Off-campus UMass Amherst users: To download campus access dissertations, please use the following link to log into our proxy server with your UMass Amherst user name and password.

Non-UMass Amherst users: Please talk to your librarian about requesting this dissertation through interlibrary loan.

Dissertations that have an embargo placed on them will not be available to anyone until the embargo expires.

Author ORCID Identifier


Open Access Dissertation

Document Type


Degree Name

Doctor of Philosophy (PhD)

Degree Program


Year Degree Awarded


Month Degree Awarded


First Advisor

Karen Kalmakis

Second Advisor

Lisa Chiodo

Third Advisor

Sally Campbell-Galman

Subject Categories

Maternal, Child Health and Neonatal Nursing | Public Health and Community Nursing


Substance use continues to rise in the United States. In 2021, 5.6 million people had an opioid use disorder (OUD). OUD is highly stigmatized and is not treated as a chronic condition. People with OUD have been denied treatment for a single positive urine drug test. Pregnant women are further at risk of criminal charges or losing custody of their child. OUD treatment success is defined as opioid abstinence and the goal of treatment is to taper off medication, despite evidence that treatment retention leads to better outcomes. The purpose of this study was to identify patterns of buprenorphine utilization and drug use that predict treatment utilization in both a general population and among women who were ever pregnant during treatment. This retrospective analysis of electronic health records contained information for 23,825 adults in OUD treatment between January 2016 and February 2018; including 1342 who were pregnant during the treatment period. Nonparametric regression was used to identify thresholds. Univariate general linear models were used to determine if patterns of medication or opioid use predicted treatment utilization. Four groups were created based on the threshold cut points to examine treatment utilization. People in the bup ↑/ opioid ↓ group (≥75% buprenorphine utilization/ ≤25% opioid use) remained in treatment longer, had fewer care interruptions, and higher retention rates. Women who were ever pregnant in the bup ↑/ opioid ↓ group had higher retention rates with fewer care interruptions, and were seen more recently. Polysubstance use did not impact the odds of being retained in treatment for those in the bup ↑/ opioid ↓ group. The thresholds identified here can be used to redefine treatment goals. People in the bup ↑/ opioid ↓ group are retained in treatment. Pregnancy increased treatment utilization rates. The current abstinence-only approach to OUD treatment is not realistic or consistent with treatment for other chronic conditions. This is most especially true for pregnant women. The results also show that use of other drugs and/or alcohol should not impact receipt of OUD treatment. OUD is a chronic condition that requires long-term treatment and should be treated as such.


Available for download on Sunday, May 26, 2024