An FIU researcher was awarded an $893,255 grant from the National Institute on Drug Abuse (NIDA) to lead a 5-year project to improve engagement in care and access to services for women with opioid use disorder (OUD).
Melissa Ward, assistant professor of epidemiology at the Robert Stempel College of Public Health & Social Work, will work to address the need for women-centered navigation systems that connect women with OUD to vital resources like medications, mental health care and social services.
The project includes developing a pilot recovery navigation system that meets the unique needs of women, increases awareness of services and resources, and destigmatizes seeking treatment for OUD. The development will be guided by input from women in recovery, their family members, and leaders in the recovery community to ensure it meets the needs of the community it will be designed to serve.
"Patient navigator programs have been very successful in helping some populations—people with cancer and HIV, for example—figure out how to navigate the health system to get the treatment and care they need," Ward says. "However, these programs have not been fully implemented or evaluated for women with OUD."
Across the United States, the opioid epidemic has escalated dramatically. This month, the Centers for Disease Control and Prevention (CDC) reported that nearly 81,000 people died due to opioid-related overdoses in 2021. The rate of opioid-related overdoses among females has also risen—from 1999 to 2020; it increased from 1.4 to 12.3 per 100,000 people.
FIU News spoke with Ward to learn more about her work and the unique challenges women face when seeking care for OUD.
What piqued your interest in opioid use disorder research?
I spent time reading and learning more about the challenges that we are seeing, particularly for women. Rates of neonatal opioid withdrawal syndrome, where babies are born in withdrawal due to moms using opioids during pregnancy, are increasing year after year. In the literature, there are a lot of interventions focused on pregnancy. However, I did some pilot work with support from FIU's Research Center in Minority Institutions and one of the preliminary findings that came out was that women really need support across the life course, not just during pregnancy.
What does this finding suggest?
If we want to support women, we need to think about expanding the available support for OUD so that it’s not just linked to pregnancy, and we need to remove the stigma that comes from seeking care. Obviously, pregnancy is a very important time, and women need all the support they can get. But we also need to provide care for women using opioids before they get pregnant, after they get pregnant and if they decide they never want to be pregnant.
What challenges do women face when seeking treatment?
Often, it is a struggle for women to navigate treatment systems if they have kids. Many treatment facilities don't accept children. So, if you need inpatient care for addiction, sometimes you have to forgo that care because the available facilities won't let you bring your kids with you.
I think women who use substances get judged in many different ways when it comes to caretaking and motherhood. But if you talk to these women, they are trying to be the best moms they possibly can be. And so, it becomes a challenge. Sometimes, they are scared to report their substance use to providers because they are worried that that provider will automatically call child protective services on them. Granted, if the child is truly endangered that is warranted. But then there are other times when that won't happen, yet moms are still worried that it will and so they don’t tell their health care providers they need help.
Another challenge is something called “telescoping,” which has to do with the trajectory of addiction. It's that period between when someone starts using a substance and when they become addicted to that substance. For women, this period appears to be shorter compared to men. Women are also more likely to have experienced severe trauma like sexual abuse, and often, if or when they present for treatment, they come in with other serious problems they need help with as well.
The recent grant you were awarded will help identify ways to better support women with opioid use disorder. Tell us more about it.
The goal of the grant is to figure out how we might leverage technology and virtual or phone-based navigation processes to help women get the care and support that they need. In some instances, we know that virtual or phone-based assistance may not be enough. So how can we best connect them with recovery groups in their area that meet in person or inpatient facilities that will treat them while also helping them figure out their childcare needs? And how can we encourage women who need help to engage with these services? By really understanding the barriers that keep women with opioid use disorder from accessing and engaging in care, we can develop a program that will truly help. That’s why building a community advisory board that includes women in recovery, their family members, and leaders in the recovery community to help lead this effort is so important.
What's one thing you think people should know about the opioid epidemic?
Often in the news, the opioid epidemic is reported as a problem that is largely affecting white men. However, many other groups are also being impacted. We must use a health equity framework to make sure we're serving everyone that's affected by the opioid epidemic. This project is really focused on using that health equity lens to serve women with opioid use disorder.
In a sad way, the opioid epidemic has gotten dwarfed by COVID-19 recently, because the number of people who died due to opioid-related overdoses last year is smaller than those who died due to the pandemic. But it’s important to remember that last year’s 81,000 opioid-related overdose deaths are still a huge, unacceptable number, especially when we have services and medications that we know help people struggling with addiction. We have a lot of work in front of us to make sure women have equitable access to those services and medications.