Dual Burden Reading & Resources

On this page, you will find links to reports and programs and citations to peer-reviewed research concerning the reproductive health needs of women(*) with opioid use disorder. We created this list not to be exhaustive, but to provide a next step for those seeking to learn more about the dual burden millions of Americans face. Readings and resources are organized as follows:

  • Framing, problem definition
  • Caring for women with OUD
  • Caring for pregnant & postpartum people with OUD
  • Disparities in care
  • Organizations & programs
  • Patterns of reproductive care among women with OUD
  • Patterns of OUD and pregnancy outcomes

Generally, we use the word “woman” because it is consistent with much of the literature and language in practice. However, because people of other gender identities can get pregnant and experience health needs related to female reproductive organs, “pregnant people”, “people who have been pregnant/given birth”, “people who may become pregnant”, and “people with female reproductive organs” represent more correct – as well as inclusive – terminology.

Back to Center for HOPES content on the Dual Burden


Framing, Problem Definition

  • CDC. (2018). The US Opioid Crisis: Addressing maternal and infant health. [Infographic]
  • Hui, K., Angelotta, C., & Fisher, C. E. (2017). Criminalizing substance use in pregnancy: misplaced priorities. Addiction (Abingdon, England)112(7), 1123-1125.
  • Krans, E. E., & Patrick, S. W. (2016). Opioid use disorder in pregnancy: health policy and practice in the midst of an epidemic. Obstetrics and gynecology128(1), 4.
  • Roberts, S. C. (2020). Good intentions are not enough: Truly supporting pregnant women with substance use disorders requires evaluating the impact of our policies and practices. Women’s Reproductive Health7(3), 181-184.
  • Terplan, M., & Minkoff, H. (2017). Neonatal abstinence syndrome and ethical approaches to the identification of pregnant women who use drugs. Obstetrics & Gynecology129(1), 164-167.
  • Terplan, M. (2017). Women and the opioid crisis: historical context and public health solutions. Fertility and sterility108(2), 195-199.
  • Vecchiarello, V. (2019). The Criminalization of Pregnancy and its Effects on Maternal Health: Understanding State Interventions. Fordham Urb. LJ47, 1051.

Caring for Women with Opioid Use Disorder

  • Health Resources and Services Administration, Office of Women’s Health. (November 2020). Caring for Women with Opioid Use Disorder: A toolkit for organization leaders and providers.
  • HRSA, Office on Women’s Health. (July 2017). Final Report: Opioid Use, Misuse, and Overdose in Women.
  • Association of Maternal & Child Health Programs. (November 2020). Promoting Access to Care for Women of Reproductive Age with Mental Health and Substance Use Disorders in Rural Communities. Issue Brief.
  • Heil, S. H., Melbostad, H. S., & Rey, C. N. (2019). Innovative approaches to reduce unintended pregnancy and improve access to contraception among women who use opioids. Preventive Medicine128, 105794.
  • Hurley, E. A., Duello, A., Finocchario-Kessler, S., Goggin, K., Stancil, S., Winnograd, R. P., & Miller, M. K. (2020). Expanding Contraception Access for Women With Opioid-Use Disorder: A Qualitative Study of Opportunities and Challenges. American Journal of Health Promotion, 0890117120927327.
  • Klaman, S. L., Turner, K., Lorvick, J., & Jones, H. E. (2020). Integrating reproductive and sexual health education and services into opioid use disorder treatment programs: a qualitative study. Journal of addiction medicine14(5), e175-e182.
  • MacAfee, L. K., Harfmann, R. F., Cannon, L. M., Minadeo, L., Kolenic, G., Kusunoki, Y., & Dalton, V. K. (2020). Substance use treatment patient and provider perspectives on accessing sexual and reproductive health services: barriers, facilitators, and the need for integration of care. Substance Use & Misuse55(1), 95-107.
  • Martin, C. E., Scialli, A., & Terplan, M. (2020). Unmet substance use disorder treatment need among reproductive age women. Drug and Alcohol Dependence206, 107679.
  • 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 & misuse51(11), 1477-1483.
  • Smith, C., Morse, E., & Busby, S. (2019). Barriers to reproductive healthcare for women with opioid use disorder. The Journal of perinatal & neonatal nursing33(2), E3-E11.

Caring for Pregnant & Postpartum People with OUD

  • Substance Abuse and Mental Health Services Administration. (2016). A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders. HHS Publication No. (SMA) 16-4978.
  • National Harm Reduction Coalition. (September 2020). Pregnancy and Substance Use: A harm reduction toolkit.
  • Collier, K. W., MacAfee, L. K., Kenny, B. M., & Meyer, M. C. (2019). Does co-location of medication assisted treatment and prenatal care for women with opioid use disorder increase pregnancy planning, length of interpregnancy interval, and postpartum contraceptive uptake?. Journal of Substance Abuse Treatment98, 73-77.
  • Ecker, J., Abuhamad, A., Hill, W., Bailit, J., Bateman, B. T., Berghella, V., … & Yonkers, K. A. (2019). Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine. American Journal of Obstetrics & Gynecology221(1), B5-B28.
  • Jones, C. W., & Terplan, M. (2018). Pregnancy and naltrexone pharmacotherapy. Obstetrics & Gynecology132(4), 923-925.
  • Krans, E. E., Campopiano, M., Cleveland, L. M., Goodman, D., Kilday, D., Kendig, S., … & Terplan, M. (2019). National Partnership for Maternal Safety: Consensus Bundle on Obstetric Care for Women With Opioid Use Disorder. Obstetrics & Gynecology134(2), 365-375.
  • Preis, H., Garry, D. J., Herrera, K., Garretto, D. J., & Lobel, M. (2020). Improving assessment, treatment, and understanding of pregnant women with opioid use disorder: The importance of life context. Women’s Reproductive Health7(3), 153-163.
  • Terplan, M., Laird, H. J., Hand, D. J., Wright, T. E., Premkumar, A., Martin, C. E., … & Krans, E. E. (2018). Opioid detoxification during pregnancy: a systematic review. Obstetrics and gynecology131(5), 803.
  • Wright, T. E., Terplan, M., Ondersma, S. J., Boyce, C., Yonkers, K., Chang, G., & Creanga, A. A. (2016). The role of screening, brief intervention, and referral to treatment in the perinatal period. American journal of obstetrics and gynecology215(5), 539-547.

Disparities in Care

  • Knight, K. R. (2020). Structural Factors That Affect Life Contexts of Pregnant People With Opioid Use Disorders: The Role of Structural Racism and the Need for Structural Competency. Women’s Reproductive Health7(3), 164-171.
  • Preis, H., Garry, D. J., Herrera, K., Garretto, D. J., & Lobel, M. (2020). Contextualizing Life Context: Discrimination, Structural Competency, and Evaluation in the Treatment of Pregnant Women With Opioid Use Disorder. Women’s Reproductive Health7(3), 185-189.
  • Schiff, D. M., Nielsen, T., Hoeppner, B. B., Terplan, M., Hansen, H., Bernson, D., … & Taveras, E. M. (2020). Assessment of Racial and Ethnic Disparities in the Use of Medication to Treat Opioid Use Disorder Among Pregnant Women in Massachusetts. JAMA Network Open3(5), e205734-e205734.

Organizations & Programs 

Patterns of Reproductive Care Among Women with OUD

  • Kotha, A., Chen, B. A., Lewis, L., Dunn, S., Himes, K. P., & Krans, E. E. (2019). Prenatal intent and postpartum receipt of long-acting reversible contraception among women receiving medication-assisted treatment for opioid use disorder. Contraception99(1), 36-41.
  • Krans, E. E., Kim, J. Y., James III, A. E., Kelley, D. K., & Jarlenski, M. (2018). Postpartum contraceptive use and interpregnancy interval among women with opioid use disorder. Drug and alcohol dependence185, 207-213.
  • Martin, C. E., Terplan, M., O’Grady, K. E., & Jones, H. E. (2018). Pregnancy intention and opioid use disorder treatment retention in the MOTHER study. The American journal on addictions.
  • MacAfee, L. K., Dalton, V., & Terplan, M. (2019). Pregnancy Intention, Risk Perception, and Contraceptive Use in Pregnant Women Who Use Drugs. Journal of addiction medicine13(3), 177-181.
  • Meschke, L. L., McNeely, C., Brown, K. C., & Prather, J. M. (2018). Reproductive health knowledge, attitudes, and behaviors among women enrolled in medication-assisted treatment for opioid use disorder. Journal of Women’s Health27(10), 1215-1224.
  • Stone, R. H., Griffin, B., Fusco, R. A., Vest, K., Tran, T., & Gross, S. (2020). Factors affecting contraception access and use in patients with opioid use disorder. The Journal of Clinical Pharmacology60, S63-S73.
  • 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 medicine80, 23-31.

Patterns of OUD and Pregnancy Outcomes

  • Vanderbilt University Medical Center, Center for Child Health Policy. (2020). Neonatal Abstinence Syndrome High-Risk Clinical Prediction Model.
  • Jones, H. E., Terplan, M., & Meyer, M. (2017). Medically assisted withdrawal (detoxification): considering the mother-infant dyad. Journal of addiction medicine11(2), 90-92.
  • Lind, J.N., Interrante, J.D., Ailes, E.C., et al. (2017). Maternal Use of Opioids During Pregnancy and Congenital Malformations: A Systematic Review. Pediatrics 139(6):e20164131.
  • Nielsen, T., Bernson, D., Terplan, M., Wakeman, S. E., Yule, A. M., Mehta, P. K., … & Schiff, D. M. (2020). Maternal and infant characteristics associated with maternal opioid overdose in the year following delivery. Addiction115(2), 291-301.
  • Reddy, U.M., Davis, J.M., Ren, Z., & Greene, M.F. (2017). Opioid Use in pregnancy, neonatal abstinence syndrome, and childhood outcomes: Executive summary of a Joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists, American Academy of Pediatrics, Society for Maternal-Fetal Medicine, Centers for Disease Control and Prevention, and the March of Dimes Foundation. Obstetrics & Gynecology 130(1),10-28.
  • Sanjanwala, A. R., & Harper, L. M. (2019). Opioid use disorder in pregnancy. Clinical Obstetrics and Gynecology62(1), 191-207.
  • Short, V. L., Hand, D. J., MacAfee, L., Abatemarco, D. J., & Terplan, M. (2018). Trends and disparities in receipt of pharmacotherapy among pregnant women in publically funded treatment programs for opioid use disorder in the United States. Journal of substance abuse treatment89, 67-74.
  • Wang, M. J., Kuper, S. G., Sims, B., Paddock, C. S., Dantzler, J., Muir, S., & Harper, L. M. (2019). Opioid detoxification in pregnancy: Systematic review and meta-analysis of perinatal outcomes. American journal of perinatology36(06), 581-587.