Best Practice of the Month
Integrating Family Planning Services Into Substance Use Disorder Treatment

Women who use substances have higher rates of unintended pregnancy and lower rates of contraceptive use compared to women who don’t use drugs. Unplanned pregnancy rates are as high as 80 percent among women who use opioids, yet family planning services are rarely delivered as part of substance use disorder (SUD) treatment. [i],[ii]

In rural areas, 37 percent of women who use non-prescribed opioids or other illicit substances reported some form of contraceptive use, compared to 66 percent of all women living in rural areas, suggesting there is a potential gap in access to family planning services.[iii] Primary care clinics providing SUD treatment in rural areas are uniquely positioned to ensure access to family planning services.

Research has found that people in SUD treatment are open to integration of reproductive, sexual health, and family planning services into their SUD care.[iv],[v],[vi] However, how these services are implemented matters quite a bit. A study exploring barriers to family planning services among women who use substances found that women’s trauma histories and mistrust of the medical system were common barriers to seeking family planning services, highlighting the importance of ensuring that family planning services are trauma-informed.[vii] Similarly, it is important to recognize that reproductive and contraceptive coercion has been used against women who use substances, so it is critical to ensure that services are offered when women want it—but that contraceptive coercion is not used when contraception is not desired.[viii]

[i] Terplan, M., Hand, D. J., Hutchinson, M., Salisbury-Afshar, E., & Heil, S. H. (2015). Contraceptive use and method choice among women with opioid and other substance use disorders: A systematic review. Preventive medicine, 80, 23–31.
[ii] Klaman, S. L., Lorvick, J., & Jones, H. E. (2019). Provision of and Barriers to Integrating Reproductive and Sexual Health Services for Reproductive-age Women in Opioid Treatment Programs. Journal of addiction medicine, 13(6), 422–429.
[iii] Levander, X. A., Foot, C. A., Magnusson, S. L., Cook, R. R., Ezell, J. M., Feinberg, J., Go, V. F., Lancaster, K. E., Salisbury-Afshar, E., Smith, G. S., Westergaard, R. P., Young, A. M., Tsui, J. I., & Korthuis, P. T. (2022). Contraception and healthcare utilization by reproductive-age women who use drugs in rural communities: A cross-sectional survey. Journal of General Internal Medicine.
[iv] Robinowitz, N., Muqueeth, S., Scheibler, J., Salisbury-Afshar, E., & Terplan M. (2016). Family Planning in Substance Use Disorder Treatment Centers: Opportunities and Challenges. Substance Use & Misuse. 2016 Sep 18;51(11):1477-83. .
[v] Stoltman, J. J. K., Lander, L. R., Patrick, J. H., Terplan, M., & Jones, H. E. (2022). Interest in Co-located Reproductive and Sexual Health Services Among Women and Men Receiving Medication for Opioid Use Disorder in an Outpatient Treatment Clinic. Frontiers in psychiatry, 13, 910389.
[vi] Martin, C.E., Parlier-Ahmad, A.B., Beck, L., Jain, V., & Terplan, M. (2022). A Comparison of Sex-Specific Reproductive and Sexual Health Needs between Addiction Medicine and Primary Care Treatment Settings. Substance Use & Misuse. 57(8):1229-1236.  
[vii] Stowell, M. A., Thomas-Gale, T., Jones, H. E., Binswanger, I., & Rinehart, D. J. (2022). Perspectives among women receiving medications for opioid use disorder: Implications for development of a peer navigation intervention to improve access to family planning services. Substance abuse, 43(1), 722–732.
[viii] Abbass, N., Malhotra, T., Bullington, W., & Arora, K. S. (2022). Ethical Issues in Providing and Promoting Contraception to Women with Opioid Use Disorder. The Journal of clinical ethics, 33(2), 112–123.

Specific considerations for clinic operations and service delivery

  • Does the SUD intake process include questions related to reproductive and sexual health needs?
  • Does the SUD intake process include non-coercive questions related to desire for pregnancy in the future?
  • Are pregnancy tests, sexually transmitted infection screening, and family planning education offered at intake and routinely available thereafter?
  • Are all clinicians offering SUD treatment in your clinic well versed in contraceptive options and relative efficacy of each option?
  •  Are all 18 FDA approved methods, including intrauterine devices (IUDs), implants, and permanent methods for both sexes, routinely discussed and offered (directly or via seamless referral)?

Primary care clinics that offer SUD treatment can help to meet family planning needs among women who use substances. Continuity relationships with patients and the existing reproductive, sexual health, and family planning services already delivered in the clinic offer a natural environment for the integration of these service lines.