J Pediatr Adolesc Gynecol. 2017 Nov 18. pii: S1083-3188(17)30508-9]

A retrospective chart review of contraceptive use among adolescents with opioid use disorder

Handy CJ, Lange HLH, Manos BE, Berlan ED and Bonny AE


Study objective: To describe contraceptive use among female adolescents initiating outpatient treatment for opioid use disorder.

Design: Retrospective chart review.

Setting: Outpatient clinic providing medication-assisted treatment for substance use disorders to adolescents and young adults.

Participants: Non-pregnant female adolescents presenting for treatment from January 1, 2013 to January 31, 2016 (N=123).

Intervention: None

Main outcome measures: Prescription contraceptive use at baseline and initiation of a new method within 90 days.

Results: Of 123 females presenting for treatment of opioid use disorder, 113 (91.9%) reported sexual activity and 80 (65.0%) were not using prescription contraception at intake. Previous pregnancy was reported by 43 (34.9%) and 20 (16.3%) were positive for a sexually transmitted infection. Contraceptive counseling was not documented for 73 (59.3%) patients. Among patients off prescription contraception at baseline, 56 of 80 (70.0%) initiated a method within the study window. Significant predictors (odds ratio; 95% confidence interval) of contraceptive initiation included prior pregnancy (8.6; 1.39-52.99), education < high school diploma/GED (7.4; 1.63-33.41), and return for follow up visit (9.8; 2.18-43.69).

Conclusion: Young women presenting for opioid use disorder treatment were at high risk of adverse reproductive health outcomes. The majority was sexually active and not using prescription contraception. Findings underscore the need for contraceptive counseling in this patient population. Optimally, these services would be provided in conjunction with substance use treatment. Improved contraceptive counseling documentation will allow evaluation of effective contraceptive counseling strategies for adolescents with opioid use disorders and may serve to inform future interventions.

Comment: Sometimes we see a woman in our care with opioid addiction, or we may even work at a specific center for these women. Since perinatal morbidity and mortality are higher in these women, it is important to counsel them well on contraception, contraceptive behavior and preferably LARCs. (HMV)