Pregnancy-capable individuals with a history of opioid use disorder (OUD) hold an inherent distrust of the healthcare system. This is one reason why contraceptive counseling could be a challenge for this population.1

“They have an understandable distrust, so it’s really on providers to learn more about their experiences and acknowledge the lens through which they make these decisions,” says Lauren Sobel, DO, MPH, complex family planning fellow at Brigham and Women’s Hospital.

New research through Boston Medical Center shows that individuals with OUD exhibit similarities to individuals with other chronic medical conditions when they are choosing a contraceptive method.1

“One thing our study strived to do is to talk about their experience with contraception and not make any recommendations for the type of contraception,” Sobel says. “When women and pregnancy-capable individuals with OUD choose a contraceptive, they actually consider many of the same factors that others choose, like weight gain, bleeding, and whether it affects their chronic medical condition.”

Pregnancy-capable individuals with OUD consider various factors that also go into their contraception decisions. These include potential relapse and protecting their future fertility.

This study and other research have serious implications for clinical practice. For instance, pregnancy-capable individuals with OUD have some unique experiences at the intersection of their disorder and their reproductive health.

“There’s certainly some unique association with women who have opioid use disorder trying to protect their future fertility, but they’re not always interested in long-acting reversible contraceptives,” she says. “They may or may not have a stable relationship with the healthcare system for things like an IUD removal.”

Essentially, while many persons with OUD have standard concerns like weight gain, some also carry unique concerns that are due to their history of OUD.

“The main thing clinicians need to do is acknowledge that individuals come to contraceptive counseling with unique experiences,” Sobel adds. “If we don’t factor in the impact of opioid use disorder on the method they use, we risk missing important cues as providers, asking uninformed questions, and we risk perpetuating stigma.”

REFERENCE

  1. Sobel L, Lee YW, O’Connell K, et al. Contraceptive decision making among pregnancy-capable individuals with opioid use disorder at a tertiary care center in Massachusetts. Contraception 2021;104:355-360.