Onsite Contraceptive Services Curb Unintended Pregnancies in Women With Opioid Use Disorder

By Marilynn Larkin

July 26, 2021

NEW YORK (Reuters Health) - For women with opioid use disorder (OUD) at risk for unintended pregnancy, onsite contraceptive services are likely more effective than usual care, but adding incentives to such services is the most cost-effective and beneficial intervention, researchers say.

"Clinicians should be aware that many women with OUD are interested in more effective contraceptive methods, including long-acting reversible contraceptives (LARCs), but are rarely able to get them in our current health care system," Dr. Sarah Heil of the University of Vermont in Burlington told Reuters Health by email.

"Co-locating contraceptive services with an opioid treatment program, with or without the addition of incentives, helps decrease the unmet contraceptive need," she said. "We encourage contraceptive service providers to look for opportunities to work with opioid treatment programs in their community."

As reported in JAMA Psychiatry, Dr. Heil and colleagues randomized 138 women (median age, 31) receiving OUD treatment and at high risk for unintended pregnancy to receive (1) usual care-i.e., information about contraceptive methods and community health care facilities; (2) onsite contraceptive services adapted from the World Health Organization, including six months of follow-up visits to assess method satisfaction; or (3) the same onsite contraceptive services plus financial incentives for attending follow-up visits.

At the six-month, graded increases in verified prescription contraceptive use were seen in those assigned to usual care (10.4%) versus contraceptive services (29.2%) versus contraceptive services plus incentives (54.8%).

Those effects were sustained at 12-months: usual care, 6.3%; contraceptive services, 25%; and contraceptive services plus incentives, 42.9%.

Further, these effects were associated with graded reductions in unintended pregnancy rates across the 12-month trial: usual care, 22.2%; contraceptive services, 16.7%; contraceptive services plus incentives, 4.9%.

Each dollar invested yielded an estimated $5.59 in societal cost-benefits for contraceptive services versus usual care; $6.14 for contraceptive services plus incentives versus usual care; and $6.96 for contraceptive services plus incentives versus contraceptive services alone.

The authors conclude, "Co-locating contraceptive services with opioid treatment programs offers an innovative, cost-effective strategy for preventing unintended pregnancy."

Dr. Hendree Jones, Director of UNC Horizons at UNC-Chapel Hill, commented on the study in an email to Reuters Health. "The findings are compelling and underscore the guidance of organizations such as the American Academy of Pediatrics, the Centers for Disease Control and the American College of Obstetricians and Gynecologists, which all urge increased contraceptive education and access for women with OUD."

"This intervention robustly shows that co-locating education and free access to contraceptive services with treatment for OUD increases contraceptive use, including the highly effective LARC," she said. "This approach to contraceptive practices removes the barriers of cost and assess. Incentivizing follow-up visits was efficacious in increasing continued access to contraceptive health care."

That said, she noted, "An unintended pregnancy is not the same as an unwanted pregnancy, and all women deserve support in making informed decisions about their reproductive health, not just avoiding pregnancy. These findings, including those of the cost-benefit analysis, should not be used to target women with opioid use or other substance use disorders and force/mandate/legislate them to use contraception."

"All women deserve access to easily accessible and free contraceptive services," she said, "not just those with OUD."

Barriers to scaling co-located or integrated substance use programs include "attitudes and beliefs, as well as system-level billing and reimbursement issues - e.g., payment systems are primarily geared to fee for service and not conducive to integration, she added. "These findings represent an important step forward in showing the compelling evidence for why Medicaid, managed care, states and health care providers need to take this issue on.

SOURCE: https://bit.ly/3zuR8HP and https://bit.ly/3BAOSR9 JAMA Psychiatry, online July 14, 2021.

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