Multilevel determinants of linkage to care among pregnant women with opioid use disorder

Abstract

Opioid use disorder (OUD) in pregnancy poses considerable risks for both the mother and the child, with rising opioid use among women of reproductive age in the United States. Although OUD is treatable, pregnant individuals frequently encounter obstacles like stigma, legal issues, and inadequate access to healthcare. This commentary examines the factors influencing access to treatment services for pregnant individuals with OUD. The proposed conceptual framework using the socioecological model emphasizes the intricate relationships among these multi-level determinants. At the individual level, social expectations of motherhood, internalized stigma, previous healthcare experiences, insufficient understanding of treatment alternatives, and absence of health insurance frequently establish substantial obstacles to care. At the interpersonal level, healthcare personnel's attitudes, training, and communication are crucial in establishing trust and promoting treatment adherence, while supportive social networks and family involvement enhance care engagement and resilience. Structurally, the systemic constraints, including the variability in Medicaid coverage, geographic inequities, and inadequate integration of prenatal and addiction care, impede access, exacerbated by punitive policies that stigmatize substance use during pregnancy. Comprehending these dynamics can guide treatments designed to enhance treatment linkage and results. Advocating for a compassionate, patient-centered methodology within healthcare systems is crucial for tackling this escalating public health epidemic and mitigating the stigma associated with opioid use during pregnancy.