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Pregnant and postpartum women with opioid use disorder (OUD) are among the most vulnerable and underserved populations in our health care system − but they can greatly benefit from a more connected system of support and treatment.

So say researchers at the (COPH), who published a new peer-reviewed paper on this widespread issue and ways to better coordinate care. “Referral linkages to support pregnant and postpartum individuals with opioid use disorders in Florida: a social network analysis,’’ appeared in Addiction Science & Clinical Practice. Additionally, the publication was named the 2026 Dr. Charles Mahan Best Student Paper in maternal and child health, presented by the USF Lawton and Rhea Chiles Center.

“These women often face numerous barriers to treatment and support, especially because of fragmented health care and social services systems,’’ said Amandeep Ratta, the study’s first author and a doctoral candidate in .

“Through a social network analysis of health care and community organizations serving this population, we wanted to understand not just what services exist in our community, but whether those services actually coordinate and refer patients to each other.’’

Also involved in the paper were , COPH alumna and professor, ; and Dr. Tanner Wright, a pediatrician and addiction medicine physician at the and neonatal hospitalist at Tampa General Hospital. Both are principal investigators of a USF program called CADENCE (Continuous and Data-drivEN CarE), which receives funding from the National Institutes of Health to integrate prenatal, pediatric, and addiction medicine care. An interactive program employing real-time data, CADENCE was integral to the new study.

Patient outcomes depend not only on individual clinical encounters, Wright explained, but also on how effectively health care and community groups work together. 

“Given the breadth of services offered through CADENCE, we know our patients rely on an extensive network of health care and community organizations,’’ he said. “Mapping and analyzing that network was a critical step toward understanding where coordination was strong, where barriers existed, and how the overall system of care could be improved.’’

The published paper provides insights into  agencies supporting women with OUD in Hillsborough County, where rates of opioid exposure during pregnancy are high. Strengthening partnerships between health care and social service agencies, the authors say, is essen­tial to improving care coordination and outcomes for this population.  

“These women often face numerous barriers to treatment and support, especially because of fragmented health care and social services systems’’

Amandeep Ratta

The team’s study identified 79 agencies in Hillsborough County supporting pregnant and postpartum individuals with OUD. Hillsborough − the fourth-largest county in Florida with nearly 1.6 million people – is an effective stage for the work being done through CADENCE, Marshall said.

“Patients come from surrounding counties to receive care through USF Health programs and to deliver at Tampa General Hospital,’’ she said. “Despite having multiple health systems and safety-net providers, access to medication for opioid use disorder and integrated prenatal care remains uneven, particularly for pregnant women who depend on Medicaid.’’

The authors of the paper asked those agencies who they referred patients to, how often, and how much they valued those relationships. They identified programs doing relevant work but not at a level that addressed the needs of the affected population. Going forward, the challenge is to build the infrastructure for standardized referral pathways, shared data, joint training, and a trauma-informed culture across the board. Just as important is to replicate CADENCE in other counties.

“What we found is that while a core group of agencies do collaborate well, the overall network is thinly connected,’’ Ratta said. “Many referral relationships exist in name only; agencies know each other but rarely actually send patients to each other. The system is underutilized and has potential for many more collaborations that will improve health care access for pregnant and postpartum women and their families.’’

Chloe, a mother from Tampa with a history of OUD, was accepted into a CADENCE clinic at Tampa General Hospital and the experience changed her life.

“Before I entered it, I was scared, afraid, shameful, embarrassed and had a million questions about taking my medications and harm to the baby,’’ she said. “Once I was accepted into the clinic, there was ease of care during the entire pregnancy, like my medication treatment, therapy and psychiatric support. They answered any and all questions I had regarding my OUD and pregnancy and were very supportive of my journey and any decisions I was going to make.’’

OUD is a chronic medical condition that affects the way the brain responds to opioids, making it difficult to reduce or stop opioid use despite a desire to do so. Like diabetes or hypertension, OUD has biological, psychological, and social components and often benefits from ongoing medical care and support. During pregnancy, treatment is especially important because it promotes the health and well-being of both the pregnant person and their developing baby.

Opioids are a group of medications and substances used to relieve pain. They include prescription medications such as oxycodone, hydrocodone, morphine, codeine, tramadol, methadone, and fentanyl, as well as illicit opioids such as heroin and illegally manufactured fentanyl. Although these medications can be effective for pain management when used appropriately, any opioid has the potential to lead to OUD in some individuals.

The opioid crisis is well-recognized as a public health emergency, but pregnant and postpartum women specifically have not received the attention or investment they deserve within that larger conversation, the report states. 

“This population often experiences multiple, overlapping forms of stigma related to pregnancy, substance use, and socioeconomic circumstances,’’ Wright said. “These experiences can create barriers to care and have lasting effects on the health and well-being of both parent and child.’’

But the health of these women cannot be secured by any single clinic or agency acting alone, Ratta said: “It requires health care providers, social service organizations, peer support groups, housing programs, transportation services, and community educators all working in a coordinated way. What our study shows is that the relationships exist.’’

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