(PS1-46) Provider Feedback on a Digital Cognitive-behavioral Intervention for Pregnant People with Opioid Use Disorder

Opioid use disorder (OUD) and opioid-involved overdose is a leading cause of maternal mortality in the US (CDC, 2022). Medications for OUD (MOUD) are first-line treatments for OUD and reduce risk for overdose. Yet, MOUD is underutilized in pregnant and postpartum people (PPP), and there are significant structural and individual barriers to engaging with care (Frazer et al., 2019). EMpowering Pregnant Women and people Receiving MOUD (EMPWR) is a brief cognitive-behavioral telemedicine intervention that aims to improve retention of PPP in OUD treatment by mitigating barriers to treatment engagement. EMPWR utilizes interoceptive exposure and CBT for Insomnia to mitigate anxiety sensitivity and sleep disturbances, respectively, which are elevated in pregnancy and those with OUD, and are independently associated with increased risk for craving, treatment discontinuation, and relapse (Dolsen & Harvey, 2017; MacLean et al., 2019; Schick et al., 2022). This study elicited feedback on EMPWR from providers who routinely treat perinatal OUD. Providers (N=10) were obstetricians (40%), family medicine/primary care providers (30%), licensed professional counselors (20%), and nurses (10%) who completed an online qualitative survey. Following a video explanation of EMPWR, providers gave feedback including whether they would recommend EMPWR to their patients, barriers to patient engagement with EMPWR, and how addressing anxiety sensitivity and insomnia would improve M/OUD treatment engagement. All providers stated they would recommend EMPWR to their patients but suggested it may be most effective for those who had achieved some stability (e.g. reliable housing). Most (80%) identified technology barriers (i.e. inconsistent access to internet capable devices/WiFi), and 50% suggested treatment fatigue and difficulty managing multiple appointments (e.g. frequent prenatal, medication appointments) could reduce participation. The importance of empowering patients with the knowledge of how anxiety sensitivity impacts cravings and dropout from OUD treatment, and the role of sleep in maintaining recovery and reducing emotion vulnerability was highlighted. Overall, providers of diverse disciplines treating PPP with OUD agree that a CBT program to improve OUD treatment retention is needed. Traditional healthcare systems are siloed, such that the needs of birthing people who use drugs are not met (Martin et al., 2021), increasing risk for overdose. Integration of EMPWR into obstetric, family medicine, and other practice settings may eliminate barriers and improve patient-centered, whole person care. Continuing to engage providers across the care continuum, as well as individuals with living experience, in the integration and sustainment of EMPWR in care settings is needed.