"I’m Finally Dealing with Everything at Once": Perinatal Women’s Help-seeking Experiences with Opioid Use Disorder and Intimate Partner Violence

Background: Opioid use disorder (OUD) and intimate partner violence (IPV) are bidirectional intersecting phenomena with adverse health consequences.¹ Despite this, little research has been conducted to describe the lived experiences of women with exposure to both, particularly among pregnant and postpartum populations.² As pregnancy can be a motivator for change, the consultation-liaison (CL) psychiatrist is ideally positioned to optimize engagement around OUD and IPV. The objective of this qualitative analysis was to characterize perinatal women’s experiences navigating services for OUD and IPV. The findings will help guide CL psychiatrists in their care of patients with these comorbidities in both inpatient and integrated care settings.

Methods: We conducted fifteen semi-structured, in-depth interviews with pregnant and postpartum women with OUD who also reported past or current experiences of IPV. Interview transcripts were independently coded by two researchers using codes that were pre-defined based on the interview guide and newly generated as transcripts were reviewed. The codes were qualitatively analyzed to identify themes related to help-seeking experiences. The study was approved by our Institutional Review Board.

Results: Participants were mostly white (N=10) with a mean age of 30.1 years. Thirteen received medication-assisted treatment. Seven reported having more than one unhealthy relationship during their lifetime. Women described seeking and receiving help from multiple different service providers, including those in healthcare, legal, and child protective services. Women also noted engagement across inpatient, outpatient, and emergency medical and psychiatric settings. Several themes emerged regarding help-seeking. Women described seeking care for OUD and IPV separately, yet recommended integrating services to better meet their needs. They described intimate partners’ influences on their substance use and their impact on ability to seek care for OUD. They felt more comfortable disclosing OUD compared to IPV. Finally, they viewed pregnancy as both a facilitator and barrier to help-seeking for OUD.

Discussion/Conclusion: Peripartum women who have experienced OUD and IPV recognize how these phenomena intersect and identify a need for more comprehensive services. Our results support universal education of IPV in hospital and integrated care settings, and provide several areas to target for optimal clinical care. These include addressing partner influence on substance use, educating patients and other providers on the connection between OUD and IPV, and optimizing engagement through direct questions and referral to integrated clinical programs, if available.

References:
1. Stone R, Rothman EF. Opioid Use and Intimate Partner Violence: A Systematic Review. Current Epidemiology Reports. 2019;6:215-230.
2. Meyer JP, Isaacs K, El-Shahawy O, Burlew AK, Wechsberg W. Research on women with substance use disorders: Reviewing progress and developing a research and implementation roadmap. Drug and Alcohol Dependence. 2019;197:158-163.