Substance Abuse and Rehabilitation (Jul 2023)
Interventions to Support Engagement in Addiction Care Postpartum: Principles and Pitfalls
Abstract
Shayna Mazel,1,* Karen Alexander,2,* Camille Cioffi,3,* Mishka Terplan2,* 1Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA; 2Friends Research Institute, Baltimore, MD, USA; 3Center on Parenting and Opioids, Prevention Science Institute, University of Oregon, Eugene, OR, USA*These authors contributed equally to this workCorrespondence: Mishka Terplan, Friends Research Institute, 1040 Park Ave, Suite 103, Baltimore, MD, 21201, USA, Tel +1 410 837 3977, Fax +1 410 752 4218, Email [email protected]: There is a fundamental disconnect between the optimal management of addiction in general and care delivery in pregnancy and postpartum. Addiction is a chronic condition requiring some degree of management across the life course. Yet, in the US, reproductive care is episodic and centers more on pregnancy than at other stages of the reproductive life course. Pregnancy is prioritized in access to insurance as almost all pregnant people are Medicaid eligible but access ends at varying points postpartum. This results in a structural mismatch: the episodic management of the chronic condition of addiction only within gestational periods. Though people with substance use disorder (SUD) may access care in pregnancy, treatment attrition is common postpartum. Postpartum is a time of increased vulnerabilities where insurance churn and newborn caretaking responsibilities collide in a context of care withdrawal from the health system and health providers. In part in consequence, return to use, SUD recurrence, overdose, and overdose death are more common postpartum than in pregnancy, and drug deaths have become a leading cause of maternal deaths in the US. This review addresses interventions to support engagement in addiction care postpartum. We begin with a scoping review of model programs and evidence-informed interventions that have been shown to increase continuation of care postpartum. We then explore the realities of contemporary care through a review of clinical and ethical principles, with particular attention to harm reduction. We conclude with suggestions of strategies (clinical, research, and policy) to improve care postpartum and highlight potential pitfalls in the uptake of evidence-based and person-centered services.Keywords: pregnancy, substance use disorder, harm reduction, medication for OUD
