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Opioid use disorder and contraception

Women on Medicaid with opioid use disorder (OUD) who use medications for opioid use disorder (MOUD) are more likely to use contraception and to undergo female sterilization than peers not prescribed MOUD, according to a study in Contraception.

The fact that less than half of commercially insured and Medicaid-insured women were prescribed MOUD provides opportunities for improving contraceptive use and integrating contraception and MOUD services, authors added.

Due to treatment and counseling requirements, authors said, women with OUD prescribed MOUD likely have increased engagement with health professionals. “But our results showed no difference in odds of contraception use by MOUD status among commercially insured women.”1

Investigators reviewed records from women with OUD ages 20 to 49 years in January 2018 who had at least 6 years of continuous commercial insurance (n = 3085) or Medicare (n = 3841). Authors set the 6-year cutoff to identify previously initiated long-acting reversible contraception (LARC) methods or use of female sterilization.

Within Medicare, the proportions of women who were and were not prescribed MOUD who were sterilized were 12.0% and 7.5%, respectively (P <0.0001).

After controlling for age, women prescribed MOUD had significantly higher odds (adjusted odds ratio 1.33) of using female sterilization versus no method compared to women not prescribed MOUD.

Additionally, 79% of patients in Medicaid who were not prescribed MOUD used neither prescription contraception nor sterilization, versus 71.1% among Medicare peers prescribed MOUD (P <0.0001).

Regarding commercial insurance, the proportions who were and were not sterilized were 3.3% and 3.1% (p = 0.755). Meanwhile, 65.8% and 66.1%, respectively, used no prescription contraception or female sterilization (P = 0.847).

“Further research is needed to assess reasons for the differential patterns of contraceptive use by insurance type,” authors wrote. Such reasons could include differences in consumer preferences and knowledge, provider influence or (lack of) prescribing behavior, coercive practices, and insurance coverage.

Authors moreover suggested improving delivery of recommended clinical care for women with OUD by integrating contraception and MOUD services in ways that align medical services and support with reproductive-health goals.

Such programs, they added, should ensure that all women are counseled and have access to the full range of methods, can make informed choices about whether and which type of contraception to use, and can discontinue LARC at any time.2,3

The fact that only 41% of commercially insured and Medicaid-insured women with OUD were even prescribed MOUD also leaves room for improvement, authors said.

Among commercially insured women, those who lived in the South were less likely to be prescribed MOUD. Within Medicaid, black women were less likely to be prescribed MOUD. These results mirror previous research that found racial and regional disparities in accessing, being prescribed, and continuing MOUD treatments.4,5

Altogether, authors said, their findings highlight the need for social and structural interventions to provide more equitable and longer-term MOUD access to women with OUD. Along with fragmented services, such women face fear of criminalization and social stigma that may hinder them from accessing and using contraception and MOUD services.6

References

1. Goyal S, Monsour M, Ko JY, et al. Contraception claims by medication for opioid use disorder prescription status among insured women with opioid use disorder, United States, 2018. Contraception. 2023;117:67-72. doi:10.1016/j.contraception.2022.09.129

2. Dehlendorf C, Krajewski C, Borrero S. Contraceptive counseling: best practices to ensure quality communication and enable effective contraceptive use. Clin Obstet Gynecol. 2014;57(4):659-673. doi:10.1097/GRF.0000000000000059

3. Higgins JA, Kramer RD, Ryder KM. Provider bias in long-acting reversible contraception (LARC) promotion and removal: perceptions of young adult women. Am J Public Health. 2016;106(11):1932-1937. doi:10.2105/AJPH.2016.303393

4. Stahler GJ, Mennis J. Treatment outcome disparities for opioid users: are there racial and ethnic differences in treatment completion across large US metropolitan areas? Drug Alcohol Depend. 2018;190:170-178. doi:10.1016/j.drugalcdep.2018.06.006

5. United States Government Accountability Office. Opioid addiction: laws, regulations, and other factors that can affect medication -assisted treatment access.https://www.gao.gov/products/gao-16-833. September 27, 2016. Accessed December 16, 2022.

6. Stone RH, Griffin B, Fusco RA, Vest K, Tran T, Gross S. Factors affecting contraception access and use in patients with opioid use disorder. J Clin Pharmacol. 2020;60 Suppl 2:S63-S73. doi:10.1002/jcph.1772