In a qualitative study of 27 patients receiving treatment for perinatal opioid use disorder in Southern Appalachia, 11 described fears that disclosure of substance use or participation in medication treatment could trigger Social Services involvement or loss of child custody. Researchers identified three connected themes: fears of agency involvement, preparation for delivery, and clinicians addressing those fears. Participants valued clear explanations of local reporting requirements and honest conversations before childbirth. The authors recommend that care teams understand applicable notification policies and discuss them openly to strengthen trust. The findings come from one regional treatment setting and may not represent all patients.
