Tailored strategies to reduce opioid overdose deaths for pregnant and postpartum women: Examples and lessons learned from the HEALing Communities Study.

INTRODUCTION

Pregnant and postpartum women (PPW) face substantial barriers to opioid use disorder (OUD) care despite overdose being a leading cause of maternal mortality in the United States. In this study, we leveraged data from the Helping End Addictions Long Term (HEALing) Communities Study (HCS), a community-engaged implementation trial aimed at reducing opioid overdose deaths, to 1) describe evidence-based practice (EBP) strategies designed to reach PPW and 2) review implementation determinants.

METHODS

We analyzed data from 50 communities across Massachusetts, New York, and Ohio that implemented the Communities That HEAL intervention from January 2020 through December 2023. HCS community coalitions used the HCS Opioid-overdose Reduction Continuum of Care Approach (ORCCA) menu to inform the selection of overdose education naloxone distribution (OEND) and medication for OUD (MOUD) EBP strategies. We used the ORCCA tracker, an HCS tool documenting strategy selection and implementation details, to identify and summarize strategies designed for PPW. We reviewed written community action and implementation plans to analyze and summarize implementation determinants.

RESULTS

The 50 communities included in this analysis selected 29 EBP strategies designed to reach PPW, and 21 (72.4 %) of the selected strategies were implemented, accounting for 3.5 % of all implemented strategies. Most (85.7 %) focused on MOUD, 31.0 % were based in rural communities, and 66.7 %, 23.8 %, and 9.5 % were delivered in healthcare sectors, behavioral health sectors, and criminal legal sectors, respectively. Barriers to implementing OUD strategies intended for PPW included a lack of staff or services with adequate experience, and stigma preventing delivery and engagement. Facilitators included leveraging existing services and community expertise to expand OUD care.

CONCLUSION

Our findings indicate a need for greater awareness of OUD among PPW and research on implementation approaches for EBPs that effectively reach this group. Leveraging existing community programs that serve PPW with substance use disorders could help expand tailored services.