Barriers to care for perinatal patients with opioid use disorder: family physician perspectives

Abstract

Background: While barriers to care for pregnant patients with opioid use disorder (OUD) have been described, the experiences and challenges of the physicians providing care to these patients are poorly understood.

Objectives: To describe the experiences of family physicians providing comprehensive care to pregnant people with OUD and the challenges they face in providing such care.

Methods: Qualitative thematic analysis of 17 semistructured interviews conducted from July 2019 to September 2020 with family physicians who possess a Drug Enforcement Administration "X" waiver and provide care to pregnant patients.

Results: Seventeen family physicians practicing in the United States who care for pregnant people with OUD were interviewed. They described physician-, patient-, and systems-level barriers to providing and accessing care for this patient population. Of the 12 interrelated themes regarding challenges to delivering and accessing this care, 3 were particularly salient: the pervasive effects of social determinants of health, a lack of adequately trained providers, and social stigma associated with pregnant people with OUD.

Conclusion: A comprehensive, multilevel, and multidisciplinary approach is necessary to address these barriers and move towards health equity for this vulnerable patient population.

Keywords: addiction medicine; at-risk groups; obstetrics/postpartum care; primary care; substance abuse; underserved populations.