Health Systems and Policy Research

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Substance use Coercion as a Barrier to Help-Seeking among Intimate Partner Violence Survivors with Opioid use Disorder

Heather Phillips1*, Eleanor Lyon1, Elizabeth E Krans2,3, Carole Warshaw2, Judy C Chang2,3 and Chelsea Pallatino4

While Intimate Partner Violence (IPV) is common among people with Opioid Use Disorder (OUD), the role of abusive partners has been under-recognized as a barrier to OUD treatment and recovery. Substance use coercion, or ways that abusive partners leverage a survivor’s substance use against them as a tactic of power and control, is both highly prevalent and presents unique challenges to accessing services or achieving recovery. This includes threats to report a survivor’s substance use to law enforcement, the immigration system, or the child welfare system as a way to maintain control within the relationship. Because opioids are largely illicit within the United States, these threats are deeply coercive and increase the risk of criminalization for survivors, which creates additional barriers to help-seeking. These findings underscore the need for integrated IPV, OUD, and recovery support services; policy changes including to state-level substance use laws that consider substance use to be a form of child abuse and endangerment; and for a coordinated public health response to substance use coercion as a critical factor driving morbidity and mortality within the opioid epidemic.