Exploring perinatal prescription opioid use and misuse in rural settings

Abstract

[EMBARGOED UNTIL 12/1/2023] Escalation of perinatal opioid use/misuse occurring during prenatal and postpartum phases has become a national public health concern due to the associated significant health risks to both maternal and fetal health. Many pregnant and postpartum women who use/misuse prescription opioids report either physical or emotional pain but the sources, co-occurrence, and timing of the factors underlying perinatal opioid use and misuse are poorly understood. Guided by the Theory of Symptom Management, three specific aims were designed to explore 1) the pain-related experiences, 2) the social-environmental factors and experiences, and 3) the healthcare-related experiences of women who used/misused prescription opioids during the perinatal period. A qualitative descriptive design was used, which allowed for exploration and discovery of a woman's complex journey that led to her decision to use/misuse prescription opioids and conducted the study with a purposeful sample of 12 childbearing-aged women residing within the US between October 2021 and July 2022. A semi-structured interview guide was used to collect data from participants in individual interviews, which were recorded, transcribed verbatim, and manually coded. Three major themes emerged from the data that highlighted perinatal women's opioid use/misuse experiences were: 1) Participants' sources of pain, pain experiences, and attempts at physical and emotional pain management, 2) The complicated dependency journey participants experienced that consist of the pathway to use/misuse, generational influences, resiliency, and motherhood's intersection with dependency and 3) The intersection of the women and the systems in which they live. Results of this study brings forth clues to the underlying pain-related elements of perinatal women']s use/misuse of opioids, where there is a tangled web of trauma, lack of resources including social support, and a total distrust of the system that has failed them during their lifetime. The women's shared experiences provide clear implications for targeted social-environmental and healthcare related interventions that could help reduce the initiation and perpetuation of use/misuse and assist these women's journey to recovery and motherhood.