title: Contraceptive use and method choice among women with opioid and other substance use disorders: A systematic review.
abstract: OBJECTIVE
  To systematically review the literature on contraceptive use by women with opioid and other substance use disorders in order to estimate overall contraceptive use and to examine method choice given the alarmingly high rate of unintended pregnancy in this population.
  
  
  METHODS
  Pubmed (1948-2014) and PsycINFO (1806-2014) databases were searched for peer-reviewed journal articles using a systematic search strategy. Only articles published in English and reporting contraceptive use within samples of women with opioid and other substance use disorders were eligible for inclusion.
  
  
  RESULTS
  Out of 580 abstracts reviewed, 105 articles were given a full-text review, and 24 studies met the inclusion criteria. The majority (51%) of women in these studies reported using opioids, with much smaller percentages reporting alcohol and cocaine use. Across studies, contraceptive prevalence ranged widely, from 6%-77%, with a median of 55%. Results from a small subset of studies (N=6) suggest that women with opioid and other substance use disorders used contraception less often than non-drug-using comparison populations (56% vs. 81%, respectively). Regarding method choice, condoms were the most prevalent method, accounting for a median of 62% of contraceptives used, while use of more effective methods, especially implants and intrauterine devices (IUDs), was far less prevalent 8%.
  
  
  CONCLUSIONS
  Women with opioid and other substance use disorders have an unmet need for contraception, especially for the most effective methods. Offering contraception services in conjunction with substance use treatment and promoting use of more effective methods could help meet this need and reduce unintended pregnancy in this population.
authors.affiliation: Behavioral Health System Baltimore, Baltimore, MD 21201, United States; Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD 21201, United States.
authors.forename: Mishka
authors.initials: M
authors.lastname: Terplan
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, Burlington, VT 05401, United States; Department of Psychiatry, University of Vermont, Burlington, VT 05401, United States.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hand
authors.affiliation: Behavioral Health System Baltimore, Baltimore, MD 21201, United States; Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD 21201, United States.
authors.forename: Melissa
authors.initials: M
authors.lastname: Hutchinson
authors.affiliation: Behavioral Health System Baltimore, Baltimore, MD 21201, United States; Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD 21201, United States.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Salisbury-Afshar
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, Burlington, VT 05401, United States; Department of Psychiatry, University of Vermont, Burlington, VT 05401, United States; Department of Psychology, University of Vermont, Burlington, VT 05401, United States.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Heil
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D002755:Choice Behavior; D003270:Contraceptive Agents; D005193:Family Planning Services; D005260:Female; D006801:Humans; D009293:Opioid-Related Disorders; D011247:Pregnancy; D019966:Substance-Related Disorders
chemical_list: D000701:Analgesics, Opioid; D003270:Contraceptive Agents
keywords: Contraceptive use; Opioids; Substance use disorders; Unintended pregnancy; Women