Many opioid treatment programs for women face barriers to providing reproductive health services

Researchers from UNC-Chapel Hill and RTI International have published one of the first studies examining reproductive and sexual health services available to women with an opioid use disorder in North Carolina opioid treatment programs.

Hendrée Jones, PhD, professor in the Department of Obstetrics and Gynecology at the UNC School of Medicine and Executive Director of the UNC Horizons Program, and Jennifer Lorvick, DrPH, Senior Public Health Scientist at RTI, were awarded a TraCS $5K-$50K Translational Research Matched Pilot Grant to conduct a needs-assessment survey of reproductive and sexual health services available to women as part of opioid treatment programs in the state.

Stacey Klaman, PhD, is the lead author of the study and worked with Jones and Lorvick on the TraCS Pilot award.

New research from the UNC Gillings School of Global Public Health found that only half of opioid treatment programs provide contraception or other reproductive and sexual health services, such as sexually transmitted infection (STI) or HIV testing, to reproductive-age women enrolled in their programs.

Dr. Stacey Klaman

Stacey Klaman, PhD, a recent doctoral graduate of the Gillings School’s Department of Maternal and Child Health, is lead author of “Provision of and Barriers to Integrating Reproductive and Sexual Health Services for Reproductive-age Women in Opioid Treatment Programs,” which was published online March 15 in the Journal of Addiction Medicine.

The study is one of the first to examine the reproductive and sexual health needs of women with opioid use disorder in North Carolina. Contraceptive use is lower among women with opioid use disorders, and women with this disorder report more unintended pregnancies, which can lead to adverse outcomes for mothers and babies. North Carolina has been significantly impacted by the national opioid epidemic, and women account for nearly half of all opioid use disorder treatment admissions in the state.

In 2017, Klaman’s team conducted a needs-assessment survey — “Opioid Treatment Program Facility Service Survey for North Carolina: Focus on Reproductive-Age Women” — among medical and program directors at opioid treatment programs in the state to collect data on program characteristics and the demographic information of female patient populations. Only half of the responding centers reported providing contraception, and fewer than half said they offer HIV or STI testing. Around half of the programs reported providing education on STI prevention and safer sex practices.

Most medical and program directors said that their female patients could benefit from reproductive and sexual health education and services, but the lack of equipment, supplies and trained staff make it difficult to integrate these offerings into their programs.

“Prior research suggests women would consider using family planning services if they were integrated into substance use treatment programs,” said Klaman. “Locating and integrating onsite reproductive and sexual health education and services within opioid treatment programs may be an innovative way to reduce unintended pregnancies, opioid-exposed pregnancies and sexually transmitted infections, and may improve the health outcomes of women.”

Klaman suggests that future research should focus on women’s preferences about which services would meet their reproductive and sexual health care needs and where they would like to receive care.

“Although we found that opioid treatment programs range in the number and types of referrals to reproductive and sexual health care services, more research is needed to understand if and how women face difficulties in following through with referrals made to outside providers,” she said.

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