Healthcare Providers' Attitudes Toward Medications for Opioid Use Disorder during Pregnancy

Background & Purpose:

Perceived stigma of substance use during pregnancy is a barrier to seeking perinatal care and substance use disorder (SUD) treatment (Nichols et al., 2021). Only 13% of U.S. pregnant individuals with SUD receive treatment (Salameh et al., 2021). Treatments for opioid use disorder (OUD) during pregnancy carry stigma in many settings, including healthcare (Crawford et al., 2022). The standard of care for OUD during pregnancy is pharmacotherapy with buprenorphine or methadone (medications for opioid use disorder [MOUDs]). Treatment with MOUDs is safer and more effective than medically supervised withdrawal (ACOG, 2017). This study examined U.S. healthcare providers’ attitudes toward MOUDs during pregnancy and associated characteristics.

Methods:

Data were combined from two online surveys of health providers (N = 555). The first survey was conducted Spring 2022 with 112 health providers recruited via social media and a ListServ for health professionals. The second survey was conducted Fall 2023 with 443 non-prescribing clinicians recruited via postcards mailed to member lists for related professional organizations. Both surveys collected demographics, practice characteristics, and attitudes toward MOUDs during pregnancy.

Results:

The sample consisted of social workers (40.4%) other mental health therapists (44.3%), nurses (9.2%), peer recovery coaches (3.4%), prescribers (1.6%), and other healthcare providers (1.1%). Most identified as female (72.4%) and White non-Hispanic (80.5%).

Most (64.3%) would recommend a combination of medications and counseling whereas 19.8% would recommend counseling alone, and 12.1% were unsure. A binary logistic regression (χ² = 68.45 [26], p < .001) found that nurses (vs. social workers; OR = 0.15, p = .032), licensed/certified healthcare providers (OR = 0.36, p = .015), and those who work in multiple settings (vs. outpatient alone; OR = 0.18, p = .009) were less likely to recommend counseling alone. Males were more likely to recommend counseling alone (vs. females; OR = 2.27, p = .002).

On a scale from 1 (not acceptable at all) to 7 (very acceptable), ratings indicated MOUDs to be slightly acceptable during pregnancy (M = 4.87, SD = 1.96). An ordinal logistic regression (χ² = 79.08 [26], p < .001) found that licensed/certified healthcare providers (OR = 2.32, p = .005) and those working in inpatient settings (vs. outpatient; OR = 2.23, p = .018) were more likely to rate MOUDs as an acceptable treatment option during pregnancy. Males (vs. females; OR = 0.60, p = .011), Black professionals (vs. White; OR = 0.37, p < .001), and mental health therapists (vs. social workers; OR = 0.46, p < .001) were less likely to rate MOUDs as acceptable

Conclusions & Implications:

Due to increasing use of substances among pregnant people in the U.S., most healthcare providers will regularly encounter pregnant persons with SUDs. These results indicate that some healthcare providers are uninformed or misinformed about the acceptability of MOUDs during pregnancy. In alignment with the social work core values, we assert that social workers, especially students, those working towards licensure, and those working in outpatient settings, should receive training on how to best serve pregnant persons with OUD.