TY - JOUR
KW - Adult
KW - Buprenorphine, Naloxone Drug Combination/therapeutic use
KW - Female
KW - Grounded theory
KW - Humans
KW - Interviews as Topic
KW - Opiate Substitution Treatment/methods/psychology
KW - Opioid-Related Disorders/drug therapy/psychology
KW - Patient-Centered Care
KW - Perinatal Care/methods
KW - Pregnancy
KW - Pregnancy Complications/drug therapy/psychology
KW - Program Evaluation
KW - Social Stigma
KW - Young Adult
AU - B. Ostrach
AU - C. Leiner
A1 - 
AB - OBJECTIVES: The objectives of this article are to present findings from recent qualitative research with patients in a combined perinatal substance use treatment program in Central Appalachia, and to describe and analyze participants' ambivalence about medication-assisted treatment for opioid use disorder (OUD), in the context of widespread societal stigma and judgement. METHODS: We conducted research in a comprehensive outpatient perinatal substance use treatment program housed in a larger obstetric practice serving a large rural, Central Appalachian region. The program serves patients across the spectrum of substance use disorders but specifically offers medication-assisted treatment to perinatal patients with OUD. We purposively and opportunistically sampled patients receiving prescriptions for buprenorphine or buprenorphine-naloxone dual product, along with prenatal care and other services. Through participant-observation and semi-structured interviews, we gathered qualitative data from 27 participants, in a total of 31 interviews. We analyzed transcripts of interviews and fieldnotes using modified Grounded Theory. RESULTS: Participants in a combined perinatal substance use treatment program value supportive, non-judgmental care but report ambivalence about medication, within structural and institutional contexts of criminalized, stigmatized substance use and close scrutiny of their pregnancies. Women are keenly aware of the social and public consequences for themselves and their parenting, if they begin or continue medication treatment for OUD. CONCLUSIONS: Substance use treatment providers should consider the social consequences of medication treatment, as well as the clinical benefits, when presenting treatment options and recommendations to patients. Patient-centered care must include an understanding of larger social and structural contexts.
AD - Department of Research, UNC Health Sciences at MAHEC; University of North Carolina-Asheville; Department of Family Medicine, Boston University School of Medicine (BO); UNC Health Sciences at MAHEC (CL).
BT - Journal of addiction medicine
C5 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
CP - 4
CY - United States
DO - 10.1097/ADM.0000000000000491
IS - 4
JF - Journal of addiction medicine
LA - eng
M1 - Journal Article
N2 - OBJECTIVES: The objectives of this article are to present findings from recent qualitative research with patients in a combined perinatal substance use treatment program in Central Appalachia, and to describe and analyze participants' ambivalence about medication-assisted treatment for opioid use disorder (OUD), in the context of widespread societal stigma and judgement. METHODS: We conducted research in a comprehensive outpatient perinatal substance use treatment program housed in a larger obstetric practice serving a large rural, Central Appalachian region. The program serves patients across the spectrum of substance use disorders but specifically offers medication-assisted treatment to perinatal patients with OUD. We purposively and opportunistically sampled patients receiving prescriptions for buprenorphine or buprenorphine-naloxone dual product, along with prenatal care and other services. Through participant-observation and semi-structured interviews, we gathered qualitative data from 27 participants, in a total of 31 interviews. We analyzed transcripts of interviews and fieldnotes using modified Grounded Theory. RESULTS: Participants in a combined perinatal substance use treatment program value supportive, non-judgmental care but report ambivalence about medication, within structural and institutional contexts of criminalized, stigmatized substance use and close scrutiny of their pregnancies. Women are keenly aware of the social and public consequences for themselves and their parenting, if they begin or continue medication treatment for OUD. CONCLUSIONS: Substance use treatment providers should consider the social consequences of medication treatment, as well as the clinical benefits, when presenting treatment options and recommendations to patients. Patient-centered care must include an understanding of larger social and structural contexts.
PP - United States
PY - 2019
SN - 1935-3227; 1932-0620
SP - 264
EP - 271
EP - 
T1 - "I didn't want to be on Suboxone at first…" - Ambivalence in Perinatal Substance Use Treatment
T2 - Journal of addiction medicine
TI - "I didn't want to be on Suboxone at first…" - Ambivalence in Perinatal Substance Use Treatment
U1 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
U2 - 30585875
U3 - 10.1097/ADM.0000000000000491
VL - 13
VO - 1935-3227; 1932-0620
Y1 - 2019
Y2 - Jul/Aug
ER -