“You have to take this medication, but then you get punished for taking it:” lack of agency, choice, and fear of medications to treat opioid use disorder across the perinatal period

Schiff, Davida M.; Work, Erin C; Muftu, Serra; Partridge, Shayla; MacMillan, Kathryn De L.; Gray, Jessica; Hoeppner, Bettina B.; Kelly, John F.; Greenfield, Shelly F.; Jones, Hendrée E.; Wilens, Timothy E.; Terplan, Mishka; Bernstein, Judith

doi:10.1016/j.jsat.2022.108765

Cited by 38 publications

(31 citation statements)

References 41 publications

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“…Risk factors for MOUD treatment non-retention during pregnancy and the postpartum period include non-White race, younger age, alcohol and drug use/use disorders, missing healthcare appointments, and MOUD-related factors, such as lower duration or dose of treatment prior to delivery ( 9 – 12 ). Qualitative studies have identified additional retention barriers of parenting stress, mood disorders, discrimination for prenatal substance use, shame about having a substance-exposed infant, lack of autonomy over treatment decisions, and scrutiny from child welfare ( 13 , 14 ). Despite this evidence, data used in these studies have limitations that prevent progress in the field.…”

Section: Introductionmentioning

confidence: 99%

Prospective acceptability of digital phenotyping among pregnant and parenting people with opioid use disorder: A multisite qualitative study

et al. 2023

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BackgroundWhile medications for opioid use disorder (MOUD) effectively treat OUD during pregnancy and the postpartum period, poor treatment retention is common. Digital phenotyping, or passive sensing data captured from personal mobile devices, namely smartphones, provides an opportunity to understand behaviors, psychological states, and social influences contributing to perinatal MOUD non-retention. Given this novel area of investigation, we conducted a qualitative study to determine the acceptability of digital phenotyping among pregnant and parenting people with opioid use disorder (PPP-OUD).MethodsThis study was guided by the Theoretical Framework of Acceptability (TFA). Within a clinical trial testing a behavioral health intervention for PPP-OUD, we used purposeful criterion sampling to recruit 11 participants who delivered a child in the past 12 months and received OUD treatment during pregnancy or the postpartum period. Data were collected through phone interviews using a structured interview guide based on four TFA constructs (affective attitude, burden, ethicality, self-efficacy). We used framework analysis to code, chart, and identify key patterns within the data.ResultsParticipants generally expressed positive attitudes about digital phenotyping and high self-efficacy and low anticipated burden to participate in studies that collect smartphone-based passive sensing data. Nonetheless, concerns were noted related to data privacy/security and sharing location information. Differences in participant assessments of burden were related to length of time required and level of remuneration to participate in a study. Interviewees voiced broad support for participating in a digital phenotyping study with known/trusted individuals but expressed concerns about third-party data sharing and government monitoring.ConclusionDigital phenotyping methods were acceptable to PPP-OUD. Enhancements in acceptability include allowing participants to maintain control over which data are shared, limiting frequency of research contacts, aligning compensation with participant burden, and outlining data privacy/security protections on study materials.

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Section: Introductionmentioning

confidence: 99%

Prospective acceptability of digital phenotyping among pregnant and parenting people with opioid use disorder: A multisite qualitative study

et al. 2023

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“…While most of the focus in psychiatry and neuroscience has been characterizing the role of sex as a biological variable in the neuropsychopharmacology of psychoactive drugs, the sociocultural construct of gender likely has an important role in determining clinical utility. For example, concerns about loss of custody of children may be a particularly salient gendered barrier to medication utilization and adherence in pregnant people with opioid use disorder [ 97 ] and other substance use disorders [ 98 ]. Dominant forms of masculinity are often associated with traits such as stubbornness, self-reliance, and victim-blaming that can lead to under-reporting of psychiatric disorders (especially mood and anxiety disorders) and lack of treatment seeking [ 99 ].…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in the Neuropsychiatric Effects and Pharmacokinetics of Cannabidiol: A Scoping Review

2022

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Cannabidiol (CBD) is a non-intoxicating cannabinoid compound with diverse molecular targets and potential therapeutic effects, including effects relevant to the treatment of psychiatric disorders. In this scoping review, we sought to determine the extent to which sex and gender have been considered as potential moderators of the neuropsychiatric effects and pharmacokinetics of CBD. In this case, 300 articles were screened, retrieved from searches in PubMed/Medline, Scopus, Google Scholar, PsycInfo and CINAHL, though only 12 met our eligibility criteria: eight studies in preclinical models and four studies in humans. Among the preclinical studies, three suggested that sex may influence long-term effects of gestational or adolescent exposure to CBD; two found no impact of sex on CBD modulation of addiction-relevant effects of Δ⁹-tetrahydrocannabinol (THC); two found antidepressant-like effects of CBD in males only; and one found greater plasma and liver CBD concentrations in females compared to males. Among the human studies, two found no sex difference in CBD pharmacokinetics in patient samples, one found greater plasma CBD concentrations in healthy females compared to males, and one found no evidence of sex differences in the effects of CBD on responses to trauma recall in patients with post-traumatic stress disorder (PTSD). No studies were identified that considered the role of gender in CBD treatment effects. We discuss potential implications and current limitations of the existing literature.

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“…In addition to risks to postpartum health, OUD increases risk for inadequate pain relief medication because of hyperalgesia [7] (increased sensitivity to feeling pain and an extreme response to pain) or the patient's fear of return to opioid or substance use [8] associated with opioid analgesia exposure [9]. Yet, inadequately treated pain can also trigger treatment non‐adherence and return to use [8]. Women are particularly susceptible to suboptimal therapies during pregnancy and lactation [10].…”

Section: Introductionmentioning

confidence: 99%

Obstetric pain management for pregnant women with opioid use disorder: A qualitative and quantitative comparison of patient and provider perspectives (QUEST study)

et al. 2023

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Background and aim Patients with opioid use disorder (OUD) may experience inadequate pain management especially during childbirth. This study assessed and compared patient and provider perspectives on analgesia during and after delivery in women with OUD. Design Prospective cohort, mixed method design including semi‐structured interviews and structured surveys with pregnant or recently pregnant patients (n = 17) and provider (n = 15) groups. Setting Prenatal clinics and hospital postpartum units. Participants Patients were pregnant women with OUD currently treated with methadone (n = 1) or buprenorphine (n = 16). Providers were obstetricians (n = 5), obstetric nurses (n = 5) and anesthesiologists (n = 5). Measurements Validated questionnaires were completed by both groups; patient interviews were conducted during the third trimester and at 5 days post‐delivery. Patient topics included pain management preferences, analgesia satisfaction and attitudes toward pain. Provider topics included labor and postpartum pain management perspectives. Interviews were independently coded and qualitatively analyzed for major themes. Findings Five major themes emerged from patient interviews: (1) neuraxial blockade was endorsed for labor pain; (2) otherwise, limited pain control options were perceived; (3) no consensus around use of opioids for pain; (4) non‐opioid options should be available; and (5) provider communication and health‐care system issues act as barriers to adequate pain management. Provider perspective themes included the following: (1) unique challenges in pain management for patients with OUD; (2) confusion on how to plan for and make perinatal adjustments to medication for OUD; (3) discrepant views on use of opioids for pain management; (4) endorsement of non‐pharmacological and non‐opioid options; and (5) need for improved provider collaboration in developing pain management plans. Conclusions Patients with opioid use disorder and health‐care providers prioritize pain management during and after childbirth, but have discrepant views on use of opioids and other pain management options. Inadequate care coordination and discrepancies in opinions need to be addressed both within care teams and between patients and providers. Clinicians would benefit from better evidence to guide clinical care of patients with OUD for patient‐centered pain management.

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“You have to take this medication, but then you get punished for taking it:” lack of agency, choice, and fear of medications to treat opioid use disorder across the perinatal period

Cited by 38 publications

References 41 publications

Prospective acceptability of digital phenotyping among pregnant and parenting people with opioid use disorder: A multisite qualitative study

Prospective acceptability of digital phenotyping among pregnant and parenting people with opioid use disorder: A multisite qualitative study

Sex Differences in the Neuropsychiatric Effects and Pharmacokinetics of Cannabidiol: A Scoping Review

Obstetric pain management for pregnant women with opioid use disorder: A qualitative and quantitative comparison of patient and provider perspectives (QUEST study)

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