BACKGROUND: Neonatal abstinence syndrome (NAS) is a group of problems that occur in opioid-exposed newborns which can lead to low birth weight, seizures, and respiratory problems. Improving access to contraception and preventing unintended pregnancies for women in opioid treatment programs who want to avoid or delay pregnancy can reduce incidence of NAS, which quadrupled in prevalence from 2003-2013 in Louisiana. The objective of this study was to describe the access to reproductive health services in Louisiana methadone clinics.
METHODS: A 37-question survey was created to assess services in each of the 10 publicly-funded Louisiana methadone clinics. Questions addressed the following domains: screening for sexually transmitted diseases (STDs), pregnancy testing, prenatal care access for pregnant women, and contraceptive services. Clinic administrators were asked to answer all questions including describing the referral process for services outside of their clinic and any concerns with the referral process or services.
RESULTS: All 10 clinics responded to the survey. In total, these clinics treat approximately 2,500 women of reproductive age and 120 pregnant women each year. Medication Assisted Treatment (MAT) options included prescriptions for methadone (all clinics), suboxone and/or Buprenorphine-Naloxone (6 clinics), Buprenorphine (5 clinics), and/or Extended Release Injectable Naltrexone (2 clinics). Staff included Physicians, Licensed Nurse Practitioners, and counselors. All clinics provided pregnancy tests upon first arrival and at detox initiation. Women could receive additional testing annually (6 clinics), as requested (3 clinics), or monthly (1 clinic). If a woman is pregnant, all clinics provide counseling and care coordination. For non-pregnant women, 50% of the clinics asked about her pregnancy intention and what she was currently doing to prevent pregnancy. Nine clinics indicated that women must be referred for any contraceptive services other than condoms, the least effective method for preventing pregnancy. One clinic did not provide condoms or referrals. All clinics provided referrals for STD testing and treatment, with internal testing available at nine clinics. Concerns included lack of proper connection to services, limited funding, knowledge of care for infants exposed to opioids, and concerns with negative stigma associated with those addicted to opioids.
CONCLUSIONS: Increasing capacity for integration of reproductive health and addiction recovery services and educating health professionals on needs of women and their infants may be necessary to reduce unintended pregnancies. Next steps include planning and capacity building for standardized care and referrals for treatment centers, educating providers on MAT in pregnancy, and identifying resources to develop an integrated model of care.