed that that women in our sample on long-term maintenance methadone, were satisfied with recovery and gained resiliency and self-efficacy in managing their lives on MOUD, prior to their pregnancy. Gaining self-efficacy can advance self-actualization, a critical ingredient for optimal recovery and healthy outcomes among this marginalized population.…”

“…52,53 If the overall goal is to improve maternal and neonatal outcomes, modifications to methadone delivery regulations can change women's negative perceptions of OTP's. 31,49 Overall best practice suggests early treatment with MOUD of confirmed pregnancy, 17,18,54 however, many women may delay treatment for fear of victimization, criminalization, and potential loss of custody of children, leading to missed opportunities for care. 30,32,55 A likely entry into health care through the hospital emergency department (ED) can provide not only early access, [56][57][58] but legally prescribed MOUD that left our sample of women feeling safer and relieved, knowing the risks involved.…”

“…52,53 If the overall goal is to improve maternal and neonatal outcomes, modifications to methadone delivery regulations can change women’s negative perceptions of OTP’s. 31,49…”

Shaping and shifting schemas on supervised injectable opioid treatment: findings from a cross-sectional qualitative study in two German treatment facilities

“…Furthermore, the “friendship potential” and repeated interaction among patients in the same clinic likely mitigated schema-consistent interpretations and allowed for change [ 26 ]. We can only speculate about additional influences (e.g., the selective uptake of information due to social hierarchies within treatment and recovery settings [ 74 ]). To reach comprehensive conclusions, future studies should systematically evaluate how people living with OUD prioritize the information they obtain from their peers.…”

Prevalence and predictors of medication for opioid use disorder among reproductive-aged women

“…(2021) suggest integration of patient-centered preconception services, including screening for pregnancy wishes, identifying desired sexual and reproductive health needs, and offering education, services, and/or referrals, in every sector that women interface with health professionals such as OUD treatment programs, primary care, and carceral settings ( Bello et al, 2021 ). Importantly, the unique barriers that women with OUD experience, including mistrust of providers and hierarchies that stigmatize people who have engaged in sex work and experienced incarceration must be taken into account by clinicians ( Fiddian-Green et al, 2022 ).…”