Among the 145 organizations that were contacted, 89 responded, comprising 61% of the total sample. Response rates varied by organization type, with responses from 100% of the seven contacted birthing hospitals (n = 7), 65% of the 31 contacted prenatal care practices (n = 20), and 58% of the 108 contacted substance use-related services programs (n = 63; sum of three categories exceeds total N due to one program listed in both prenatal care and SUD categories). Among SUD programs, response rates ranged from 24% of recovery residences to 100% of withdrawal management/stabilization units.
Table 1
Frequency of Caring for Pregnant Patients with OUD
| Always Row % (n) | Frequently Row % (n) | Sometimes Row % (n) | Rarely Row % (n) | Never Row % (n) | Unsure Row % (n) |
Birthing Hospitals (n = 7) | 28.2% (2) | 42.9% (3) | 28.2% (2) | 0 | 0 | 0 |
Prenatal Care Practices (n = 20) | 20.0% (4) | 15.0% (3) | 30.0% (6) | 35.0% (7) | 0 | 0 |
SUD Programs (n = 63)* | 6.3% (4) | 12.7% (8) | 33.3% (21) | 34.9% (22) | 7.9% (5) | 4.8% (3) |
OBOT (n = 12) | 0 | 25.0% (3) | 16.7% (2) | 50.0% (6) | 8.3% (1) | 0 |
OTP (n = 21) | 4.8% (1) | 19.0% (4) | 52.4% (11) | 23.8% (5) | 0 | 0 |
SSPs (n = 7) | 0 | 0 | 28.6% (2) | 28.6% (2) | 14.3% (1) | 28.6% (2) |
Residential (n = 12) | 0 | 8.3% (1) | 25.0% (3) | 50.0% (6) | 8.3% (1) | 8.3% (1) |
Recovery Residence (n = 8) | 37.5% (3) | 0 | 25.0% (2) | 12.5% (1) | 25.0% (2) | 0 |
Withdrawal Management(n = 6) | 0 | 16.7% (1) | 33.3% (2) | 50.0% (3) | 0 | 0 |
*Total N for SUD programs is less than sum of subcategories due to several programs falling into multiple categories. |
Organizations were asked to indicate the frequency with which they provided care for pregnant patients with OUD on a five-point Likert scale, ranging from “always” to “never” (Table 1), as well as the average number of pregnant patients with OUD treated per month. Birthing hospitals reported caring for this population with greater frequency (71.4% always or frequently) than prenatal care practices (35.0% always/frequently) or SUD programs (19.0% always/frequently). Among SUD programs, OTPs and recovery residences reported more frequently caring for this population, with only 23.8% of OTPs and 37.5% of recovery residences selecting “rarely” or “never.” Most birthing hospitals reported treating 10–20 pregnant patients per month with OUD, whereas the majority of PNC practices and SUD programs reported treating five or fewer.
Table 2
OUD and Pregnancy Screening Practices
| Birthing Hospitals (n = 7) Column % (n) | Prenatal Care Practices (n = 20) Column % (n) | SUD Programs (n = 63) Column % (n) |
Assess for OUD at intake | 100% (7) | 95.0% (19) | N/A |
With informal verbal/written screening | 57.1% (4) | 65.0% (13) | N/A |
With validated verbal/written tool | 28.6% (2) | 45.0% (9) | N/A |
With urine toxicology | 85.7% (6) | 60.0% (12) | N/A |
With urine toxicology only | 14.3% (1) | 0 | N/A |
Assess for pregnancy at intake | N/A | N/A | 85.7% (54) |
With urine pregnancy test | N/A | N/A | 60.3% (38) |
Table 2 shows reported screening practices. Birthing hospitals and PNC practices were asked whether and how they screen for OUD at intake for services. Almost all responding organizations reported screening for OUD; most reported using urine toxicology (85.7% of birthing hospitals, 60.0% of PNC practices) and informal verbal/written screening (57.1% of birthing hospitals, 65.0% of PNC practices). One birthing hospital reported using only urine toxicology to screen for OUD. SUD programs were asked about whether and how they screen for pregnancy at intake. While 85.7% of programs assessed pregnancy status, only 60.3% utilized urine pregnancy tests. Urine pregnancy testing was most frequently reported by OTPs (100%), withdrawal management programs (83.3%), and residential programs (80.0%).
Table 3
SUD-Related Service Availability During Pregnancy
| Birthing Hospitals (n = 7) | Prenatal Care Practices (n = 20) | SUD Programs (n = 63)* |
| Available Column % (n) | Available Column % (n) | Available Column % (n) | Unavailable to pregnant patients only Column % (n) | Unavailable to all patients Column % (n) |
Buprenorphine initiation | 57.1% (4) | 25.0% (5) | 66.7% (42) | 6.3% (4) | 22.2% (14) |
Buprenorphine maintenance | 100% (7) | 35.0% (7) | 69.8% (44) | 6.3% (4) | 22.2% (14) |
Methadone initiation | 57.1% (4) | 0 | 47.6% (30) | 3.2% (2) | 47.6% (30) |
Methadone maintenance | 100% (7) | 0 | 55.6% (35) | 3.2% (2) | 39.7% (25) |
Naltrexone initiation | 42.9% (3) | 10.0% (2) | 34.9% (22) | 11.1% (7) | 50.8% (32) |
Naltrexone maintenance | 57.1% (4) | 10.0% (2) | 36.5% (23) | 9.5% (6) | 49.2% (31) |
Withdrawal management – alcohol/benzos | 71.4% (5) | 10.0% (2) | 34.9% (22) | 4.8% (3) | 57.1% (36) |
Withdrawal management – opioids | 71.4% (5) | 0 | 38.1% (24) | 7.9% (5) | 49.2% (31) |
Brief intervention (SBIRT) | 100% (7) | 50.0% (10) | 68.9% (44) | 1.6% (1) | 25.4% (16) |
Peer recovery support | 100% (7) | 25.0% (5) | 74.6% (47) | 1.6% (1) | 23.8% (15) |
Non-peer treatment linkage services | 71.4% (5) | 40.0% (8) | 91.9% (57) | 0 | 3.2% (2) |
Individual SUD counseling | 0 | 25.0% (5) | 85.2% (52) | 1.6% (1) | 14.3% (9) |
Group SUD counseling | 0 | 15.0% (3) | 74.6% (47) | 1.6% (1) | 22.2% (14) |
Naloxone – direct distribution | 14.3% (1) | 10.0% (2) | 69.8% (44) | 3.2% (2) | 42.9% (27) |
Naloxone – providing prescriptions | 42.9% (3) | 35.0% (7) | 50.8% (32) | 3.2% (2) | 42.9% (27) |
Naloxone – prescribe OR distribute | 42.9% (3) | 35.0% (7) | 84.1% (53) | 3.2% (2) | 12.7% (8) |
Other harm reduction services (e.g., providing sterile supplies) | 14.3% (1) | 5.0% (1) | 34.9% (22) | 1.6% (1) | 58.7% (37) |
*SUD program columns do not always add up to 100%, as programs could mark “Unsure/Don’t Know” |
Birthing hospitals and PNC practices were asked to indicate the availability of specific SUD-related services; SUD programs were asked to specify whether these services were available to all patients, pregnant patients only, non-pregnant patients only, or unavailable to all patients (Table 3). Regarding medications for opioid use disorder (MOUD), all birthing hospitals reported capacity to continue buprenorphine and methadone for patients taking these medications at the time of admission, but fewer (57%) reported that MOUD initiation was available. Thirty-five percent of PNC practices reported offering buprenorphine maintenance, while only 25% offered buprenorphine initiation.
Most SUD programs that offered buprenorphine or methadone reported availability to all patients regardless of pregnancy status, with some notable exceptions. In particular, 76% of responding OTPs reported offering buprenorphine, and none of these programs limited this service based on pregnancy status. One of the 21 responding OTPs reported that their program did not offer methadone during pregnancy. In addition, of the five withdrawal management programs that offered buprenorphine initiation/maintenance to the general population, one of these programs denied initiation and one denied both initiation and maintenance to pregnant people. Four withdrawal management programs offered methadone maintenance and two offered methadone initiation overall; none of these programs limited methadone based on pregnancy status. SUD programs were asked to indicate whether they required obstetrics evaluation prior to initiating MOUD–60.4% reported requiring no obstetric evaluation, 4.2% required ultrasound, 18.8% required outpatient obstetric evaluation, 2.1% required inpatient hospitalization, and 18.8% were unsure.
Withdrawal management services were less widely available than MOUD, with more organizations offering opioid than alcohol/benzodiazepine withdrawal management. Five of seven birthing hospitals reported offering management of opioid and alcohol/benzodiazepine withdrawal. Only 10% of PNC practices offered opioid withdrawal management, and none offered alcohol/benzodiazepine withdrawal management. Among SUD programs, two of five withdrawal management programs offering alcohol/benzodiazepine withdrawal management reported restricting this service to non-pregnant patients only.
Linkage to treatment via SBIRT (i.e., screening, behavioral intervention and referral to treatment), peer recovery support, and/or non-peer treatment linkage services was most widely available at birthing hospitals and SUD programs. Among PNC practices, only half conducted SBIRT, 25% offered peer recovery support, and 40% offered non-peer treatment linkage.
Harm reduction services, including naloxone provision, were less often available at birthing hospitals and prenatal care practices than at SUD programs. Nearly two-thirds of birthing hospitals and PNC practices reported neither prescribing nor distributing naloxone, whereas only 16% of SUD programs reported neither service. Other harm reduction services (e.g., distribution of sterile supplies) were reported by 35% of SUD programs but only 14% of birthing hospitals and 5% of PNC practices.
Table 4
Availability of Family-Focused Practices and Policies Within SUD Programs
| Services for perinatal patients^ Row % (n) | Services for parents# Row % (n) | Housing available during pregnancy Row % (n) | Children allowed onsite w/ legal guardian Row % (n) |
SUD Programs Overall (n = 63)* | 19% (12) | 14.3% (9) | 44.4% (28) | 44.4% (28) |
OBOT (n = 12) | 16.7% (5) | 8.3% (1) | 8.3% (1) | 50.0% (6) |
OTP (n = 21) | 23.8% (5) | 9.5% (2) | 23.8% (5) | 57.1% (12) |
SSPs (n = 7) | 14.3% (1) | 14.3% (1) | 28.6% (2) | 57.1% (4) |
Residential (n = 12) | 16.7% (2) | 16.7% (2) | 91.7% (11) | 16.7% (2) |
Recovery Res (n = 8) | 25.0% (2) | 25.0% (2) | 87.5% (7) | 50.0% (4) |
Withdrawal (n = 6) | 0 | 16.7% (2) | 66.7% (4) | 0 |
* Total N for SUD programs is less than sum of subcategories due to several programs falling into multiple categories. ^ Defined as “pregnant or within 1 year of birth, termination, or pregnancy loss.” # Defined as “individuals with children under age 5.” |
To assess specific focus on the perinatal population as well as family-friendliness, SUD programs were asked several questions about tailored services (Table 4). The minority of programs reported having specialized services for perinatal patients or for parents. Among the programs offering inpatient/residential level services, 92% of residential programs, 88% of recovery residences, and 67% of withdrawal management units reported offering housing to pregnant patients. Children were allowed on-site more often among outpatient programs (50% OBOT, 57% OTP, 57% SSPs) than inpatient programs (none of the withdrawal management programs, 17% residential, 50% recovery residences).
Table 5
Information/Resources Needed by Organizations to Better Serve Perinatal Patients with OUD
| Birthing Hospitals (n = 7) Column % (n) | Prenatal Care Practices (n = 20) Column % (n) | SUD Programs (n = 63) Column % (n) |
Education on meds for OUD in pregnancy | 57.1% (5) | 30.0% (6) | 36.7% (22) |
Education on other SUD treatment in pregnancy | 85.7% (6) | 35.0% (7) | 43.3% (26) |
Education on pregnancy-related medical concerns | 85.7% (6) | 25.0% (5) | 46.7% (28) |
Specialist consultation for SUD tx in pregnancy | 85.7% (6) | 40.0% (8) | 38.3% (23) |
Specialist consultation for pregnancy-related medical concerns | 57.1% (4) | 5.0% (1) | 43.3% (26) |
Increased availability of specific resources for patients | 85.7% (6) | 30.0% (6) | 41.7% (25) |
Support for implementation for clinical workflows or policies | 42.9% (3) | 5.0% (1) | 13.3% (8) |
Onsite sexual health services provided by external partner | 28.6% (2) | 5.0% (1) | 23.3% (14) |
Onsite SUD treatment services provided by external partner | 57.1% (4) | 15.0% (3) | 13.8% (8) |
Ability to distribute naloxone to individuals directly | 14.3% (1) | 0 | 16.7% (10) |
Respondents were asked “What information or resources would enable your organization to better serve this population?”; answer options included resources potentially available through the city health department or community partners (Table 5). Availability of resources for patients was among the top four responses for all three organization categories (86% birthing hospitals, 30% PNC practices, 42% SUD programs). Education/specialist consultation related to MOUD and other SUD treatment were among the most commonly endorsed by birthing hospitals and PNC practices. Conversely, education/specialist consultation on pregnancy-related medical concerns was among the most commonly endorsed by SUD treatment programs.