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Substance abuse, maternal, compliance, contraception


Behavioral Medicine | Medicine and Health Sciences | Obstetrics and Gynecology | Quality Improvement | Substance Abuse and Addiction



West Virginia leads the nation in substance abuse deaths per capita. This epidemic has given rise to a novel population of high-risk, obstetric patients with opiate abuse. Appropriate education, counseling, and implementation of contraception are of extreme importance among this population, due to the risks of unintended pregnancy.


This study was a retrospective chart review to determine compliance and uptake of contraceptive methods by patients in a maternal buprenorphine maintenance program prior to and following implementation of standardized contraception education and Medicaid coverage of immediate postpartum long-acting reversible contraceptives (LARC). Rates of planned contraception and rates of actual method initiation were compared between two groups representing two distinct time periods before and after the intervention.


Rates of highly effective contraception options were noted to significantly increase following dedicated education and Medicaid coverage (p = 0.04). Patients receiving no contraception at all significantly decreased following these interventions (p = 0.003). Patients desiring surgical sterilization continued to encounter barriers to care as the rate of actual sterilization to desired sterilization remained low.


As numbers and follow-up increase, we speculate that these findings will translate into a reduced number of unintended pregnancies in this vulnerable population. Continued efforts must be made to appropriately educate and counsel the high-risk obstetric population with substance abuse in West Virginia regarding contraception options and availability.