Un-Erasing Race in a Medical-Legal Partnership: Antiracist Health Justice Advocacy by Design

This Article covers a potential response to a Massachusetts state law which has been interpreted to require health care providers and birthing hospitals to report to state authorities any infant born to a person taking medication of opioid use disorder. While the statute mandates reports where a professional has reasonable cause to believe that a child is suffering physical or emotional injury as a result of substance dependence at birth, the Article highlights that many institutions report all infants born to persons with substance abuse disorders, regardless of risk of harm, for fear of penalty for failure to report. As a result, many individuals endure months or years long involvement with state authorities without warrant. Many patients avoid necessary pre- and perinatal care, addiction treatment, or both for fear of repercussions. Importantly, the Authors note that these challenges have been disproportionately impacting the Black community. As a potential solution, the Authors explore the possibility of an academic medical legal partnership which would support patients of a regional referral center and medical home for the treatment of substance use disorder in pregnancy. The Authors advocate for the use of such partnerships across different communities. Furthermore, they claim that academic medical legal partnerships which utilize an antiracist design can 1) shift the dialogue regarding social determinants of health and 2) fulfill ABA curriculum standards in law schools

Un-Erasing Race in a Medical-Legal Partnership: Antiracist Health Justice Advocacy by Design

This Article covers a potential response to a Massachusetts state law which has been interpreted to require health care providers and birthing hospitals to report to state authorities any infant born to a person taking medication of opioid use disorder. While the statute mandates reports where a professional has reasonable cause to believe that a child is suffering physical or emotional injury as a result of substance dependence at birth, the Article highlights that many institutions report all infants born to persons with substance abuse disorders, regardless of risk of harm, for fear of penalty for failure to report. As a result, many individuals endure months or years long involvement with state authorities without warrant. Many patients avoid necessary pre- and perinatal care, addiction treatment, or both for fear of repercussions. Importantly, the Authors note that these challenges have been disproportionately impacting the Black community. As a potential solution, the Authors explore the possibility of an academic medical legal partnership which would support patients of a regional referral center and medical home for the treatment of substance use disorder in pregnancy. The Authors advocate for the use of such partnerships across different communities. Furthermore, they claim that academic medical legal partnerships which utilize an antiracist design can 1) shift the dialogue regarding social determinants of health and 2) fulfill ABA curriculum standards in law schools

Frequency and associated risk factors of non-fatal overdose reported by pregnant women with opioid use disorder

Abstract Background Little is known about opioid overdose or naloxone access among pregnant women. Objectives The objectives of this study were to determine the prevalence of non-fatal overdose, risk factors for overdose, and naloxone access among third trimester women in treatment for opioid use disorder. Methods We collected baseline data from a case management parental-support intervention study. To explore the association of variables with past year overdose, we used Wilcoxon rank-sum test, Chi square or Fisher’s exact tests. Results Among 99 participants, 14% (95% CI 7–21%) reported past year overdose and 67% (95% CI 57–76%) had received overdose education and a naloxone kit. Younger age was the only variable associated with past year overdose. Conclusions In this sample, past year non-fatal overdose was common, younger age was a risk factor, and most participants had received a naloxone kit. Further work is needed to understand whether younger age is a risk factor in the general population of pregnant women with opioid use disorder and to identify other potential risk factors for overdose in this population

Supporting the implementation of written exposure therapy for posttraumatic stress disorder in an obstetrics-substance use disorder clinic in the Northeastern United States

Pregnant people with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) constitute a highly vulnerable population. PTSD and SUD confer risks to both the pregnant person and the fetus, including a host of physical and mental health consequences. When PTSD and SUD co-occur, potential negative impacts are amplified, and the symptoms of each may exacerbate and maintain the other. Pregnancy often increases engagement in the healthcare system, presenting a unique and critical opportunity to provide PTSD and SUD treatment to birthing people motivated to mitigate risks of losing custody of their children. This paper presents implementation process outcomes of Written Exposure Therapy (WET), a brief, scalable, and sustainable evidence-based PTSD treatment delivered to pregnant persons receiving care in an integrated obstetrical-addiction recovery program at Boston Medical Center. Trial participants (N = 18) were mostly White, non-Hispanic (61.1%), not currently working (77.8%), had a high school or lower level of education (55.5%), had an annual household income less than $35,000 (94.4%), and were living in a substance use residential program (55.6%). We examined intervention feasibility, acceptability, appropriateness, adoption; barriers and facilitators to implementation; and feedback on supporting uptake and sustainability of the intervention using coded qualitative sources (consultation field notes [N = 47] and semi-structured interviews [N = 5]) from providers involved in trial planning and treatment delivery. Results reflected high acceptability, appropriateness, and adoption of WET. Participants described system-, provider-, and patient-level barriers to implementation, offered suggestions to enhance uptake, but did not raise concerns about core components of the intervention. Findings suggest that WET is an appropriate and acceptable PTSD treatment for this difficult-to-reach, complex population, and has the potential to positively impact pregnant persons and their children

Developing a Women’s Health track within addiction medicine fellowship: reflections and inspirations

Abstract Background Women who use drugs face sexism and intersectional stigma that influence their drug use experiences and treatment needs. There is a need to build the capacity of addiction medicine specialists who can deliver gender-responsive services and advance research and policy in women-focused addiction care. We describe the development of a Women’s Health track within an addiction medicine fellowship program and reflect on successes, challenges, and future directions. Main body The Women’s Health track was developed in collaboration between program leaders in Addiction Medicine and Obstetrics/Gynecology. Implementing the track led to the development of women-focused rotations and continuity clinics, as well as enrichment of women’s health didactic education for all fellows. The fellowship track spurred interdepartmental mentorship and collaboration on research and advocacy projects. Conclusion Addiction medicine fellowships can replicate this curriculum model to advance women-focused education, research, and policy. Future curricula should focus on structural sexism in drug use and addiction treatment throughout a woman’s life course