Experiences of healthcare discrimination and treatment outcomes among pregnant and postpartum people with opioid use disorder

Introduction: Experiences of discrimination among pregnant and postpartum people with opioid use disorder likely affect utilization of medications for opioid use disorder (MOUD), which reduce the risk of overdose and death. We evaluated experiences of discrimination in this population by healthcare setting and estimated their effects on MOUD treatment outcomes. Methods: Participants who had received MOUD at least once during pregnancy were enrolled into this retrospective cohort study. A modified Healthcare Discrimination Scale assessed discrimination within prenatal care (PNC) and substance use disorder treatment (SUD) settings. Patient-members from the Empower project codesigned survey items to measure treatment outcomes: MOUD misuse, discontinuation, return to use, and overdose. We examined the proportion of participants who endorsed each item on the Healthcare Discrimination Scale and summed the total scores by healthcare setting. Relative risk (RR) and 95 % confidence intervals (CI) were estimated using log-binomial models. Results: Among 100 participants, 57 reported experiencing discrimination, 56 within PNC and 33 within SUD clinics. Discrimination in the SUD setting was associated with an over two-fold increased risk of MOUD discontinuation (RR 2.56, CI 1.19-5.54) and return to use (RR 2.36, CI 1.18-4.73). Increased risk of misusing MOUD was associated with discrimination in both PNC (RR 2.6, 95 % CI 1.06-6.40) and SUD (RR 3.26, CI 1.59-6.70) settings. Conclusions: Experiences of discrimination were common, especially in prenatal care settings, and were associated with postpartum MOUD misuse. Addressing discrimination within healthcare settings may improve treatment outcomes for pregnant and postpartum people with OUD.