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This is the primary outcomes article for CTN-0080-A-2. Introduction: Racial and ethnic inequities persist in medication treatment initiation and adherence for pregnant and postpartum people with opioid use disorder (OUD). Our objective was to understand the experiences of “positive outliers,” specifically pregnant and postpartum people of color with OUD who utilized medication treatment and engaged in a randomized clinical trial for buprenorphine despite historical, cultural, and structural barriers.

Methods: We conducted two sets of semi-structured qualitative interviews. First, trained peers with lived expertise as mothers in recovery interviewed individuals who identified with a non-white race and/or ethnicity and enrolled in the Medication Treatment for OUD in Expectant Mothers (MOMs) trial (NCT03918850). Second, we interviewed principal investigators, clinicians, and research coordinators from the 13 MOMs trial sites. We used an inductive thematic approach informed by the Social Ecological Model of Racism and Anti-Racism. Transcripts were double-coded and reviewed until consensus was reached. Preliminary findings from participant and staff interviews were merged and triangulated with peers to inform theme development.

Results: We completed 17 interviews with MOMs trial participants from 7 sites. Participants identified as Hispanic (29%), Black non-Hispanic (24%), multi-racial Hispanic (18%), multi-racial non-Hispanic (18%), and American Indian, Native Hawaiian, or Pacific Islander (12%). Thirty-two interviews with trial staff were also completed. Three themes emerged: (1) Although some participants expected racist treatment and research exploitation, all participants interviewed reported non-discriminatory, non-judgmental care within the MOMs trial; (2) Compassionate care, frequent, personalized, and integrated encounters, and emotional support helped counteract prior stigmatizing and discriminatory health care interactions, enabling participants of color to feel particularly supported, trusted, and empowered during the MOMs trial; and (3) Despite pervasive cultural stigma around addiction and concerns about taking an investigational drug while pregnant, participants expressed that pregnancy status, care team trust, and transparent communication with MOMs trial staff encouraged medication utilization and adherence.

Conclusion: Facilitators of successful engagement in the MOMs trial and retention in medication treatment among pregnant and postpartum people of color with OUD included non-judgmental care, sustained trust, and frequent contact. Key perinatal OUD clinical interventions and trial improvements include personalized communication and scheduling flexibility to promote engagement of marginalized populations.

Related protocols: CTN-0080-A-2

Asians and Pacific Islanders (API) have large disparities in utilization of substance use treatment compared to other racial groups. This CTN platform study analyzed factors that shape API experiences accessing and engaging in community-based treatment from the perspective of treatment providers. Semi-structured interviews were conducted with 40 treatment providers who work with API clients in treatment programs in the Western States and Pacific Nodes of the CTN (San Francisco and Los Angeles). Transcribed interview data was analyzed in ATLAS.ti using a content analysis approach.

There were three main findings. First, treatment providers found the API category itself is too broad and heterogeneous to meaningfully explain substance use patterns. Second, beyond race/ethnicity, structural factors such as poverty, neighborhood, housing, and age had an impact on API substance use. Third, factors such as family, immigration status, religion, language, stigma played complex roles in API treatment experiences, contingent on how client, programs, and providers attended to differences in these categories.

Conclusions: From the perspective of the treatment providers interviewed, there are multiple, intersecting factors that shaped their API clients’ experiences in substance use treatment. Future research can more closely examine and measure the role of structural factors and the potential for structural interventions in API treatment experience, and more research is needed to explore how substance use stigma operates within API communities as well.

Related protocols: CTN-0038-Ot

This is the Results Article for CTN-0038-Ot.

This study examined motivations and barriers to substance abuse treatment entry and treatment continuation among Asian Americans and Pacific Islander (AAPI) substance users. APPI substance users (N=61) were recruited from substance abuse treatment programs in California and Hawaii. Semi-structured interviews and interviewer-administered surveys assessed barriers and facilitators to entering substance abuse treatment.

Barriers included peer pressure, family influences, and fear of “losing face.” Facilitators included peer support, involvement in the criminal justice system, a perceived need for treatment, and culturally competent substance abuse treatment services. Family and peer influences may act as both facilitators and impediments. AAPI substance using populations face many of the same individual-level and structural and systems barriers to entry to treatment as other substance using populations. However, similar to other racial/ethnic minority groups, it is important to address cultural differences. It may be important to keep in mind the ideas of family harmony, solidarity, and subordination of individual goals for the sake of family goals while designing substance abuse treatments for this population. In addition, integrating culturally sensitive screening tools, brief interventions, and referral to substance abuse treatment in medical care settings and non-traditional settings (e.g., health fairs, community cultural celebrations) may increase the numbers of AAPIs who seek substance abuse treatment.

Related protocols: CTN-0038-Ot