Substance Use

Why It Matters for Providers

In 2025, over 15% of Americans 12 years and older met criteria for a substance use disorder (SUD) in the past year (PDF). Yet most primary care physicians and hospitalists don’t feel prepared to screen or provide treatment for patients with SUD. A survey of general internists indicated that 1 in 3 view substance use disorders as different from other chronic diseases, and 1 in 10 believe that those who use substances inappropriately should be punished.

SUD is a chronic, treatable medical condition with relapse rates comparable to asthma, hypertension or diabetes. When we treat SUD as if it is a moral failing, we may discourage patients from seeking help, delay diagnosis and worsen health outcomes.

SUD stigma in healthcare settings is associated with provider “burnout” and increased stress. In a study of emergency department (ED) physicians, respondents indicated working with patients with SUD was unsatisfying, and patients with SUD were more frequently seen as “irritating”.

SUD & Pregnancy

Estimates are that at least 5% of pregnant persons use one or more addictive substances in the US, and in Texas, drug poisoning was the number one cause of maternal death between 2020 and 2023. Research shows that fear of judgment in healthcare settings is a significant barrier for pregnant individuals who use substances. National data indicate they are approximately 70% more likely to receive inadequate prenatal care compared to those without substance use.

In Bexar County, this trend contributes to our high rates of congenital syphilis. Concerns about being stigmatized, reported, or losing custody not only prevents patients from seeking timely care, but also contribute to pregnancy-related mortality. 

Hearing Patient Stories

First‑person accounts provide valuable insight into how individuals experience pregnancy care while managing SUD. The narratives below, from individuals in recovery who sought treatment during pregnancy, reinforce that substance use in pregnancy does not indicate a lack of concern for one’s health or baby. The stories reinforce that each patient’s journey is unique and shaped by resilience, barriers, and other experiences within the healthcare system.

Provider attitudes, care access and respectful communication can determine whether patients feel supported or silenced. Metro Health profoundly appreciates their willingness to provide insight into how stigma, evidence‑based treatment and compassionate care shaped their clinical outcomes.

• Opioid Storytelling: Angel
• Opioid Storytelling: Julia
• Opioid Storytelling: Vanessa

Supporting Recovery During Pregnancy

Every recovery journey is different, and evidence-based resources are available. Providers play a critical role in connecting patients to treatment and related services, and pregnancy offers a powerful opportunity for change.

Metro Health encourages providers to learn more about:

Screening & Intervention

The American College of Obstetricians and Gynecologists (ACOG) recommends universal verbal screening with evidence-based questionnaires at the first prenatal visit, followed by intervention and referral.

Informed Consent for Urine Drug Testing

Routine drug testing is not recommended by ACOG. Obtain informed patient consent before testing, and do not use a positive test to deter or deny care.

Treatment and Recovery Options

Medication-assisted treatment (MAT) with methadone or buprenorphine, in combination with behavioral therapy, is endorsed by CDC, ACOG, SAMHSA, and SMFM as best practice. A waiver is no longer needed to prescribe buprenorphine for opioid use disorder, and SAMHSA encourages providers to treat patients within their own practice. Buprenorphine is available at many commercial pharmacies.

Trauma Informed CPS Reporting

Family separation can have devastating effects on both parent and child. Using a strengths-based, standardized approach, like the Camden Coalition toolkit, can support patients and help providers navigate sensitive conversations.

Harm Reduction to Save Lives

Fatal overdose eliminates the opportunity to initiate or engage in the recovery process. Integrating harm reduction reduces relapse and supports healthier pregnancies.

Read the CDC clinical guidance on "Substance Use During Pregnancy".

Building a Compassionate Care Environment

Every patient deserves to feel safe, respected, and supported when seeking care. To foster a more compassionate and informed healthcare community, Metro Health encourages providers to:

• Listen to patient stories to deepen clinical empathy
• Engage in trauma-informed, evidence-based training
• Connect patients with resources like the SACRD Substance Use Portal and Be Well Texas for treatment and recovery options.

Metro Health remains committed to reducing stigma and improving maternal, infant, child, and adolescent health in San Antonio and Bexar County. Supporting pregnant patients with SUD strengthens families and builds a healthier community for everyone.