VICTA: An unexpected home for contraceptive care

Few people think of contraceptive care as part of an opioid treatment center despite staggering statistics showing more than seven million women in the United States struggle with substance use disorders (SUDs), a population that faces a disproportionately high rate of unintended pregnancies as well as low rates of contraception access and use. Lisa Peterson, COO of VICTA, saw a more? integrated approach to outpatient substance abuse recovery and treatment center - one that incorporated contraceptive care as part of the services. A partnership with Upstream helped bring that goal to life.

“VICTA was started with a vision of an opioid treatment provider that had ancillary services because we know people who use drugs are stigmatized [in the healthcare system],” says Lisa Peterson, COO of VICTA, an outpatient substance abuse recovery and treatment center in Providence, RI. “We've developed a truly integrated model here where all of the providers are able to work both in addiction medicine and quote unquote physical medicine.”

Patients with SUDS often encounter multiple barriers to accessing contraceptive care. These include everything from fear of criminalization and mistrust of health care providers to intimate partner violence and histories of sexual trauma. In addition, many patients with SUDS lack both support networks and information about their contraception options. But while the need to provide contraceptive care to VICTA patients was apparent, it was not obvious – especially to patients.

“It had long been my dream to incorporate reproductive healthcare into that integrated care model. Luckily, Upstream came our way,” Peterson explains. She says that the mention of contraception during counseling sessions initially surprised VICTA clients. “But pretty quickly we saw folks starting to see the value.”

The key to why it worked is easy to understand: patient empowerment and non-coercive care, a bedrock of the Upstream training model. “A lot of this population has been involved with domestic violence or they’ve suffered trauma from a young age. Being able to decide to get on birth control and decide what method works best is one small piece that they can take control of,” explains Lisa Rodrigues, a VICTA nurse practitioner.?

With providers who are experienced discussing sensitive issues like substance abuse, the Upstream training helped VICTA staff gain the confidence to discuss pregnancy intentions as part of their comprehensive screenings, and to follow up as needed with additional information or prescriber referrals. The program’s success even mobilized the center to hire its first OB-GYN provider to meet demand.?

“It is important to offer all of our clients the opportunity to have more of a choice and to have more autonomy and recognize that having more autonomy is very much part of their recovery,” Peterson says. “Every time I hear that someone got the contraceptive care that they were looking for, that's what keeps me going. We're really proud of what we're doing here.”