Methods: Qualitative interviews and focus groups were conducted throughout the state of TX over a two-year period. Quantitative data were collected using a participant demographics form and the Stressful Life Events Screening Questionnaire (SLEQ). We recruited women who had experienced an opioid use relapse and/or overdose, during the maternal period, from gender specific, substance use disorders treatment programs and through street outreach. We also recruited family members, friends and the significant others of women who have died of a maternal overdose.
Results: We used thematic analysis to analyze the qualitative data. Two experienced qualitative researchers first analyzed the data independent of each other. Following this, they discussed emerging themes until a consensus was reached. We used descriptive statistics to summarize our demographic and survey data.
Conclusion: Women and family members (N=50) provided insight into the contextual factors surrounding maternal overdose death. They (80%) reported 4 or more significant life stressors including: (a) losing a loved one to an accident, homicide, or suicide, (b) being repeatedly ridiculed, ignored, or put down by a loved one, (c) having been physically forced to have sexual intercourse, and (d) experiencing physical abuse. Further, the following four qualitative themes were identified: (a) losing the baby/escaping the pain, (b) needing support, (c) trauma, and (d) mental health symptoms. Participants described how the involvement of Child Protective Services contributed to relapse placing the women at risk for overdose. They discussed how emotional support needed during the pregnancy that was often unavailable. As identified in our quantitative data, a lifetime of significant trauma was common among participants. Finally, symptoms of mental illness were also described. The findings of this study are being used to develop targeted interventions to prevent overdose death in this vulnerable population of women.