(823) Prenatal and Opioid Treatment Provider Practices, Knowledge, and Attitudes Regarding Perinatal Opioid Use Disorder Care

Pregnant patients with opioid use disorder (OUD) face significant barriers to comprehensive care, despite the availability of effective treatments. We aimed to identify structural and clinical gaps that contribute to missed treatment opportunities during pregnancy.

Study Design:

We administered a national cross-sectional survey (Oct 2020-Mar 2021) to clinicians providing obstetric and/or addiction care. The survey assessed practices, communication, attitudes, and training regarding OUD management during pregnancy. Descriptive statistics, chi-square tests, and Mann-Whitney tests were used to compare groups.

Results:

Of the 113 respondents (80 [73%] female) from 28 states, 63 (56%) primarily provided prenatal care, and 50 (44%) primarily provided addiction care. Most practiced in the ambulatory setting (70 [62%]) and regularly (44 [39%]) or occasionally (50 [44%]) managed pregnant patients with OUD. Subgroup demographic and practice characteristics were similar. Despite broad endorsement of harm reduction strategies (78 [69%] strongly endorsed), 33 (30%) clinicians lacked harm reduction training. Only 60 (51%) were formally trained on treating OUD in pregnancy.

Among addiction providers, 48 (96%) offered pregnancy testing, though 5 (10.0%) only at intake and 34 (68%) only upon request or per symptoms. Most (43 [86%]) offered family planning services. Thirteen (26.0%) recommended but did not refer to prenatal care, and only 18 (36.0%) had protocols for patients unable to access prenatal care. Among referring providers, 7 (16%) did not communicate with the receiving provider post-referral. 

Among prenatal care providers, 25 (40%) managed OUD themselves. Most (59 [94%]) supported MOUD treatment during pregnancy, with 38 (60%) strongly agreeing. However, 16 (26%) viewed treating this population as challenging.

Conclusion:

This study highlights critical gaps in care coordination, training, and protocols that leave pregnant people who use drugs vulnerable to delays in prenatal and addiction care access. Innovative care models -- such as co-located care -- may help prevent avoidable harms due to delays in care.