Joint localization of contraceptive services and opioid treatment programs can help prevent unwanted pregnancy


Credit: Larner College of Medicine, University of Vermont

The increase in maternal opioid use has nearly doubled the number of babies born with neonatal withdrawal syndrome (NAS) in the United States in the past ten years. This statistic prompted the Centers for Disease Control and Prevention and the American Academy of Pediatrics to call for intensive efforts to reduce opioid use during pregnancy, such as ensuring access to contraception to prevent unintended pregnancies. desired among women who use opioids. More than 75% of women with opioid use disorder (TUU) claim to have had an unwanted pregnancy, but are less likely to use effective contraception compared to women who do not use drugs. The results of a multi-year trial found that a two-part intervention with co-localized contraceptive services in opioid treatment programs and financial incentives could offer an effective solution.

The results of this study funded by the National Institutes of Health were published as Psychiatry JAMA Online First article July 14.

The trial, led by Sarah Heil, Ph.D., a professor of psychiatry at the Vermont Center on Behavior and Health at Larner College of Medicine at the University of Vermont, tested a new two-component intervention based on behavioral economics. , which combines co-located contraceptive services with a treatment program with to attend follow-up visits. The aim of the study was to determine whether joint localization services could effectively remove barriers to initiating contraceptive use (defined as pills, patch, ring, injection, intrauterine device / IUD, and implant), as well as examine the benefits of adding incentives to help alleviate the burden associated with coming to follow-up visits. Incentives were obtained only to attend follow-up visits and did not depend on contraceptive use.

“Women with TAO have the same right to decide if and when to have children as other women, but their persistently high rate of unwanted pregnancies suggests that the way contraceptive services are provided does not work for most of them. Heil said.

A total of 138 women aged 20 to 44 who received TUU medications and had a high risk of unwanted pregnancy between 2015 and 2018 were enrolled. Participants were randomly assigned to one of three conditions: care usual, contraceptive services or contraceptive services plus financial incentives. The results of the trial showed gradual increases in contraceptive use of verified prescription at the end of the six-month intervention period (usual care was 10.4%; contraceptive services were 29.2%; and contraceptives plus incentives of 54.8%) and were maintained during the 12-month final evaluation, which showed contraceptive adherence at 6.3% with regular care vs. 25% with co-localized contraceptive services vs. 42.9% with more incentive co-localized contraceptive services. These numbers also coincided with a gradual decrease of rates during the 12-month trial (usual care at 22.2% vs. contraceptive services at 16.7% vs. more incentive contraceptive services at 4.9%). Also, one found that every dollar invested produced a $ 5.59 social benefit for contraceptive services versus regular care, $ 6.14 for more contraceptive services versus regular care, and $ 6.96 for contraceptive services versus regular services. more incentive contraceptives.

“For women with TAO who don’t want to get pregnant, the two interventions we’ve tried provide contraceptive services that best meet their needs and do so in a cost-effective way,” Heil said.

Although both interventions yielded benefits, the combination of on-site contraceptive services and financial incentives was the most effective and cost-effective intervention. These results offer promising solutions to help increase access to prescription contraception to prevent unwanted pregnancies who use opioids.

Researchers are developing a new, woman-controlled contraceptive product

More information:
Sarah H. Heil et al, Efficacy and cost-benefit of in situ contraceptive services with and without incentives among women with opioid use disorder with a high risk of unwanted pregnancy, Psychiatry JAMA (2021). DOI: 10.1001 / jamapsychiatry.2021.1715

Citation: Co-locating contraceptive services and opioid treatment programs can help prevent unwanted pregnancy (2021, July 16) recovered on July 16, 2021 at -co-locating-contraceptives-opioid-treatment- unintended.html

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