Contraceptive Pearl: Special Considerations for People with Substance Use Disorder (SUD)

Written by Sheila Attaie, D.O.

Substance Use Disorder (SUD) is a treatable chronic illness.  People with SUD have higher rates of unintended pregnancy, sexually transmitted diseases, infertility, and mortality related to pregnancy; and lower rates of contraceptive use¹. People with SUD face profound stigma, barriers to care, and even criminalization when interfacing with the medical industrial complex. For example, in 2021, an Indigenous woman in Oklahoma was imprisoned for manslaughter after suffering a miscarriage and having a positive test for methamphetamines². Judges and prison officials have curtailed reproductive liberties by coercing people with SUD to accept sterilization or long acting contraception³.

Clinicians can support people who use substances by acknowledging prior trauma, applying a reproductive justice framework, and employing some clinical pearls:

  • Substance use is not a contraindication to any contraceptive method!
  • Substance use disorder does not, in itself, impair one’s ability to make medical decisions. A person who can understand the risks and benefits of a procedure is able to consent¹
  • Contraceptive care for people who use drugs should be provided alongside comprehensive preventative, harm reduction, and primary care services. This includes offering routine sexually transmitted infection (STI) screenings, pre-exposure prophylaxis for HIV (PrEP), medication for addiction treatment and withdrawal, trauma screening, mental health services, cancer prevention, contraception, abortion, prenatal care, and community services like housing, food, and legal aid.
  • Urine toxicology is not medically indicated before providing contraceptive or abortion care¹. It does not diagnose acute intoxication or a use disorder. It is an expensive test with false-positive and false-negative results which can have serious consequences.
  • Chronic substance use can result in oligo or amenorrhea through its effects on the hypothalamic-pituitary-adrenal axis. Clinicians should inform patients that pregnancy may occur even when periods are infrequent¹.
  • For people with SUD who want to conceive, trauma-informed care and medication for addiction treatment should be considered to support safe and healthy pregnancies.


Your Birth Control Choices Fact Sheet

Medical Eligibility Criteria for Initiating Contraception

IUD Self-Removal Fact Sheet


Woodhams, Elisabeth. Partners in Contraceptive Choice and Knowledge: Substance Use Disorder and Family Planning Care; November 18, 2021; Boston, MA

Collman A. An Oklahoma Woman’s jail sentence for manslaughter after a miscarriage highlights an ‘extreme acceleration’ in prosecuting pregnancy over the last 16 years. Business Insider. Published October 20, 2021. Accessed December 21, 2021.

Dwyer, Colin. “Judge Promises Reduced Jail Time If Tennessee Inmates Get Vasectomies.” NPR, 21 July 2017.

Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep 2016;65(No. RR-3):1–104. DOI:

Kale N. Urine Drug Tests: Ordering and Interpreting Results. Am Fam Physician. 2019;99(1):33-39.

Ti A, Stone RH, Whiteman M, Curtis KM. Safety and effectiveness of hormonal contraception for women who use opioids: A systematic review. Contraception. 2019;100(6):480-483. doi:10.1016/j.contraception.2019.08.006


The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.