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Ratner JA, Kirschner JH, Spencer B, Terplan M. Services for perinatal patients with opioid use disorder: a comprehensive Baltimore City-wide 2023 assessment. Addict Sci Clin Pract 2024; 19:73. [PMID: 39407344 PMCID: PMC11476604 DOI: 10.1186/s13722-024-00507-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 10/07/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND Overdose is a leading cause of maternal mortality; in response, maternal mortality review committees have recommended expanding substance use disorder (SUD) screening, improving collaboration between obstetric and SUD treatment providers, and reducing fragmentation in systems of care. We undertook an analysis of the perinatal SUD treatment landscape in Baltimore, Maryland in order to identify barriers to treatment engagement during pregnancy and the postpartum period and guide system improvement efforts. METHODS We conducted a survey of seven birthing hospitals, 31 prenatal care practices, and 108 SUD treatment providers in Baltimore from April-June 2023. Organizations were asked to quantify care for perinatal patients with opioid use disorder (OUD) as well as about screening, service availability, referral practices, and support needed to improve care. RESULTS 61% of the 145 contacted organizations responded. Birthing hospitals reported caring for pregnant persons with OUD with greater frequency than prenatal care practices or SUD treatment programs. Most birthing hospitals and prenatal care practices reported screening for OUD at intake, but the minority reported using validated tools. Service availability varied by type of organization and type of service. In general, prenatal care practices offered the fewest number of SUD-related services. Most SUD treatment programs that offered buprenorphine or methadone to the general population also offered these medications to pregnant patients. Withdrawal management for comorbid alcohol/benzodiazepine use disorders during pregnancy was more limited. The majority of birthing hospitals and prenatal care practices reported offering neither direct naloxone distribution nor prescriptions. Few SUD treatment programs offered tailored services for perinatal patients or for parents of young children, and many programs do not permit children onsite. Respondents reported high levels of interest in education and consultative support on SUD treatment in pregnancy within obstetric settings and on pregnancy-related medical concerns within SUD programs. CONCLUSIONS This project provides a comprehensive picture of services available for treatment of perinatal OUD in a major US city. Results have served as a guide for ongoing citywide system improvement efforts by our project team and offer a model for other jurisdictions hoping to strengthen services for perinatal OUD and reduce maternal mortality.
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Affiliation(s)
- Jessica A Ratner
- Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Stocks C, Lander LR, J Zullig K, Davis S, Lemon K. Pre-COVID Trends in Substance Use Disorders and Treatment Utilization During Pregnancy in West Virginia 2016-2019. J Womens Health (Larchmt) 2024; 33:1349-1357. [PMID: 38572925 DOI: 10.1089/jwh.2023.0888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Introduction: Access to prenatal care offers the opportunity for providers to assess for substance use disorders (SUDs) and to offer important treatment options, but utilization of treatment during pregnancy has been difficult to measure. This study presents pre-COVID trends of a subset of SUD diagnosis at the time of delivery and related trends in treatment utilization during pregnancy. Materials and Methods: A retrospective cohort design was used for the analysis of West Virginia Medicaid claims data from 2016 to 2019. Diagnosis of SUDs at the time of delivery and treatment utilization for opioid use disorder (OUD) and non-OUD diagnosis during pregnancy across time were the principal outcomes of interest. This study examined data from n = 49,398 pregnant individuals. Results: Over the 4-year period, a total of 2,830 (5.7%) individuals had a SUD diagnosis at the time of delivery. The frequency of opioid-related diagnoses decreased by 29.3%; however, non-opioid SUD diagnoses increased by 55.8%, with the largest increase in the diagnosis of stimulant use disorder (30.9%). Treatment for OUD increased by 13%, but treatment for non-opioid SUD diagnoses during pregnancy declined by 41.1% during the same period. Conclusions: Interventions enacted within West Virginia have improved access and utilization of treatment for OUD in pregnancy. However, consistent with national trends in the general population, non-opioid SUD diagnoses, especially for stimulants, have rapidly increased, while treatment for this group decreased. Early identification and referral to treatment by OB-GYN providers are paramount to reducing pregnancy and postpartum complications for the mother and neonate.
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Affiliation(s)
- Carol Stocks
- Health Affairs Institute, West Virginia University, Charleston, West Virginia, USA
| | - Laura R Lander
- Department of Behavioral Medicine and Psychiatry, Rockefeller Neurosciences Institute, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Keith J Zullig
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Stephen Davis
- Department of Health Policy, Management and Leadership, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Kelly Lemon
- Department of Obstetrics and Gynecology, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
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Jeminiwa R, Dadabaev F, Kim H, Gannon M, Myers R, Abatemarco DJ. Perspectives of physicians and doulas on shared decision-making and decision counseling in the treatment of pregnant women with opioid use disorders. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 168:209526. [PMID: 39343140 DOI: 10.1016/j.josat.2024.209526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 09/12/2024] [Accepted: 09/14/2024] [Indexed: 10/01/2024]
Abstract
INTRODUCTION Research about the application of shared decision-making (SDM) in the context of Medication Assisted Treatment (MAT) for pregnant women with opioid use disorder (OUD) is limited. The objectives of our study were to 1) examine facilitators of and barriers to SDM for the initiation of MAT in clinical practice and 2) evaluate the receptivity of clinicians and doulas involved in the care of women with OUD to the use of an online software application to facilitate SDM about MAT. METHODS This qualitative study utilized semi-structured interviews with consenting physicians and doulas who provided care for pregnant women with OUD between November 2021 and May 2022. Participants were asked about factors influencing SDM in practice. In addition, the study asked participants about the feasibility of using the Jefferson Decision Counseling Guide© (JDCG) to educate pregnant women with OUD as to the benefits and risks of undergoing MAT versus no treatment and to help patients clarify their treatment preference. The study recorded the interview and transcribed it verbatim using Rev. transcription services. The study used thematic analyses to code the data and identify key barriers and facilitators of SDM and perceptions of the SDM tool. RESULTS Nineteen participants completed interviews. The study identified several barriers to SDM including time constraints, lack of decision counseling tools at points of care, and patients presenting in an actively high state or withdrawing. Peer workers or other trained personnel, giving patients more time, and comfort in decision counseling are examples of facilitators identified by the participants of the study. Participants believed that the counseling tool could facilitate conversations with patients and should be integrated into the workflow. CONCLUSION In this qualitative study, we identified several barriers and facilitators of SDM to initiate MAT for pregnant women with OUD. Our findings indicate that there are challenges and opportunities for healthcare systems to increase SDM in this marginalized patient population. Feedback from participants highlighted their receptivity to the use of SDM tools to facilitate meaningful conversations in various settings that can guide decision making about care.
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Affiliation(s)
- Ruth Jeminiwa
- Department of Pharmacy Practice, Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA 19107, United States of America.
| | - Fadel Dadabaev
- Jefferson College of Pharmacy, Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA 19107, United States of America
| | - Heeyoung Kim
- Jefferson College of Pharmacy, Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA 19107, United States of America
| | - Megan Gannon
- College of Nursing, Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA 19107, United States of America
| | - Ronald Myers
- Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, United States of America
| | - Diane J Abatemarco
- College of Nursing, Thomas Jefferson University, 1233 Locust Street, Suite 400, Philadelphia, PA, 19107, United States of America
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Wouk K, Caton L, Bass R, Ali B, Cody T, Jones EP, Caron O, Luseno W, Ramage M. Patient navigation for perinatal substance use disorder treatment: A systematic review. Drug Alcohol Depend 2024; 260:111324. [PMID: 38761697 DOI: 10.1016/j.drugalcdep.2024.111324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Substance use during the perinatal period (i.e., pregnancy through the first year postpartum) can pose significant maternal and infant health risks. However, access to lifesaving medications and standard care remains low for perinatal persons who use substances. This lack of substance use disorder treatment access stems from fragmented services, stigma, and social determinants of health-related barriers that could be addressed using patient navigators. This systematic review describes patient navigation models of care for perinatal people who use substances and associated outcomes. METHODS We conducted a structured search of peer-reviewed, US-focused, English- or Spanish-language articles from 2000 to 2023 focused on 1) patient navigation, 2) prenatal and postpartum care, and 3) substance use treatment programs using PubMed, Scopus, PsycINFO, and CINAHL databases. RESULTS After meeting eligibility criteria, 17 studies were included in this review. The majority (n=8) described outpatient patient navigation programs, with notable hospital (n=4) and residential (n=3) programs. Patient navigation was associated with reduced maternal substance use, increased receipt of services, and improved maternal and neonatal health. Findings were mixed for engagement in substance use disorder treatment and child custody outcomes. Programs that co-located care, engaged patients across the perinatal period, and worked to build trust and communication with family members and service providers were particularly successful. CONCLUSION Patient navigation may be a promising strategy for improving maternal and infant health outcomes among perinatal persons who use substances. More experimental research is needed to test the effect of patient navigation programs for perinatal persons who use substances compared to other models of care.
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Affiliation(s)
- Kathryn Wouk
- Pacific Institute for Research and Evaluation (PIRE), Chapel Hill, NC, USA; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Lauren Caton
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebekah Bass
- Project CARA (Care that Advocates Respect, Resilience, and Recovery for All), Mountain Area Health Education Center, NC, USA
| | - Bina Ali
- Pacific Institute for Research and Evaluation (PIRE), Beltsville, MD, USA
| | - Tammy Cody
- Project CARA (Care that Advocates Respect, Resilience, and Recovery for All), Mountain Area Health Education Center, NC, USA
| | - Emily P Jones
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Olivia Caron
- Project CARA (Care that Advocates Respect, Resilience, and Recovery for All), Mountain Area Health Education Center, NC, USA; University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Winnie Luseno
- Pacific Institute for Research and Evaluation (PIRE), Chapel Hill, NC, USA
| | - Melinda Ramage
- Project CARA (Care that Advocates Respect, Resilience, and Recovery for All), Mountain Area Health Education Center, NC, USA
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Bello JK, Dell NA, Laxton AM, Conte M, Chen L. Prevalence and predictors of medication for opioid use disorder among reproductive-aged women. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 11:100239. [PMID: 38711835 PMCID: PMC11070671 DOI: 10.1016/j.dadr.2024.100239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 05/08/2024]
Abstract
Background Women of reproductive age would benefit from treatment of opioid use disorder (OUD) prior to pregnancy to improve maternal and infant outcomes. In this study, we aimed to identify the prevalence of medication for OUD (MOUD) and characterize correlates of MOUD receipt among 12-49-year-old women with OUD seeking treatment in publicly funded substance use disorder treatment programs at the time of their first treatment episode. Methods This cross-sectional study explores the demographic and clinical characteristics of women of reproductive age with OUD receiving publicly funded substance use treatment services. We used data from the concatenated 2015-2021 Treatment Episode Data Set-Admissions (TEDS-A), which documents demographic and clinical characteristics of patient admissions to publicly funded substance use treatment services in the United States. Results In the sample of females aged 12-49 with no prior treatment admissions and primary OUD (n=325,512), 40.53% received MOUD (n=131,930), including 39.40% of non-pregnant women (n=115,315) and 52.79% of pregnant women (n=8423). Pregnant women had significantly higher odds of receiving MOUD (aOR = 2.42, 95%CI: 2.30, 2.54) compared to non-pregnant women. Non-white race, treatment setting, and treatment self-referral were also associated with higher levels of MOUD. Conclusions We identified a significant unmet need among both pregnant and non-pregnant women with OUD seeking care in publicly funded treatment clinics. While women who are pregnant are significantly more likely to receive evidence-based treatment with MOUD, still 47.21% of pregnant women did not receive MOUD. All reproductive-aged women with OUD should be offered evidence-based treatment options, including MOUD.
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Affiliation(s)
- Jennifer K. Bello
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | - Aaron M. Laxton
- School of Social Work, Saint Louis University, St. Louis, MO, USA
- Assisted Recovery Centers of America, St. Louis, MO, USA
| | - Mary Conte
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Lynn Chen
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
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He Y, Chaiyachati BH, Matone M, Bastos S, Kallem S, Mehta A, Wood JN. "Instead of just taking my baby, they could've actually given me a chance": Experiences with plans of safe care among birth parents impacted by perinatal substance use. CHILD ABUSE & NEGLECT 2024; 152:106798. [PMID: 38615413 PMCID: PMC11206134 DOI: 10.1016/j.chiabu.2024.106798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/05/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Federal legislation mandates healthcare providers to notify child protective service (CPS) agencies and offer a voluntary care plan called a "plan of safe care" (POSC) for all infants born affected by prenatal substance use. While POSCs aim to provide supportive services for families impacted by substance use, little is known about birth parents' perceptions and experiences. OBJECTIVE To examine birth parents' perceptions and experiences regarding POSC. PARTICIPANTS AND SETTING Parents offered a POSC in Philadelphia in the prior year were included. METHODS This is a qualitative interview study. Participants were recruited from birth hospitals and community-based programs with telephone consent and interview procedures. Transcripts were analyzed using an inductive, grounded theory approach to identify content themes. RESULTS Twelve birth parents were interviewed (30.7 % of eligible, contacted individuals). Fear of CPS involvement and stigma were common. Some birth parents reported that the increased scrutiny related to POSCs negatively impacted their attitudes toward healthcare providers and medications for opioid use disorder (MOUD). While parents found the consolidated resource information helpful, many did not know how to access services. Finally, parents desired more individualized plans tailored to their unique family needs. CONCLUSIONS Stigma, confusion, and fear of CPS involvement undermine the goal of POSCs to support substance-exposed infants and birth parents. Providers serving this population should be transparent regarding CPS notifications, provide compassionate, non-stigmatizing care, and offer coordination services to support engagement after discharge. Policymakers should consider separating POSCs from CPS to avoid exacerbating fear and mistrust.
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Affiliation(s)
- Yuan He
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America; Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, United States of America.
| | - Barbara H Chaiyachati
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America; Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, United States of America; Safe Place: Center for Child Protection and Health, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Meredith Matone
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America; Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Shelley Bastos
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Stacey Kallem
- Philadelphia Department of Public Health, Philadelphia, PA, United States of America
| | - Aasta Mehta
- Philadelphia Department of Public Health, Philadelphia, PA, United States of America
| | - Joanne N Wood
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America; Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, United States of America; Safe Place: Center for Child Protection and Health, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
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Kim K, Liu G, Dick AW, Choi SW, Agbese E, Corr TE, Hsuan C, Wright MS, Park S, Velott D, Leslie DL. Timing of treatment for opioid use disorder among birthing people. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 161:209289. [PMID: 38272119 PMCID: PMC11090704 DOI: 10.1016/j.josat.2024.209289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND The number of pregnant women with opioid use disorder (OUD) has increased over time. Although effective treatment options exist, little is known about the extent to which women receive treatment during pregnancy and at what stage of pregnancy care is initiated. METHODS Using a national private health insurance claims database, we identified women aged 13-49 who gave birth in 2006-2019 and had an OUD or nonfatal opioid overdose (NFOO) diagnosis during the year prior to or at delivery. We then identified women who received their first OUD treatment prior to or during pregnancy. In this cross-sectional study, we investigated how rates and timing of the initial OUD treatment changed over time. Furthermore, we examined factors associated with early initiation of OUD treatment among birthing people. RESULTS Of the 7057 deliveries from 6747 women with OUD or NFOO, 63.3 % received any OUD treatment. Rates of OUD treatment increased from 42.9 % in 2006 to 69 % in 2019. Of those treated, in 2006, 54.5 % received their first treatment prior to conception and 24.2 % initiated care during the 1st trimester. In 2019, 68.9 % received their first treatment prior to conception, and 15.1 % initiated care during the 1st trimester. The percentage of women who were first treated in the 2nd trimester or later decreased from 21.2 % in 2006 to 16.1 % in 2019. Factors associated with early treatment initiation include being 25 years or older (age 25-34: aOR, 1.51, 95 % CI, 1.28-1.78; age 35-49: aOR, 1.82, 95 % CI, 1.39-2.37), living in urban areas (aOR, 1.28; 95 % CI, 1.05-1.56), having pre-existing behavioral health comorbidities such as anxiety disorders (aOR, 1.8; 95 % CI, 1.40-2.32), mood disorders (aOR, 1.63; 95 % CI, 1.02-2.61), and substance use disorder other than OUD (aOR, 2.56; 95 % CI, 2.03-3.32). CONCLUSION Overall, rates of OUD treatment increased over time, and more women initiated OUD treatment prior to conception. Despite these improvements, over one-third of pregnant women with OUD/NFOO either received no treatment or did not initiate care until the 3rd trimester in 2019. Future research should examine barriers to OUD treatment initiation among pregnant women.
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Affiliation(s)
- Kyungha Kim
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | | | - Sung W Choi
- School of Public Affairs, The Pennsylvania State University, Harrisburg, PA, USA
| | - Edeanya Agbese
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Tammy E Corr
- Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Charleen Hsuan
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA
| | - Megan S Wright
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Penn State Law, University Park, PA, USA; Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
| | - Sujeong Park
- School of Public Affairs, The Pennsylvania State University, Harrisburg, PA, USA
| | - Diana Velott
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Douglas L Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
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Hensel D, Helou NE, Zhang F, Stout MJ, Raghuraman N, Friedman H, Carter E, Odibo AO, Kelly JC. The Impact of a Multidisciplinary Opioid Use Disorder Prenatal Clinic on Breastfeeding Rates and Postpartum Care. Am J Perinatol 2024; 41:884-890. [PMID: 35668653 DOI: 10.1055/s-0042-1748526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To evaluate the hypothesis that patients with opioid use disorder (OUD), who receive prenatal care in a multidisciplinary, prenatal OUD clinic, have comparable postpartum breastfeeding rates, prenatal and postpartum visit compliance, and postpartum contraceptive use when compared with matched controls without a diagnosis of OUD. STUDY DESIGN This was a retrospective, matched, cohort study that included all patients who received prenatal care in a multidisciplinary, prenatal OUD clinic-Clinic for Acceptance Recovery and Empowerment (CARE)-between September 2018 and August 2020. These patients were maintained on opioid agonist therapy (OAT) throughout their pregnancy. CARE patients were matched to controls without OUD in a 1:4 ratio for mode of delivery, race, gestational age ± 1 week, and delivery date ± 6 months. The primary outcome was rate of exclusive breastfeeding at maternal discharge. Secondary outcomes included adherence with prenatal care (≥4 prenatal visits), adherence with postpartum care (≥1 postpartum visit), postpartum contraception plan prior to delivery, and type of postpartum contraceptive use. Conditional multivariate logistic regression was used to account for possible confounders in adjusted calculations. RESULTS A total of 210 patients were included (42 CARE and 168 matched controls). Despite having lower rates of adequate prenatal care, 40 CARE patients (95%) were exclusively breastfeeding at discharge resulting in CARE patients being significantly more likely to be breastfeeding at discharge (adjusted relative risk (aRR): 1.28, 95% confidence interval [CI]: 1.05-1.55). CARE patients and controls demonstrated no difference in postpartum visit compliance (86 vs. 81%, aRR: 1.03, 95% CI: 0.76-1.40) or effective, long-term contraception use (48 vs. 48%; aRR: 0.81, 95% CI: 0.36-1.84). CONCLUSION In the setting of multidisciplinary OUD prenatal care during pregnancy, patients with OUD were more likely to be breastfeeding at the time of discharge than matched controls, with no difference in postpartum visit compliance or effective, long-term contraception. KEY POINTS · Women with OUD are more likely to breastfeed when engaged in a multidisciplinary prenatal clinic.. · Women with OUD had no difference in LARC use when engaged in a multidisciplinary prenatal clinic.. · Women with OUD had no difference in postpartum visit rate in a multidisciplinary prenatal clinic..
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Affiliation(s)
- Drew Hensel
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Nicole El Helou
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Fan Zhang
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Molly J Stout
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Nandini Raghuraman
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Hayley Friedman
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Ebony Carter
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Anthony O Odibo
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Jeannie C Kelly
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Short VL, Abatemarco DJ, Gannon M. Breastfeeding Intention, Knowledge, and Attitude of Pregnant Women in Treatment for Opioid Use Disorder. Am J Perinatol 2024; 41:82-88. [PMID: 34839473 PMCID: PMC9142755 DOI: 10.1055/s-0041-1740145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective of this study was to describe breastfeeding intention, knowledge, and attitude, and sources of infant feeding information during the prenatal period among a cohort of pregnant women in treatment for opioid use disorder (OUD). STUDY DESIGN Pregnant women who were receiving treatment for OUD and in the third trimester completed a questionnaire that measured demographic characteristics, infant feeding intentions, breastfeeding beliefs and attitudes, and sources of breastfeeding information. Frequency counts and percentages and means and standard deviations were used to describe data. RESULTS Sixty-five women completed the survey. Three-fourths reported some intention to breastfeeding. While attitudes around breastfeeding were generally positive, less than half of respondents knew the recommendations and infant health benefits of breastfeeding. CONCLUSION Prenatal programs for women in treatment for OUD should consider addressing patient-reported concerns and gaps in knowledge regarding the benefits of and recommendation for breastfeeding. KEY POINTS · Breastfeeding has unique benefits for mother-infant dyads affected by maternal OUD.. · Breastfeeding decisions are influenced by maternal psychosocial factors (e.g., knowledge and attitudes), however, such factors have not been previously assessed in women in treatment for OUD.. · Results indicate that attitudes around breastfeeding are positive but knowledge gaps exist..
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Affiliation(s)
- Vanessa L Short
- Department of Obstetrics and Gynecology, Sydney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Diane J Abatemarco
- Department of Obstetrics and Gynecology, Sydney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Meghan Gannon
- Department of Obstetrics and Gynecology, Sydney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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Mattson NM, Ohlendorf JM, Haglund K. Grounded Theory Approach to Understand Self-Management of Opioid Recovery Through Pregnancy and Early Parenting. J Obstet Gynecol Neonatal Nurs 2024; 53:34-45. [PMID: 37778395 DOI: 10.1016/j.jogn.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/02/2023] [Accepted: 09/07/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE To develop a theory to explain the processes women use to self-manage recovery from opioid use disorder during pregnancy, the postpartum period, and early parenting. DESIGN Constructivist grounded theory approach. PARTICIPANTS Women (N = 16) who gave birth during the past 12 months and used medication for opioid use disorder for recovery through pregnancy and the postpartum period. METHODS We recruited participants through seven medication-assisted treatment clinics in a mid-size Midwestern city and the surrounding suburbs and through online parenting and recovery community groups with national-based memberships. We conducted semistructured, individual audio interviews from November 2020 to July 2021. Interviews continued until we reached theoretical and meaning saturation. We used constant comparative methods during initial and intermediate coding. RESULTS Participants described a central process, Growing as a Healthy Dyad, that included six processes they used to self-manage recovery: Maintaining Vigilance, Performing Self-Care, Putting in the Work of Recovery, Advocating, Navigating Social Support, and Acquiring Skills and Knowledge. These processes were affected by personal and social contextual factors. CONCLUSIONS The grounded theory, Self-Management of Opioid Recovery Through Pregnancy and Early Parenting, can be used to explain the unique processes of self-management by women in opioid recovery and highlights the need for a strengths-based approach to caring for the maternal-infant dyad.
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Yazdanfard S, Thornton D, Bhatt P, Fatima B, Khalid J, Song J, Varisco TJ. Regional Variation in Opioid-Related Emergency Medical Services Transfers During the COVID-19 Pandemic: An Interrupted Time Series Analysis. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:74-80. [PMID: 38258862 DOI: 10.1177/29767342231208823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND The COVID-19 pandemic has impacted public infrastructure and healthcare utilization. However, regional variation in opioid-related harm secondary to COVID-19 remains poorly understood. This study aimed to measure the regional variation in the association between stay-at-home orders (SAHOs) and nonfatal opioid-related emergency medical services (EMS) transfers in the United States. METHODS In this interrupted time series design, counts of nonfatal opioid overdoses were identified in each week between July 29, 2019 and December 27, 2020 from the National Emergency Medical Services Information System Dataset. A longitudinal, interrupted time series model was used to compare the change in the number of nonfatal opioid overdose transfers between the pre-pandemic period (July 29, 2019-January 6, 2020) and the pandemic period (June 1, 2020-December 27, 2020). The time period between January 7, 2020 and May 31, 2020 was treated as a washout period to account for state-level variation in the timing of SAHO implementation. RESULTS We identified 277 141 adult nonfatal opioid-related overdose EMS transfers in the United States across all census regions. After implementation of the SAHO, EMS transfers significantly increased in all regions, with an increase most notable in the Southern United States (2161, 95% CI: 1699-2623 transfers per week). In the post-SAHO period between June 1 and December 27, 2020, EMS transfers declined from this regional peak in the Southern, Midwestern, and Northeastern United States. No change in trend was observed in the Western United States. CONCLUSION These findings underscore the importance of tailoring public health policies regionally. While most regions saw a modest decline in opioid-related EMS transfers after an initial increase, the COVID-19 pandemic led to notable increases in opioid-related EMS transfers nationwide. Future research should focus on identifying public health strategies to counteract the deleterious effects of the COVID-19 pandemic on opioid-related morbidity.
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Affiliation(s)
- Sahar Yazdanfard
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
- Prescription Drug Misuse Education and Research Center, University of Houston College of Pharmacy, Houston, TX, USA
| | - Douglas Thornton
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
- Prescription Drug Misuse Education and Research Center, University of Houston College of Pharmacy, Houston, TX, USA
| | - Prachet Bhatt
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
- Prescription Drug Misuse Education and Research Center, University of Houston College of Pharmacy, Houston, TX, USA
| | - Bilqees Fatima
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
| | - Javeria Khalid
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
| | - Juhyeon Song
- Prescription Drug Misuse Education and Research Center, University of Houston College of Pharmacy, Houston, TX, USA
| | - Tyler Jordan Varisco
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
- Prescription Drug Misuse Education and Research Center, University of Houston College of Pharmacy, Houston, TX, USA
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Scott KA, Shogren M, Shatzkes K. Reducing Fear to Help Build Healthy Families: Investing in Non-Punitive Approaches to Helping People with Substance Use Disorder. Matern Child Health J 2023; 27:177-181. [PMID: 37755582 PMCID: PMC10691989 DOI: 10.1007/s10995-023-03772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Many pregnant and parenting people with substance use disorders (SUD) refrain from seeking perinatal care or treatment for their SUD for fear of being treated poorly by health care providers and/or triggering a child welfare investigation. For those who do seek treatment, there are relatively few clinicians willing and able to prescribe medications for opioid use disorder (MOUD) to pregnant people. Both stigma and lack of access to treatment put many pregnant and parenting people at risk. Drug-related deaths contribute significantly to U.S. maternal mortality rates, with people at especially high risk of drug overdose in the months following delivery. METHODS The Foundation for Opioid Response Efforts (FORE) is a national philanthropy focused on finding and fostering solutions to the opioid crisis. We draw lessons from our grantees' efforts to expand access to substance use treatment and recovery supports for pregnant and parenting people. RESULTS To build systems of care that ensure more pregnant people get timely perinatal care, we need to expand training for perinatal providers on how to provide OUD treatment, clarify child welfare reporting rules, and engage and support trusted organizations and community-based services. CONCLUSIONS In addition to changes to our systems of SUD treatment and recovery, we need greater philanthropic investment in efforts to combat the public health crisis of substance use and overdose among pregnant and parenting people. Private funders have the leeway to act quickly, take risks, and demonstrate the effectiveness of new approaches, building the case for investment of public resources in such initiatives.
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Affiliation(s)
- Karen A Scott
- Foundation for Opioid Response Efforts, 110 West. 40th Street, New York, NY, 10018, USA.
| | - Maridee Shogren
- College of Nursing and Professional Disciplines, University of North Dakota, 430 Oxford Street Stop 9025 Grand Forks, Grand Forks, ND, 58202, USA
| | - Kenneth Shatzkes
- Foundation for Opioid Response Efforts, 110 West. 40th Street, New York, NY, 10018, USA
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Wang X, Meisel Z, Kellom K, Whitaker J, Strane D, Chatterjee A, Rosenquist R, Matone M. Receipt and duration of buprenorphine treatment during pregnancy and postpartum periods in a national privately-insured cohort. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 9:100206. [PMID: 38045493 PMCID: PMC10690545 DOI: 10.1016/j.dadr.2023.100206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/05/2023]
Abstract
Background Research gaps exist on the use of medications for opioid use disorder (OUD) among birthing people. Methods This retrospective cohort study included people who underwent childbirth deliveries during 2017-2020 and had a diagnosis of OUD identified from a national private insurance claims database. Buprenorphine prescriptions received during the year before childbirth and the year after childbirth were obtained from pharmacy claims. Logistic regressions were used to estimate associations between receipt of buprenorphine and individual and state-level factors. Results Among a sample of 1,523 birthing people diagnosed with OUD, 540 (35.5 %) received buprenorphine during the pregnancy or postpartum periods. About half (51.5 %) of new recipients of buprenorphine received treatment for at least six months and, of those, one-third experienced a treatment interruption. The buprenorphine receipt rate differed significantly by race and ethnicity: 28.8 % of non-Hispanic Black birthing people with OUD and 22.8 % of Hispanic birthing people with OUD received buprenorphine treatment in contrast to 37.7 % of non-Hispanic white birthing people (aOR 0.53 [95 % CI 0.35-0.81] and 0.59 [95 % CI 0.37-0.96], respectively). The buprenorphine use rate increased over time from 29.7 % in 2017 to 42.9 % in 2020. Birthing people living in states with punitive policies related to substance use in pregnancy had the lowest buprenorphine use rate of 22.7 % as compared to 43.0 % in states with least restrictive policies. Conclusion In this national sample of privately-insured individuals, by 2020, 42.9 % of birthing people with OUD received buprenorphine treatment. Treatment discontinuation and interruptions were common in the period surrounding childbirth.
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Affiliation(s)
- Xi Wang
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Zachary Meisel
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine Kellom
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jennifer Whitaker
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Douglas Strane
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Anyun Chatterjee
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rebecka Rosenquist
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Meredith Matone
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Zivin K, Zhang X, Tilea A, Clark SJ, Hall SV. Relationship between Depression and Anxiety during Pregnancy, Delivery-Related Outcomes, and Healthcare Utilization in Michigan Medicaid, 2012-2021. Healthcare (Basel) 2023; 11:2921. [PMID: 37998413 PMCID: PMC10671817 DOI: 10.3390/healthcare11222921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023] Open
Abstract
To evaluate associations between depression and/or anxiety disorders during pregnancy (DAP), delivery-related outcomes, and healthcare utilization among individuals with Michigan Medicaid-funded deliveries. We conducted a retrospective delivery-level analysis comparing delivery-related outcomes and healthcare utilization among individuals with and without DAP between January 2012 and September 2021. We used generalized estimating equation models assessing cesarean and preterm delivery; 30-day readmission after delivery; severe maternal morbidity within 42 days of delivery; and ambulatory, inpatient, emergency department or observation (ED), psychotherapy, or substance use disorders (SUD) visits during pregnancy. We adjusted models for age, race/ethnicity, urbanicity, federal poverty level, and obstetric comorbidities. Among 170,002 Michigan Medicaid enrollees with 218,890 deliveries, 29,665 (13.6%) had diagnoses of DAP. Compared to those without DAP, individuals with DAP were more often White, rural dwelling, had lower income, and had more comorbidities. In adjusted models, deliveries with DAP had higher odds of cesarean and preterm delivery OR = 1.02, 95% CI: [1.00, 1.05] and OR = 1.15, 95% CI: [1.11, 1.19] respectively), readmission within 30 days postpartum (OR = 1.14, 95% CI: [1.07, 1.22]), SMM within 42 days (OR = 1.27, 95% CI: [1.18, 1.38]), and utilization compared to those without DAP diagnoses (ambulatory: OR = 7.75, 95% CI: [6.75, 8.88], inpatient: OR = 1.13, 95% CI: [1.11, 1.15], ED: OR = 1.86, 95% CI: [1.80, 1.92], psychotherapy: OR = 172.8, 95% CI: [160.10, 186.58], and SUD: OR = 5.6, 95% CI: [5.37, 5.85]). Among delivering individuals in Michigan Medicaid, DAP had significant associations with adverse delivery-related outcomes and greater healthcare use. Early detection and intervention to address mental illness during pregnancy may help mitigate burdens of these complex yet treatable disorders.
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Affiliation(s)
- Kara Zivin
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
- Department of Psychiatry, Michigan Medicine, Ann Arbor, MI 48109, USA
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI 48109, USA
| | - Xiaosong Zhang
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI 48109, USA
| | - Anca Tilea
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI 48109, USA
| | - Sarah J. Clark
- Ambulatory Care Program, Department of Pediatrics, Michigan Medicine, Ann Arbor, MI 48109, USA
| | - Stephanie V. Hall
- Department of Psychiatry, Michigan Medicine, Ann Arbor, MI 48109, USA
- Department of Learning Health Sciences, Michigan Medicine, Ann Arbor, MI 48109, USA
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O'Donoghue AL, Reichheld A, Anderson TS, Zera CA, Dechen T, Stevens JP. Decline in Prenatal Buprenorphine/Naloxone Fills during the COVID-19 Pandemic in the United States. J Addict Med 2023; 17:e399-e402. [PMID: 37934549 DOI: 10.1097/adm.0000000000001228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
OBJECTIVES Pregnancy provides a critical opportunity to engage individuals with opioid use disorder in care. However, before the COVID-19 pandemic, there were multiple barriers to accessing buprenorphine/naloxone during pregnancy. Care disruptions during the pandemic may have further exacerbated these existing barriers. To quantify these changes, we examined trends in the number of individuals filling buprenorphine/naloxone prescriptions during the COVID-19 pandemic. METHODS We estimated an interrupted time series model using linked national pharmacy claims and medical claims data from prepandemic (May 2019 to February 2020) to the pandemic period (April 2020 to December 2020). We estimated changes in the growth rate in the monthly number of individuals filling buprenorphine/naloxone prescriptions in the 6 months preceding a delivery claim, per 100,000 pregnancies, during the COVID-19 pandemic. RESULTS We identified 2947 pregnant individuals filling buprenorphine/naloxone prescriptions. Before the pandemic, there was positive growth in the monthly number of individuals filling buprenorphine/naloxone prescriptions (4.83%; 95% confidence interval [CI], 3.82-5.84%). During the pandemic, this monthly growth rate declined for both individuals on commercial insurance and individuals on Medicaid (all payers: -5.53% [95% CI, -6.65% to -4.41%]; Medicaid: -7.66% [95% CI, -10.14% to -5.18%]; Commercial: -3.59% [95% CI, -5.32% to -1.87%]). CONCLUSION The number of pregnant individuals filling buprenorphine/naloxone prescriptions was increasing, but this growth has been lost during the pandemic.
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Affiliation(s)
- Ashley L O'Donoghue
- From the Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA (ALO, AR, TSA, TD, JPS); Harvard Medical School, Boston, MA (ALO, TSA, CAZ, JPS); Tufts University School of Medicine, Boston, MA (AR); Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA (TSA); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (CAZ); and Division for Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (JPS)
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Kao L, Lee C, Parayil T, Kramer C, Sufrin CB. Assessing provision of MOUD and obstetric care in U.S. jails: A content analysis of policies submitted by 59 jails. Drug Alcohol Depend 2023; 248:109877. [PMID: 37244223 PMCID: PMC10330906 DOI: 10.1016/j.drugalcdep.2023.109877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/29/2023]
Abstract
AIMS AND BACKGROUND Thousands of pregnant people with opioid use disorder (OUD) interface with the United States (US) carceral system annually. However, little is known about the consistency and breadth of medications for opioid use disorder (MOUD) for incarcerated pregnant people in jail, even at facilities that offer treatment; the goal of our study is to illuminate the current practices for OUD management in US jails. METHODS We collected and analyzed 59 self-submitted jail policies related to OUD and/or pregnancy from a national, cross-sectional survey of reported MOUD practices for pregnant people in a geographically diverse sample of US jails. Policies were coded for MOUD access, provision, and scope, then compared to respondents' submitted survey responses. RESULTS Of 59 policies, 42 (71%) mentioned OUD care during pregnancy. Among these 42 polices that mentioned OUD care during pregnancy, 41 (98%) allowed MOUD treatment, 24 (57%) expressed continuing pre-existing MOUD treatment that was started in the community pre-arrest, 17 (42%) initiated MOUD in custody, and only 2 (5%) mentioned providing MOUD continuation post-partum. Facilities varied in MOUD duration, provision logistics, and discontinuation policies. Only 11 (19%) policies were completely concordant with their survey response regarding MOUD provision in pregnancy. CONCLUSIONS The conditions, criteria, and the comprehensiveness of MOUD provision and protocols for pregnant people in jail remain variable. The findings demonstrate the need to develop a universal comprehensive MOUD framework for incarcerated pregnant people to reduce the increased likelihood of death from opioid overdose upon release and in the peripartum period.
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Affiliation(s)
- Lynn Kao
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, 4940 Eastern Ave., A101, Baltimore, MD21224, United States.
| | - Chanel Lee
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, 4940 Eastern Ave., A101, Baltimore, MD21224, United States
| | - Trisha Parayil
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, 4940 Eastern Ave., A101, Baltimore, MD21224, United States
| | - Camille Kramer
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, 4940 Eastern Ave., A101, Baltimore, MD21224, United States
| | - Carolyn B Sufrin
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, 4940 Eastern Ave., A101, Baltimore, MD21224, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 4940 Eastern Ave., A101, Baltimore, MD21224, United States
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Austin AE, Durrance CP, Ahrens KA, Chen Q, Hammerslag L, McDuffie MJ, Talbert J, Lanier P, Donohue JM, Jarlenski M. Duration of medication for opioid use disorder during pregnancy and postpartum by race/ethnicity: Results from 6 state Medicaid programs. Drug Alcohol Depend 2023; 247:109868. [PMID: 37058829 PMCID: PMC10198927 DOI: 10.1016/j.drugalcdep.2023.109868] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/31/2023] [Accepted: 04/02/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Medication for opioid use disorder (MOUD) is evidence-based treatment during pregnancy and postpartum. Prior studies show racial/ethnic differences in receipt of MOUD during pregnancy. Fewer studies have examined racial/ethnic differences in MOUD receipt and duration during the first year postpartum and in the type of MOUD received during pregnancy and postpartum. METHODS We used Medicaid administrative data from 6 states to compare the percentage of women with any MOUD and the average proportion of days covered (PDC) with MOUD, overall and by type of MOUD, during pregnancy and four postpartum periods (1-90 days, 91-180 days, 181-270 days, and 271-360 days postpartum) among White non-Hispanic, Black non-Hispanic, and Hispanic women diagnosed with OUD. RESULTS White non-Hispanic women were more likely to receive any MOUD during pregnancy and all postpartum periods compared to Hispanic and Black non-Hispanic women. For all MOUD types combined and for buprenorphine, White non-Hispanic women had the highest average PDC during pregnancy and each postpartum period, followed by Hispanic women and Black non-Hispanic women (e.g., for all MOUD types, 0.49 vs. 0.41 vs. 0.23 PDC, respectively, during days 1-90 postpartum). For methadone, White non-Hispanic and Hispanic women had similar average PDC during pregnancy and postpartum, and Black non-Hispanic women had substantially lower PDC. CONCLUSIONS There are stark racial/ethnic differences in MOUD during pregnancy and the first year postpartum. Reducing these inequities is critical to improving health outcomes among pregnant and postpartum women with OUD.
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Affiliation(s)
- Anna E Austin
- Department of Maternal and Child Health and Injury Prevention Research Center, University of North Carolina at Chapel Hill, United States; Injury Prevention Research Center, University of North Carolina at Chapel Hill, United States.
| | | | - Katherine A Ahrens
- Public Health Program, Muskie School of Public Service, University of Southern Maine, United States
| | - Qingwen Chen
- Department of Health Policy and Management, University of Pittsburgh, United States
| | - Lindsey Hammerslag
- Institute for Biomedical Informatics, University of Kentucky, United States
| | - Mary Joan McDuffie
- Center for Community Research & Service, Biden School of Public Policy and Administration, University of Delaware, United States
| | - Jeffery Talbert
- Institute for Biomedical Informatics, University of Kentucky, United States
| | - Paul Lanier
- School of Social Work, University of North Carolina at Chapel Hill, United States
| | - Julie M Donohue
- Department of Health Policy and Management, University of Pittsburgh, United States
| | - Marian Jarlenski
- Department of Health Policy and Management, University of Pittsburgh, United States
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Kropp FB, Smid MC, Lofwall MR, Wachman EM, Martin PR, Murphy SM, Wilder CM, Winhusen TJ. Collaborative care programs for pregnant and postpartum individuals with opioid use disorder: Organizational characteristics of sites participating in the NIDA CTN0080 MOMs study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 149:209030. [PMID: 37023858 DOI: 10.1016/j.josat.2023.209030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/17/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
INTRODUCTION Pregnant individuals with substance use disorders face complex issues that may serve as barriers to treatment entry and retention. Several professional organizations have established recommendations on comprehensive, collaborative approaches to treatment to meet the needs of this population, but information on real-world application is lacking. Sites participating in the NIDA CTN0080 "Medication treatment for Opioid use disorder in expectant Mothers (MOMs)"-a randomized clinical trial of extended release compared to sublingual buprenorphine among pregnant and postpartum individuals (PPI)-were selected, in part, because they have a collaborative approach to treating PPI with opioid use disorder (OUD). However, organizational differences among sites and how they implement expert recommendations for collaborative care could impact study outcomes. METHODS Prior to study launch at each of the 13 MOMs sites, investigators used the Pregnancy and Addiction Services Assessment (PAASA) to collect information about organizational factors. Input from a team of addiction, perinatal, and economic evaluation experts guided the development of the PAASA. Investigators programmed the PAASA into a web-based data system and summarized the resultant site data using descriptive statistics. RESULTS Study sites represented four US census regions. Most sites were specialty obstetrics & gynecology (OB/GYN) programs providing OUD services (n = 9, 69.2 %), were affiliated with an academic institution (n = 11, 84.6 %), and prescribed buprenorphine in an ambulatory/outpatient setting (n = 11, 84.6 %); all sites offered access to naloxone. Sites reported that their population was primarily White, utilized public insurance, and faced numerous psychosocial barriers to treatment. Although all sites offered many services recommended by expert consensus groups, they varied in how they coordinated these services. CONCLUSIONS By providing the organizational characteristics of sites participating in the MOMs study, this report assists in filling the current gap in knowledge regarding similar programs providing services to PPI with OUD. Collaborative care programs such as those participating in MOMs are uniquely positioned to participate in research to determine the most effective models of care and to determine how research can be integrated into those clinical care settings.
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Affiliation(s)
- Frankie B Kropp
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA.
| | - Marcela C Smid
- University of Utah, 50 N. Medical Drive, Salt Lake City, UT 84132, USA.
| | - Michelle R Lofwall
- Departments of Behavioral Science and Psychiatry, University of Kentucky College of Medicine, 845 Angliana Avenue, Lexington, KY 40508, USA.
| | - Elisha M Wachman
- Boston Medical Center, 801 Albany Street, Boston, MA 02119, USA.
| | - Peter R Martin
- Vanderbilt Psychiatric Hospital, Vanderbilt University Medical Center, 1601 23rd Avenue South, Suite 3035, Nashville, TN 372124, USA.
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
| | - Christine M Wilder
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA.
| | - T John Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA.
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Barber CM, Terplan M. Principles of care for pregnant and parenting people with substance use disorder: the obstetrician gynecologist perspective. Front Pediatr 2023; 11:1045745. [PMID: 37292372 PMCID: PMC10246753 DOI: 10.3389/fped.2023.1045745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 04/17/2023] [Indexed: 06/10/2023] Open
Abstract
Substance use in pregnant and parenting persons is common, yet still underdiagnosed. Substance use disorder (SUD) is one of the most stigmatized and undertreated chronic medical conditions, and this is exacerbated in the perinatal period. Many providers are not sufficiently trained in screening or treatment for substance use, so gaps in care for this population persist. Punitive policies towards substance use in pregnancy have proliferated, lead to decreased prenatal care, do not improve birth outcomes, and disproportionately impact Black, Indigenous, and other families of color. We discuss the importance of understanding the unique barriers of pregnancy-capable persons and drug overdose as one of the leading causes of maternal death in the United States. We highlight the principles of care from the obstetrician-gynecologist perspective including care for the dyad, person-centered language, and current medical terminology. We then review treatment of the most common substances, discuss SUD during the birthing hospitalization, and highlight the high risk of mortality in the postpartum period.
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Affiliation(s)
- Cecily May Barber
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, United States
- Department of Obstetrics and Gynecology, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Mishka Terplan
- Friends Research Institute, Baltimore, MD, United States
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States
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Banks DE, Fentem A, Li X, Paschke M, Filiatreau L, Woolfolk C, Cavazos-Rehg P. Attitudes Toward Medication for Opioid Use Disorder Among Pregnant and Postpartum Women and People Seeking Treatment. J Addict Med 2023; 17:356-359. [PMID: 37267191 PMCID: PMC10248185 DOI: 10.1097/adm.0000000000001113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Pregnant and postpartum women and people (PPWP) who use opioids experience higher rates of morbidity, preterm labor, and stillbirth than those who do not. Although medication for opioid use disorder (MOUD) is the standard of treatment, utilization among PPWP has remained low because of MOUD stigma and misconceptions. The current report examined general and pregnancy-related MOUD attitudes, norms, and self-efficacy among PPWP seeking treatment. METHODS Participants (n = 33) receiving MOUD at a Midwestern clinic reported beliefs about MOUD in general using the Attitudes toward Methadone Questionnaire (modified to include all MOUD) and during pregnancy/postpartum using an investigator-generated scale based on previous research. Participants responded using a 5-point scale from "strongly agree" to "strongly disagree" with higher scores indicating more positive attitudes. Analyses examined the bivariate association of attitudes with MOUD subjective norms and self-efficacy, also measured via investigator-generated scales. RESULTS Respondents reported positive attitudes toward MOUD use during pregnancy, with most agreeing it was safe. However, up-to-half of participants reported uncertainty regarding the appropriate dosage of MOUD and its impact on the fetus and/or neonate. Both general and pregnancy/postpartum-related MOUD attitudes were positively associated with subjective norms toward MOUD. CONCLUSIONS Pregnant and postpartum women and people reported high uncertainty about MOUD use despite currently using it, emphasizing the need for strategies that assess and mitigate MOUD-related stigma. Findings suggest that familial support and stigma impact attitudes toward MOUD and highlight the importance of accurate psychoeducation and social supports for patients and their families to improve the acceptance and utilization of MOUD among PPWP.
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Affiliation(s)
- Devin E. Banks
- Department of Psychological Sciences, University of Missouri – St. Louis, One University Blvd. 325 Stadler Hall, St. Louis, MO 63121
| | - Andrea Fentem
- Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Xiao Li
- Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Maria Paschke
- Department of Psychological Sciences, University of Missouri – St. Louis, One University Blvd. 325 Stadler Hall, St. Louis, MO 63121
| | - Lindsey Filiatreau
- Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Candice Woolfolk
- Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Patricia Cavazos-Rehg
- Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
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Kitsantas P, Aljoudi SM, Baker KM, Peppard L, Oh KM. Racial/ethnic differences in medication for addiction treatment for opioid use disorders among pregnant women in treatment facilities supported by state funds. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 148:208960. [PMID: 37102193 DOI: 10.1016/j.josat.2023.208960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/31/2022] [Accepted: 01/17/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Medication for addiction treatment (MAT) for opioid use disorder (OUD) in pregnant women is known to improve neonatal health outcomes. Despite the benefits of this evidence-based treatment for OUD, MAT has been underutilized during pregnancy among certain racial/ethnic groups of women in the United States. The purpose of this study was to examine racial/ethnic differences and factors that affect MAT administration among pregnant women with OUD seeking treatment at publicly funded facilities. METHODS We used data from the 2010-2019 Treatment Episode Data Set system. The analytic sample included 15,777 pregnant women with OUD. We built logistic regression models to examine associations between race/ethnicity and MAT and determine differences and similarities in factors that may influence the use of MAT across racial/ethnic groups of pregnant women with OUD. RESULTS Although in this sample only 31.6 % received MAT, an increasing trend of MAT receipt has been observed during 2010-2019. Approximately 44 % of the Hispanic pregnant women received MAT, and this was significantly higher than non-Hispanic Black (27.1 %) and White (31.3 %) women. Even after adjusting for potential confounders, the adjusted odds of receiving MAT during pregnancy were lower for Black (AOR = 0.57, 95 % CI 0.44, 0.75) and White (AOR = 0.75, 95 % CI 0.61, 0.91) women compared to Hispanic women. Not being in the labor force increased the odds of receiving MAT in Hispanic women relative to their employed counterparts while homelessness or dependent living decreased the odds of MAT for White women compared to those living independently. Regardless of their racial/ethnic background, pregnant women younger than 29 years old were less likely to receive MAT relative to older women; however, if they were arrested once prior to admission to treatment, they had significantly higher odds of receiving MAT than those with no arrests. Treatment of at least 7 months was associated with a higher likelihood of MAT across all racial/ethnic groups. CONCLUSIONS This study highlights the underutilization of MAT, particularly among pregnant Black and White women who seek treatment for OUD in publicly funded treatment facilities. A multi-dimensional approach to MAT intervention programs is needed to increase MAT for all pregnant women and reduce racial/ethnic inequities.
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Affiliation(s)
- Panagiota Kitsantas
- Department of Health Administration and Policy, George Mason University, 4400 University Dr., MS 1J3, Fairfax, VA 22030-4444, United States of America.
| | - Salman M Aljoudi
- Department of Health Administration and Policy, George Mason University, 4400 University Dr., MS 1J3, Fairfax, VA 22030-4444, United States of America
| | - Kelley M Baker
- Department of Health Administration and Policy, George Mason University, 4400 University Dr., MS 1J3, Fairfax, VA 22030-4444, United States of America
| | - Lora Peppard
- Washington/Baltimore HIDTA 1800 Alexander Bell Drive, Suite 300, Reston, VA 20191
| | - Kyeung Mi Oh
- School of Nursing, George Mason University, 4400 University Dr., MS 3C4, Fairfax, VA 22030-4444, United States of America
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Charron E, White A, Carlston K, Abdullah W, Baylis JD, Pierce S, Businelle MS, Gordon AJ, Krans EE, Smid MC, Cochran G. Prospective acceptability of digital phenotyping among pregnant and parenting people with opioid use disorder: A multisite qualitative study. Front Psychiatry 2023; 14:1137071. [PMID: 37139320 PMCID: PMC10149825 DOI: 10.3389/fpsyt.2023.1137071] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
Background While medications for opioid use disorder (MOUD) effectively treat OUD during pregnancy and the postpartum period, poor treatment retention is common. Digital phenotyping, or passive sensing data captured from personal mobile devices, namely smartphones, provides an opportunity to understand behaviors, psychological states, and social influences contributing to perinatal MOUD non-retention. Given this novel area of investigation, we conducted a qualitative study to determine the acceptability of digital phenotyping among pregnant and parenting people with opioid use disorder (PPP-OUD). Methods This study was guided by the Theoretical Framework of Acceptability (TFA). Within a clinical trial testing a behavioral health intervention for PPP-OUD, we used purposeful criterion sampling to recruit 11 participants who delivered a child in the past 12 months and received OUD treatment during pregnancy or the postpartum period. Data were collected through phone interviews using a structured interview guide based on four TFA constructs (affective attitude, burden, ethicality, self-efficacy). We used framework analysis to code, chart, and identify key patterns within the data. Results Participants generally expressed positive attitudes about digital phenotyping and high self-efficacy and low anticipated burden to participate in studies that collect smartphone-based passive sensing data. Nonetheless, concerns were noted related to data privacy/security and sharing location information. Differences in participant assessments of burden were related to length of time required and level of remuneration to participate in a study. Interviewees voiced broad support for participating in a digital phenotyping study with known/trusted individuals but expressed concerns about third-party data sharing and government monitoring. Conclusion Digital phenotyping methods were acceptable to PPP-OUD. Enhancements in acceptability include allowing participants to maintain control over which data are shared, limiting frequency of research contacts, aligning compensation with participant burden, and outlining data privacy/security protections on study materials.
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Affiliation(s)
- Elizabeth Charron
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Tulsa, OK, United States
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Ashley White
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Kristi Carlston
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Walitta Abdullah
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jacob D Baylis
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Stephanie Pierce
- Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Michael S Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Adam J Gordon
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Elizabeth E Krans
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, United States
- Center for Perinatal Addiction Research, Education and Evidence-based Solutions (Magee CARES), Magee-Womens Research Institute, Pittsburgh, PA, United States
| | - Marcela C Smid
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, United States
| | - Gerald Cochran
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
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23
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Bhadra-Heintz NM, Garcia S, Entrup P, Trimble C, Teater J, Rood K, Trent Hall O. Years of Life Lost due to Unintentional Drug Overdose among Perinatal Individuals in the United States. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 36:100842. [PMID: 37028239 DOI: 10.1016/j.srhc.2023.100842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 02/20/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND The United States has one of the highest maternal mortality rates of developing countries, but the contribution of perinatal drug overdose is not known. Communities of color also have higher rates of maternal morbidity and mortality when compared to White communities, however the contribution due to overdose has not yet been examined in this population. OBJECTIVES To quantify the years of life lost due to unintentional overdose in perinatal individuals from 2010 to 2019 and assess for disparity by race. STUDY DESIGN This was a cross-sectional retrospective study with summary-level mortality statistics for the years 2010-2019 obtained from the Centers for Disease Control (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) mortality file. A total of 1,586 individuals of childbearing age (15-44 years) who died during pregnancy or six weeks postpartum (perinatal) from unintentional overdose in the United States from January 1, 2010 to December 31, 2019 were included. Total years of life lost (YLL) was calculated and summated for White, Black, Hispanic, Asian/Pacific Islander, and American Indian/Native Alaska women. Additionally, the top three overall causes of death were also identified for women in this age group for comparison. RESULTS Unintentional drug overdose accounted for 1,586 deaths and 83,969.78 YLL in perinatal individuals from 2010 to 2019 in the United States. Perinatal American Indian/Native American individuals had a disproportionate amount of YLL when compared to other ethnic groups, with 2.39% of YLL due to overdose, while only making up 0.80% of the population. During the last two years of the study, only American Indian/Native American and Black individuals had increased rates of mortality when compared to other races. During the ten-year study period, when including the top three causes of mortality, unintentional drug overdoses made up 11.98% of the YLL overall and 46.39% of accidents. For the years 2016-2019, YLL due to unintentional overdose was the third leading cause of YLL overall for this population. CONCLUSIONS Unintentional drug overdose is a leading cause of death for perinatal individuals in the United States, claiming nearly 84,000 years of life over a ten-year period. When examining by race, American Indian/Native American women are most disproportionately affected.
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White SA, McCourt A, Bandara S, Goodman DJ, Patel E, McGinty EE. Implementation of State Laws Giving Pregnant People Priority Access to Drug Treatment Programs in the Context of Coexisting Punitive Laws. Womens Health Issues 2023; 33:117-125. [PMID: 36272928 DOI: 10.1016/j.whi.2022.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 08/23/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In response to increased prenatal drug use since the 2000s, states have adopted treatment-oriented laws giving pregnant and postpartum people priority access to public drug treatment programs as well as multiple punitive policy responses. No prior studies have systematically characterized these state statutes or examined implementation of state priority access laws in the context of co-existing punitive laws. METHODS We conducted legal mapping to examine state priority access laws and their overlap with state laws deeming prenatal drug use to be child maltreatment, mandating reporting of prenatal drug use to child protective services, or criminalizing prenatal drug use. We also conducted interviews with 51 state leaders with expertise on their states' prenatal drug use laws to understand how priority access laws were implemented. RESULTS Thirty-three states and the District of Columbia have a priority access law, and more than 80% of these jurisdictions also have one of the punitive prenatal drug use laws described. Leaders reported major barriers to implementing state priority access laws, including the lack of drug treatment programs, stigma, and conflicts with punitive prenatal drug use laws. CONCLUSIONS Our results suggest that state laws granting pregnant and postpartum people priority access to drug treatment programs are likely insufficient to significantly increase access to evidence-based drug treatment. Punitive state prenatal drug use laws may counteract priority access laws by impeding treatment seeking. Findings highlight the need to allocate additional resources to drug treatment for pregnant and postpartum people.
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Affiliation(s)
- Sarah A White
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, Maryland.
| | - Alexander McCourt
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, Maryland
| | - Sachini Bandara
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, Maryland
| | - Daisy J Goodman
- Dartmouth-Hitchcock Medical Center, Department of Obstetrics and Gynecology, Lebanon, New Hampshire
| | - Esita Patel
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, Maryland
| | - Emma E McGinty
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, Maryland
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25
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Kiluk BD, Kleykamp BA, Comer SD, Griffiths RR, Huhn AS, Johnson MW, Kampman KM, Pravetoni M, Preston KL, Vandrey R, Bergeria CL, Bogenschutz MP, Brown RT, Dunn KE, Dworkin RH, Finan PH, Hendricks PS, Houtsmuller EJ, Kosten TR, Lee DC, Levin FR, McRae-Clark A, Raison CL, Rasmussen K, Turk DC, Weiss RD, Strain EC. Clinical Trial Design Challenges and Opportunities for Emerging Treatments for Opioid Use Disorder: A Review. JAMA Psychiatry 2023; 80:84-92. [PMID: 36449315 PMCID: PMC10297827 DOI: 10.1001/jamapsychiatry.2022.4020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Importance Novel treatments for opioid use disorder (OUD) are needed to address both the ongoing opioid epidemic and long-standing barriers to existing OUD treatments that target the endogenous μ-opioid receptor (MOR) system. The goal of this review is to highlight unique clinical trial design considerations for the study of emerging treatments for OUD that address targets beyond the MOR system. In November 2019, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership with the US Food and Drug Administration sponsored a meeting to discuss the current evidence regarding potential treatments for OUD, including cannabinoids, psychedelics, sedative-hypnotics, and immunotherapeutics, such as vaccines. Observations Consensus recommendations are presented regarding the most critical elements of trial design for the evaluation of novel OUD treatments, such as: (1) stage of treatment that will be targeted (eg, seeking treatment, early abstinence/detoxification, long-term recovery); (2) role of treatment (adjunctive with or independent of existing OUD treatments); (3) primary outcomes informed by patient preferences that assess opioid use (including changes in patterns of use), treatment retention, and/or global functioning and quality of life; and (4) adverse events, including the potential for opioid-related relapse or overdose, especially if the patient is not simultaneously taking maintenance MOR agonist or antagonist medications. Conclusions and Relevance Applying the recommendations provided here as well as considering input from people with lived experience in the design phase will accelerate the development, translation, and uptake of effective and safe therapeutics for individuals struggling with OUD.
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Affiliation(s)
- Brian D Kiluk
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Bethea A Kleykamp
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Sandra D Comer
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Roland R Griffiths
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew W Johnson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kyle M Kampman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Marco Pravetoni
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Medical Center, Seattle
| | - Kenzie L Preston
- Clinical Pharmacology and Therapeutics Research Branch, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cecilia L Bergeria
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael P Bogenschutz
- Department of Psychiatry, NYU Grossman School of Medicine, New York University, New York
| | - Randall T Brown
- Department of Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine and Public Health, Madison
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert H Dworkin
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter S Hendricks
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham
| | | | - Thomas R Kosten
- Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Dustin C Lee
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Frances R Levin
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Aimee McRae-Clark
- Department of Psychiatry, Medical University of South Carolina, Charleston
| | - Charles L Raison
- Department of Human Development and Family Studies, School of Human Ecology, University of Wisconsin-Madison
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison
| | | | - Dennis C Turk
- University of Washington School of Medicine, Seattle
| | - Roger D Weiss
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Eric C Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Khachikian T, Amaro H, Guerrero E, Kong Y, Marsh JC. Disparities in opioid treatment access and retention among women based on pregnancy status from 2006 to 2017. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 2. [PMID: 35369381 PMCID: PMC8975179 DOI: 10.1016/j.dadr.2022.100030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: The purpose of this study is to assess differences in wait time and retention in opioid use disorder (OUD) treatment among a sample of pregnant and non-pregnant women from low-income urban communities in Los Angeles, California. Methods: Data were collected in 9 waves consisting of consecutive years from 2006 to 2011, and then including 2013, 2015, and 2017. The sample consisted of 12,558 women, with 285 being pregnant and 12,273 being non-pregnant. We compared pregnant women with non-pregnant women at admission on key characteristics and relied on two multilevel negative binomial regressions analyses to examine factors related to access (days on the waiting list) and retention (days in treatment). Results: We detected disparities existed in access and retention. Pregnant women spent less time waiting to initate treatment than non-pregnant women and, once in treatment, had longer treatment episodes. Among pregnant women, clients identifying as Latina or Other waited longer to enter treatment compared to clients identifying as non-Latina White or Black. Women entering residential waited longer than those entering methadone or counseling services. Pregnant women were more likely to be in treatment longer if they had mental health issues, greater parenting responsibilities (number of children less than 18), and greater SUD severity (number of prior treatment episodes). Conclusions: Findings suggest pregnant women’s access and retention can be improved through Medicaid coverage and through the implementation of a standard of care that includes MOUD (methadone) along with ancillary health and social services.
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Affiliation(s)
- Tenie Khachikian
- University of Chicago, School of Social Service Administration, 969 E. 60th Street, Chicago, IL 60637, USA
- Corresponding author.
| | - Hortensia Amaro
- Florida International University, Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, 11200 SW 8th St, AHC4, Miami, Florida 33199, USA
| | - Erick Guerrero
- I-LEAD Institute, Research to End Healthcare Disparities Corp, 12300 Wilshire Blvd, Suite 210, Los Angeles, CA 90025 USA
| | - Yinfei Kong
- California State University, Fullerton, College of Business and Economics, 800N State College Blvd, Fullerton CA 92831 USA
| | - Jeanne C. Marsh
- University of Chicago, School of Social Service Administration, 969 E. 60th Street, Chicago, IL 60637, USA
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Hostetter K, Thakkar B, Edwards C, Martin CE. Addiction curriculum design for medical students. CLINICAL TEACHER 2022; 19:29-35. [PMID: 34808694 PMCID: PMC8792370 DOI: 10.1111/tct.13438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND As mortality and morbidity due to substance use disorder (SUD) are increasing for women, especially during pregnancy and postpartum, it is imperative to equip medical providers with skills to identify SUD and initiate treatments. We designed a curriculum to provide third-year medical students with clinical exposure to SUD during pregnancy. APPROACH This novel, experience-based SUD curriculum was focused on providing adequate knowledge, skills and confidence to provide compassionate, patient-centred care to women with SUD. Obstetrics and Gynecology clerkship third-year medical students rotated 1 day through a clinic that provides Obstetrics and Gynecology and addiction medicine services. Congruent with COVID-19 limitations, students completed pre-clinic assignments and in-clinic tasks (e.g., screening, brief intervention, referral to treatment [SBIRT]) under supervision. EVALUATION After implementation of this pilot curriculum, 20 students and 10 teachers completed surveys (100% response rate) with open-ended response items. Quantitative data and open-ended responses using electronic surveys were sequentially analysed to evaluate the curriculum's feasibility and acceptability. IMPLICATIONS We designed a novel curriculum that focused on SUD learning objectives and providing exposure to third-year medical students, and our findings indicate that it is feasible and acceptable to both students and teachers. In the future, we plan to provide this curriculum to both our third- and fourth-year medical students, and we encourage teachers and providers at other institutions to utilise it during their clinical training.
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Affiliation(s)
- Kara Hostetter
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Bhushan Thakkar
- Department of Obstetrics & Gynecology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Cherie Edwards
- Office of Assessment, Evaluation, and Scholarship, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Caitlin Eileen Martin
- Department of Obstetrics & Gynecology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA,Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia, USA
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Differential Gateways, Facilitators, and Barriers to Substance Use Disorder Treatment for Pregnant Women and Mothers: A Scoping Systematic Review. J Addict Med 2022; 16:e185-e196. [PMID: 34380985 PMCID: PMC8828806 DOI: 10.1097/adm.0000000000000909] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Access to substance use disorder (SUD) treatment is complex, and more so for pregnant women and mothers who experience unique barriers. This scoping systematic review aimed to summarize contemporary findings on gateways, facilitators, and barriers to treatment for pregnant women and mothers with SUD. METHODS We used the scoping review methodology and a systematic search strategy via MEDLINE/PubMed and Google Scholar. The search was augmented by the similar article lists for sources identified in PubMed. Scholarly and peer-reviewed articles that were published in English from 1996 to 2019 were included. A thematic analysis of the selected studies was used to summarize pathways to SUD treatment and to identify research gaps. RESULTS The analysis included 41 articles. Multiple gateway institutions were identified: health care settings, social service agencies, criminal justice settings, community organizations, and employers. Some of the identified facilitators and barriers to SUD treatment were unique to pregnant women and mothers (eg, fear of incarceration for child abuse). Both personal (emotional support and social support) and child-related factors (loss of children, suspension or termination of parental rights, the anticipation of reuniting with children) motivated women to seek treatment. Major access barriers included fear, stigma, charges of child abuse, inconvenience, and financial hardship. CONCLUSIONS There has been progress in implementing different types of interventions and treatments for that were attentive to pregnant women and mothers' needs. We developed a conceptual model that characterized women's pathways to treatment by deciphering women's potential engagement in gateway settings.
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Explaining Racial-ethnic Disparities in the Receipt of Medication for Opioid Use Disorder during Pregnancy. J Addict Med 2022; 16:e356-e365. [PMID: 35245918 PMCID: PMC9440158 DOI: 10.1097/adm.0000000000000979] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Factors contributing to racial and ethnic disparities in medication for opioid use disorder (MOUD) receipt during pregnancy are largely unknown. We quantified the contribution of individual, healthcare access and quality, and community factors to racial-ethnic disparities in MOUD during pregnancy and postpartum among Medicaid-enrolled pregnant women with opioid use disorder (OUD). METHODS This retrospective cohort study used regression and nonlinear decomposition to examine how individual, healthcare access and quality, and community factors explain racial-ethnic disparities in MOUD receipt among Medicaid-enrolled women with OUD who had a live birth from 2011 to 2017. The exposure was self-reported race and ethnicity. The outcomes were any MOUD receipt during pregnancy or postpartum. All factors included were identified from the literature. RESULTS Racial-ethnic disparities in individual, healthcare access and quality, and community factors explained 15.8% of the racial-ethnic disparity in MOUD receipt during pregnancy and 68.9% of the disparity in the postpartum period. Despite comparable healthcare utilization, non-White/Hispanic women were diagnosed with OUD 37 days later in pregnancy, on average, than non-Hispanic White women, which was the largest contributor to the racial-ethnic disparity in MOUD receipt during pregnancy (111.0%). The racial-ethnic disparity in MOUD receipt during pregnancy was the largest contributor (112.2%) to the racial-ethnic disparity in MOUD in the postpartum period. CONCLUSIONS Later diagnosis of OUD in pregnancy among non-White/Hispanic women partially explains the disparities in MOUD receipt in this population. Universal substance use screening earlier in pregnancy, combined with connecting patients to evidence-based and culturally competent care, is one approach that could close the observed racial-ethnic disparity in MOUD receipt.
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Henninger MW, Clements AD, Kim S, Rothman EF, Bailey BA. Prevalence of Opioid Use and Intimate Partner Violence among Pregnant Women in South-Central Appalachia, USA. Subst Use Misuse 2022; 57:1220-1228. [PMID: 35591760 DOI: 10.1080/10826084.2022.2076872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Recent research indicates that pregnant women in rural communities are at increased risk of experiencing IPV and comorbid illicit opioid use compared to urban-residing pregnant women. Few studies of the interactions among rurality, substance use, and victimization in pregnant women exist. The current study sought to examine the relationship between IPV and opioid use and the interaction effects of rurality in Appalachian pregnant women. Methods: A convenience sample of pregnant women who were enrolled in a smoking cessation research study was used for this analysis. Participants included 488 pregnant women from five prenatal clinics in South-Central Appalachia. Data were from self-reported assessments and semi-structured interviews on substance use and IPV conducted from first trimester of pregnancy through eight months postpartum. Results: Four hundred and ten participants reported experiencing any form of IPV in the past year. Logistic regression results indicated that physical IPV was associated with opioid use, but sexual and psychological IPV were not. The moderation model indicated direct effects between IPV and opioid use, but were not moderated by rurality. Conclusion: This study suggests a need to further understand the relationship between substance use, IPV, and rurality in pregnant women. The specific subtopic of opioid use by pregnant women living in rural communities, and its relationship to IPV victimization and adverse fetal and maternal health outcomes, continues to be an understudied, but critically important area. Limitations and future directions pertaining to IPV screenings and interventions for pregnant women are discussed.
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Affiliation(s)
- Matthew W Henninger
- Department of Counseling, School, and Educational Psychology, University at Buffalo - The State University of New York
| | - Andrea D Clements
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA
| | - Sunha Kim
- Department of Counseling, School, and Educational Psychology, University at Buffalo - The State University of New York
| | - Emily F Rothman
- Department of Community Health Sciences, Boston University, School of Public Health, Boston, Massachusetts, USA
| | - Beth A Bailey
- College of Medicine, Central Michigan University, Mount Pleasant, Michigan, USA
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Kelley AT, Smid MC, Baylis JD, Charron E, Begaye LJ, Binns-Calvey A, Archer S, Weiner S, Pettey W, Cochran G. Treatment access for opioid use disorder in pregnancy among rural and American Indian communities. J Subst Abuse Treat 2021; 136:108685. [PMID: 34953636 DOI: 10.1016/j.jsat.2021.108685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/28/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Opioid use disorder (OUD) in pregnancy disproportionately impacts rural and American Indian (AI) communities. With limited data available about access to care for these populations, this study's objective was to assess clinic knowledge and new patient access for OUD treatment in three rural U.S. counties. MATERIAL AND METHODS The research team used unannounced standardized patients (USPs) to request new patient appointments by phone for white and AI pregnant individuals with OUD at primary care and OB/GYN clinics that provide prenatal care in three rural Utah counties. We assessed a) clinic familiarity with buprenorphine for OUD; b) appointment availability for buprenorphine treatment; c) appointment wait times; d) referral provision when care was unavailable; and e) availability of OUD care at referral locations. We compared outcomes for AI and white USP profiles using descriptive statistics. RESULTS The USPs made 34 calls to 17 clinics, including 4 with publicly listed buprenorphine prescribers on the Substance Abuse and Mental Health Services Administration website. Among clinical staff answering calls, 16 (47%) were unfamiliar with buprenorphine. OUD treatment was offered when requested in 6 calls (17.6%), with a median appointment wait time of 2.5 days (IQR 1-5). Among clinics with a listed buprenorphine prescriber, 2 of 4 (50%) offered OUD treatment. Most clinics (n = 24/28, 85.7%) not offering OUD treatment provided a referral; however, a buprenorphine provider was unavailable/unreachable 67% of the time. The study observed no differences in appointment availability between AI and white individuals. CONCLUSIONS Rural-dwelling AI and white pregnant individuals with OUD experience significant barriers to accessing care. Improving OUD knowledge and referral practices among rural clinics may increase access to care for this high-risk population.
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Affiliation(s)
- A Taylor Kelley
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, United States of America; Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, 500 Foothill Drive, Building 2, Salt Lake City, UT 84148, United States of America; Department of Internal Medicine, Division of General Internal Medicine, University of Utah School of Medicine, 30 N 1900 E 5R341, Salt Lake City, UT 84132, United States of America.
| | - Marcela C Smid
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, United States of America; Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E 2B300, Salt Lake City, UT 84132, United States of America
| | - Jacob D Baylis
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, United States of America
| | - Elizabeth Charron
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, United States of America
| | - Lori Jo Begaye
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, United States of America
| | - Amy Binns-Calvey
- Department of Medicine, Division of Academic Internal Medicine and Geriatrics, University of Illinois at Chicago, 840 South Wood Street, CSN 440, Chicago, IL 60612, United States of America
| | - Shayla Archer
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, United States of America
| | - Saul Weiner
- Jesse Brown VA Medical Center, Medical Services, 820 S Damen Ave, Chicago, IL 60612, United States of America; Department of Medicine, Division of Academic Internal Medicine and Geriatrics, University of Illinois at Chicago, 840 South Wood Street, CSN 440, Chicago, IL 60612, United States of America
| | - Warren Pettey
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, United States of America
| | - Gerald Cochran
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, United States of America
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Weber A, Miskle B, Lynch A, Arndt S, Acion L. Substance Use in Pregnancy: Identifying Stigma and Improving Care. Subst Abuse Rehabil 2021; 12:105-121. [PMID: 34849047 PMCID: PMC8627324 DOI: 10.2147/sar.s319180] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
This review examines the impact of stigma on pregnant people who use substances. Stigma towards people who use drugs is pervasive and negatively impacts the care of substance-using people by characterizing addiction as a weakness and fostering beliefs that undermine the personal resources needed to access treatment and recover from addiction, including self-efficacy, help seeking and belief that they deserve care. Stigma acts on multiple levels by blaming people for having a problem and then making it difficult for them to get help, but in spite of this, most pregnant people who use substances reduce or stop using when they learn they are pregnant. Language, beliefs about gender roles, and attitudes regarding fitness for parenting are social factors that can express and perpetuate stigma while facilitating punitive rather than therapeutic approaches. Because of stigmatizing attitudes that a person who uses substances is unfit to parent, pregnant people who use substances are at heightened risk of being screened for substance use, referred to child welfare services, and having their parental rights taken away; these outcomes are even more likely for people of color. Various treatment options can successfully support recovery in substance-using pregnant populations, but treatment is underutilized in all populations including pregnant people, and more knowledge is needed on how to sustain engagement in treatment and recovery activities. To combat stigma when working with substance-using pregnant people throughout the peripartum period, caregivers should utilize a trauma-informed approach that incorporates harm reduction and motivational interviewing with a focus on building trust, enhancing self-efficacy, and strengthening the personal skills and resources needed to optimize health of the parent-baby dyad.
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Affiliation(s)
- Andrea Weber
- Department of Psychiatry, University of Iowa Health Care, Iowa City, IA, USA
| | - Benjamin Miskle
- Department of Psychiatry, University of Iowa Health Care, Iowa City, IA, USA
| | - Alison Lynch
- Department of Psychiatry, University of Iowa Health Care, Iowa City, IA, USA
| | - Stephan Arndt
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Laura Acion
- Universidad de Buenos Aires - CONICET, Instituto de Cálculo, Ciudad Autónoma de Buenos Aires, Argentina
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A Low-threshold Comprehensive Shared Medical Appointment Program for Perinatal Substance Use in an Underserved Population. J Addict Med 2021; 16:e203-e209. [PMID: 34510086 DOI: 10.1097/adm.0000000000000912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We describe retention in care, medication for opioid use disorder (MOUD) prescribing, and urine toxicology outcomes of a comprehensive perinatal shared medical appointment model that combined medication, group-based counseling, and recovery supports. METHODS We conducted a retrospective study of program retention between 11/1/16 and 3/31/20 in pregnant and postpartum women with substance dependence or use disorder. Disengagement reasons, MOUD prescribing, and urine toxicology were abstracted from medical records. A Cox proportional hazards model was used to evaluate risk factors for program disengagement. RESULTS Approximately 87% of patients had OUD and 80% were pregnant at the initial visit (N = 140). Retention at 3 months, 6 months, 1 year, and 2 years was approximately 86%, 78%, 66%, and 48%, respectively. Over 97% of patients were prescribed MOUD and 88% of all urine toxicology results were negative for non-prescribed opioids. Patients enrolled after initiation of wraparound services (HR 0.52, 95% CI 0.28-0.96) and those attending more shared medical appointments (HR 0.90, 95% CI 0.87-0.93) had a lower hazard of disengagement after controlling for other covariates. Loss to follow-up was the most common disengagement reason. CONCLUSIONS A low-threshold, comprehensive perinatal shared medical appointment program had high retention rates, increased access to evidence-based MOUD, and high rates of opioid-negative urine toxicology. Participants enrolled after wraparound services began had a lower hazard of disengagement. Future research in perinatal substance use should evaluate the most optimal and cost-effective components of comprehensive programs to inform standard of care.
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Prevalence of Adverse Childhood Experiences of Parenting Women in Drug Treatment for Opioid Use Disorder. Community Ment Health J 2021; 57:872-879. [PMID: 32556861 DOI: 10.1007/s10597-020-00661-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
Descriptive adverse childhood experience (ACE) prevalence data on parenting women seeking treatment for opioid use disorder (OUD) is limited, despite this group being one of the fastest growing sub-populations of the opioid epidemic. The aim of this study was to: (1) determine prevalence of ACEs) in a population of parenting women in treatment for OUD, (2) characterize ACEs, and (3) compare study ACE data to Pennsylvania Behavioral Risk Factor Surveillance System (PA BRFSS) to normalize study results. Between 2014 and 2018, ACEs were collected from parenting women (N = 152) enrolled in treatment for OUDs. Results showed on average women were 30.3 years of age (SD 4.6, range 22-41 years) non-Hispanic (87.0%), white (74.0%), and held a high school education or less (76.0%). The mean total ACE score was 4.3 (SD 2.3; range 0-8). Most women reported 4 ≥ ACEs (65.0%), while only 5.0% reported 0 ACEs. The current sample had higher mean ACE score (4.3 PSMDT vs. 1.4 PA BRFSS Data) than PA BRFSS Data. The burden of ACEs in parenting women in treatment for OUD is significant. Understanding the trauma parenting women in drug treatment have experienced, may support efforts to reduce stigma of this population. Public health intervention and policy work that is trauma proactive is needed to address this growing epidemic.
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Abstract
: Acknowledging the needs and challenges of women with opioid use disorder is an essential step to reduce the opioid epidemic in the United States. Efforts that can help women include increasing psychosocial services to address trauma, increasing access to medication treatment for opioid use disorder, reducing barriers and stigma that impede access to and retention on treatment, and addressing structural and policy barriers. This commentary discusses the reasons why women-focused treatment for opioid use disorder is necessary and makes specific recommendations for interventions, treatment, services, and policies that can reduce barriers to care and improve treatment and retention among women.
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Faherty LJ, Heins S, Kranz AM, Stein BD. Postpartum Treatment for Substance Use Disorder Among Mothers of Infants with Neonatal Abstinence Syndrome and Prenatal Substance Exposure. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2021; 2:163-172. [PMID: 34235503 PMCID: PMC8243701 DOI: 10.1089/whr.2020.0128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 11/12/2022]
Abstract
Background: Little is known about rates of substance use disorder (SUD) treatment for women in dyads affected by substance use in the immediate postpartum period. This study's objectives were to (1) identify characteristics of mothers of infants with neonatal abstinence syndrome (NAS) and/or prenatal substance exposure (PSE) who did or did not receive SUD treatment in the first 60 days postpartum and (2) describe timing of treatment receipt. Methods: This descriptive study examined linked mother-infant dyads using Medicaid data from Louisiana, Massachusetts, and Wisconsin for 2006-2009. Dyads were included if the infant had NAS and/or PSE. Descriptive statistics on sociodemographic characteristics, prenatal SUD, mental health conditions, Medicaid enrollment, and health care utilization were reported for women who did and did not receive SUD treatment in the first 60 days postpartum. The distribution of each variable was compared using chi-square tests. The timing of first postpartum treatment in weeks since delivery was examined. Results: Among Medicaid-insured women whose infants had in utero substance exposure, 15% received any postpartum SUD treatment. Fewer than half were diagnosed with SUD prenatally. Of those who received postpartum SUD treatment, 68% had received prenatal treatment. No association was observed between postpartum SUD treatment receipt and months of Medicaid enrollment in the year before delivery, prenatal visits, or postpartum visit attendance. Conclusions: Most women who likely need postpartum SUD treatment did not receive it and multipronged solutions are needed. These findings provide a useful baseline for evaluations of policies aimed at improving maternal health.
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Affiliation(s)
- Laura J. Faherty
- RAND Corporation, Boston, Massachusetts, USA
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Sara Heins
- RAND Corporation, Pittsburgh, Pennsylvania, USA
| | | | - Bradley D. Stein
- RAND Corporation, Pittsburgh, Pennsylvania, USA
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Rosenthal EW, Short VL, Cruz Y, Barber C, Baxter JK, Abatemarco DJ, Roman AR, Hand DJ. Racial inequity in methadone dose at delivery in pregnant women with opioid use disorder. J Subst Abuse Treat 2021; 131:108454. [PMID: 34098304 DOI: 10.1016/j.jsat.2021.108454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/17/2021] [Accepted: 04/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Medications for opioid use disorder, including methadone, combined with comprehensive wraparound services, are the gold standard for treatment in pregnancy. Higher methadone doses are associated with treatment retention in pregnancy and relapse prevention. Given known inequities where individuals of color tend to be prescribed lower doses of opioids for other conditions, the purpose of this study was to determine whether there is racial inequity in methadone dose at delivery in pregnant women with opioid use disorder. METHODS Retrospective review of medical charts identified pregnant women (N = 339) treated with methadone for opioid use disorder during pregnancy at one center from 2012 to 2017. Variables extracted from medical records included race, demographic and relevant clinical information (e.g., methadone dose at delivery, height, weight, etc.). Analyses used simple and multiple linear regressions to determine associations between these characteristics and methadone dose at delivery. RESULTS The mean methadone doses at delivery among women of color and white women were 105.8 mg and 144.9 mg, respectively (p < .0001). After adjusting for maternal age, gestational age at delivery, body mass index, type of opioid used, and parity, race was significantly and independently associated with methadone dose at delivery, with women of color receiving 36.2 mg less than white women (p = .0003). CONCLUSIONS Pregnant women of color with opioid use disorder received 67% of the dose of methadone at delivery that white women received. Antiracist responses to prevent provider bias in evaluating dose needs are needed to correct this inequity and prevent undertreatment of opioid use disorder among women of color.
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Affiliation(s)
- Emily W Rosenthal
- Department of Obstetrics & Gynecology, Boston Medical Center, 85 E. Concord St., Boston, MA 02118, United States of America.
| | - Vanessa L Short
- Department of Obstetrics & Gynecology, Thomas Jefferson University, 833 Chestnut St., Philadelphia, PA 19107, United States of America
| | - Yuri Cruz
- Department of Obstetrics & Gynecology, St. Luke's Hospital, 801 Ostrum St., Bethlehem, PA 18015, United States of America
| | - Cecily Barber
- Department of Obstetrics & Gynecology, Thomas Jefferson University, 833 Chestnut St., Philadelphia, PA 19107, United States of America
| | - Jason K Baxter
- Department of Obstetrics & Gynecology, Thomas Jefferson University, 833 Chestnut St., Philadelphia, PA 19107, United States of America
| | - Diane J Abatemarco
- Department of Obstetrics & Gynecology, Thomas Jefferson University, 833 Chestnut St., Philadelphia, PA 19107, United States of America
| | - Amanda R Roman
- Department of Obstetrics & Gynecology, Thomas Jefferson University, 833 Chestnut St., Philadelphia, PA 19107, United States of America
| | - Dennis J Hand
- Department of Obstetrics & Gynecology, Thomas Jefferson University, 833 Chestnut St., Philadelphia, PA 19107, United States of America; Department of Psychiatry & Human Behavior, Thomas Jefferson University, 1233 Locust St. Suite 401, Philadelphia, PA 19107, United States of America
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Burduli E, Jones HE, Brooks O, Barbosa-Leiker C, Johnson RK, Roll J, McPherson SM. Development and Implementation of a Mobile Tool for High-Risk Pregnant Women to Deliver Effective Caregiving for Neonatal Abstinence Syndrome: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e27382. [PMID: 33856360 PMCID: PMC8085745 DOI: 10.2196/27382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The United States continues to experience an alarming rise in opioid use that includes women who become pregnant and related neonatal abstinence syndrome (NAS) in newborns. Most newborns experiencing NAS require nonpharmacological care, which entails, most importantly, maternal involvement with the newborn. To facilitate positive maternal-newborn interactions, mothers need to learn effective caregiving NAS strategies when they are pregnant; however, an enormous gap exists in the early education of mothers on the symptoms and progression of NAS, partly because no education, training, or other interventions exist to prepare future mothers for the challenges of caring for their newborns at risk for NAS. OBJECTIVE In this paper, we describe a mixed methods, multistage study to adapt an existing mobile NAS tool for high-risk pregnant women and assess its usability, acceptability, and feasibility in a small randomized controlled trial. METHODS Stage 1 will include 20 semistructured interviews with a panel of neonatology experts, NAS care providers, and mothers with experience caring for NAS-affected newborns to gather their recommendations on the management of NAS and explore their perspectives on the care of these newborns. The findings will guide the adaptation of existing mobile NAS tools for high-risk pregnant women. In stage 2, we will test the usability, acceptability, and feasibility of the adapted mobile tool via surveys with 10 pregnant women receiving opioid agonist therapy (OAT). Finally, in stage 3, we will randomize 30 high-risk pregnant women receiving OAT to either receive the adapted mobile NAS caregiving tool or usual care. We will compare these women on primary outcomes-maternal drug relapse and OAT continuation-and secondary outcomes-maternal-newborn bonding; length of newborn hospital stays; readmission rates; breastfeeding initiation and duration; and postpartum depression and anxiety at 4, 8, and 12 weeks postpartum. RESULTS This project was funded in July 2020 and approved by the institutional review board in April 2020. Data collection for stage 1 began in December 2020, and as of January 2021, we completed 18 semistructured interviews (10 with NAS providers and 8 with perinatal women receiving OAT). Common themes from all interviews will be analyzed in spring 2021 to inform the adaptation of the NAS caregiving tool. The results from stage 1 are expected to be published in summer 2021. Stage 2 data collection will commence in fall 2021. CONCLUSIONS The findings of this study have the potential to improve NAS care and maternal-newborn outcomes and lead to commercialized product development. If effective, our new tool will be well suited to tailoring for other high-risk perinatal women with substance use disorders. TRIAL REGISTRATION ClinicalTrials.gov NCT04783558; https://clinicaltrials.gov/ct2/show/NCT04783558. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/27382.
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Affiliation(s)
- Ekaterina Burduli
- College of Nursing, Washington State University, Spokane, WA, United States
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, United States
| | - Hendrée E Jones
- UNC Horizons, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Olivia Brooks
- College of Nursing, Washington State University, Spokane, WA, United States
| | | | | | - John Roll
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Sterling Marshall McPherson
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, United States
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
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Titus-Glover D, Shaya FT, Welsh C, Qato DM, Shah S, Gresssler LE, Vivrette R. Opioid use disorder in pregnancy: leveraging provider perceptions to inform comprehensive treatment. BMC Health Serv Res 2021; 21:215. [PMID: 33691677 PMCID: PMC7945667 DOI: 10.1186/s12913-021-06182-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medications for opioid use disorder (MOUD) are recommended with adjuvant behavioral therapies, counseling, and other services for comprehensive treatment of maternal opioid use disorder. Inadequate access to treatment, lack of prescribing providers and complex delivery models are among known barriers to care. Multi-disciplinary provider input can be leveraged to comprehend factors that facilitate or inhibit treatment. The objective of this study is to explore provider perceptions of MOUD and factors critical to comprehensive treatment delivery to improve the care of pregnant women with opioid use disorder. METHODS A qualitative research approach was used to gather data from individual provider and group semi-structured interviews. Providers (n = 12) responded to questions in several domains related to perceptions of MOUD, treatment delivery, access to resources, and challenges/barriers. Data were collected, transcribed, coded (by consensus) and emerging themes were analyzed using grounded theory methodology. RESULTS Emerging themes revealed persistent gaps in treatment and challenges in provider, health systems and patient factors. Providers perceived MOUD to be a "lifeline" to women. CONCLUSIONS Inconsistencies in treatment provision, access and uptake can be improved by leveraging provider perceptions, direct experiences and recommendations for an integrated team-based, patient-centered approach to guide the care of pregnant women with opioid use disorder.
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Affiliation(s)
- Doris Titus-Glover
- Department of Pharmaceutical Health Services Research (PHSR), School of Pharmacy, University of Maryland, Baltimore, USA.
- Present address: School of Nursing, University of Maryland, Baltimore, Universities at Shady Grove, 9640 Gudelsky Drive, Rockville, MD, 20850, USA.
| | - Fadia T Shaya
- Department of Pharmaceutical Health Services Research (PHSR), School of Pharmacy, University of Maryland, Baltimore, USA
| | - Christopher Welsh
- Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, USA
| | - Danya M Qato
- Department of Pharmaceutical Health Services Research (PHSR), School of Pharmacy, University of Maryland, Baltimore, USA
| | - Savyasachi Shah
- Department of Pharmaceutical Health Services Research (PHSR), School of Pharmacy, University of Maryland, Baltimore, USA
| | - Laura E Gresssler
- Department of Pharmaceutical Health Services Research (PHSR), School of Pharmacy, University of Maryland, Baltimore, USA
| | - Rebecca Vivrette
- Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, USA
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Campbell J, Matoff-Stepp S, Velez ML, Cox HH, Laughon K. Pregnancy-Associated Deaths from Homicide, Suicide, and Drug Overdose: Review of Research and the Intersection with Intimate Partner Violence. J Womens Health (Larchmt) 2021; 30:236-244. [PMID: 33295844 PMCID: PMC8020563 DOI: 10.1089/jwh.2020.8875] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The leading causes of pregnancy-associated deaths, as defined by the Centers for Disease Control and Prevention, are homicide, suicide, and drug overdose. Intimate partner violence during pregnancy has been shown to contribute to maternal mortality from pregnancy-associated deaths. In this article, we discuss these leading causes of pregnancy-associated deaths. We review the prevalence, demographic characteristics, and possible factors leading to each cause of death, as well as evidence-based methods of identification, prevention, and intervention. The review also will include data showing racial and ethnic inequities. In addition, we identify gaps and guiding questions for further research, as well as suggestions for immediate changes in practice and policy.
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Affiliation(s)
| | - Sabrina Matoff-Stepp
- Office of Planning, Analysis, and Evaluation, Health Resources and Services Administration, Rockville, Maryland, USA
| | - Martha L. Velez
- Center for Addiction and Pregnancy, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Helen Hunter Cox
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kathryn Laughon
- Department of Family, Community & Mental Health Systems, University of Virginia School of Nursing, Charlottesville, Virginia, USA
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Peeler M, Gupta M, Melvin P, Bryant AS, Diop H, Iverson R, Callaghan K, Wachman EM, Singh R, Houghton M, Greenfield SF, Schiff DM. Racial and Ethnic Disparities in Maternal and Infant Outcomes Among Opioid-Exposed Mother-Infant Dyads in Massachusetts (2017-2019). Am J Public Health 2020; 110:1828-1836. [PMID: 33058701 PMCID: PMC7661985 DOI: 10.2105/ajph.2020.305888] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 11/04/2022]
Abstract
Objectives. To examine the extent to which differences in medication for opioid use disorder (MOUD) in pregnancy and infant neonatal opioid withdrawal syndrome (NOWS) outcomes are associated with maternal race/ethnicity.Methods. We performed a secondary analysis of a statewide quality improvement database of opioid-exposed deliveries from January 2017 to April 2019 from 24 hospitals in Massachusetts. We used multivariable mixed-effects logistic regression to model the association between maternal race/ethnicity (non-Hispanic White, non-Hispanic Black, or Hispanic) and prenatal receipt of MOUD, NOWS severity, early intervention referral, and biological parental custody at discharge.Results. Among 1710 deliveries to women with opioid use disorder, 89.3% (n = 1527) were non-Hispanic White. In adjusted models, non-Hispanic Black women (AOR = 0.34; 95% confidence interval [CI] = 0.18, 0.66) and Hispanic women (AOR = 0.43; 95% CI = 0.27, 0.68) were less likely to receive MOUD during pregnancy compared with non-Hispanic White women. We found no statistically significant associations between maternal race/ethnicity and infant outcomes.Conclusions. We identified significant racial/ethnic differences in MOUD prenatal receipt that persisted in adjusted models. Research should focus on the perspectives and treatment experiences of non-Hispanic Black and Hispanic women to ensure equitable care for all mother-infant dyads.
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Affiliation(s)
- Mary Peeler
- Mary Peeler is with the Johns Hopkins School of Medicine, Baltimore, MD. Munish Gupta and Mary Houghton are with the Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA. Patrice Melvin is with Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston. Allison S. Bryant is with the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston. Hafsatou Diop is with the Massachusetts Department of Public Health, Boston. Ronald Iverson is with the Department of Obstetrics and Gynecology, Boston Medical Center, Boston. Katherine Callaghan is with the Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worchester, MA. Elisha M. Wachman is with the Division of Neonatology, Department of Pediatrics, Boston Medical Center. Rachana Singh is with the Division of Newborn Medicine, Baystate Children's Hospital, Springfield, MA. Shelly F. Greenfield is with the Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA. Davida M. Schiff is with the Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston
| | - Munish Gupta
- Mary Peeler is with the Johns Hopkins School of Medicine, Baltimore, MD. Munish Gupta and Mary Houghton are with the Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA. Patrice Melvin is with Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston. Allison S. Bryant is with the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston. Hafsatou Diop is with the Massachusetts Department of Public Health, Boston. Ronald Iverson is with the Department of Obstetrics and Gynecology, Boston Medical Center, Boston. Katherine Callaghan is with the Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worchester, MA. Elisha M. Wachman is with the Division of Neonatology, Department of Pediatrics, Boston Medical Center. Rachana Singh is with the Division of Newborn Medicine, Baystate Children's Hospital, Springfield, MA. Shelly F. Greenfield is with the Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA. Davida M. Schiff is with the Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston
| | - Patrice Melvin
- Mary Peeler is with the Johns Hopkins School of Medicine, Baltimore, MD. Munish Gupta and Mary Houghton are with the Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA. Patrice Melvin is with Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston. Allison S. Bryant is with the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston. Hafsatou Diop is with the Massachusetts Department of Public Health, Boston. Ronald Iverson is with the Department of Obstetrics and Gynecology, Boston Medical Center, Boston. Katherine Callaghan is with the Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worchester, MA. Elisha M. Wachman is with the Division of Neonatology, Department of Pediatrics, Boston Medical Center. Rachana Singh is with the Division of Newborn Medicine, Baystate Children's Hospital, Springfield, MA. Shelly F. Greenfield is with the Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA. Davida M. Schiff is with the Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston
| | - Allison S Bryant
- Mary Peeler is with the Johns Hopkins School of Medicine, Baltimore, MD. Munish Gupta and Mary Houghton are with the Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA. Patrice Melvin is with Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston. Allison S. Bryant is with the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston. Hafsatou Diop is with the Massachusetts Department of Public Health, Boston. Ronald Iverson is with the Department of Obstetrics and Gynecology, Boston Medical Center, Boston. Katherine Callaghan is with the Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worchester, MA. Elisha M. Wachman is with the Division of Neonatology, Department of Pediatrics, Boston Medical Center. Rachana Singh is with the Division of Newborn Medicine, Baystate Children's Hospital, Springfield, MA. Shelly F. Greenfield is with the Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA. Davida M. Schiff is with the Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston
| | - Hafsatou Diop
- Mary Peeler is with the Johns Hopkins School of Medicine, Baltimore, MD. Munish Gupta and Mary Houghton are with the Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA. Patrice Melvin is with Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston. Allison S. Bryant is with the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston. Hafsatou Diop is with the Massachusetts Department of Public Health, Boston. Ronald Iverson is with the Department of Obstetrics and Gynecology, Boston Medical Center, Boston. Katherine Callaghan is with the Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worchester, MA. Elisha M. Wachman is with the Division of Neonatology, Department of Pediatrics, Boston Medical Center. Rachana Singh is with the Division of Newborn Medicine, Baystate Children's Hospital, Springfield, MA. Shelly F. Greenfield is with the Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA. Davida M. Schiff is with the Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston
| | - Ronald Iverson
- Mary Peeler is with the Johns Hopkins School of Medicine, Baltimore, MD. Munish Gupta and Mary Houghton are with the Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA. Patrice Melvin is with Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston. Allison S. Bryant is with the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston. Hafsatou Diop is with the Massachusetts Department of Public Health, Boston. Ronald Iverson is with the Department of Obstetrics and Gynecology, Boston Medical Center, Boston. Katherine Callaghan is with the Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worchester, MA. Elisha M. Wachman is with the Division of Neonatology, Department of Pediatrics, Boston Medical Center. Rachana Singh is with the Division of Newborn Medicine, Baystate Children's Hospital, Springfield, MA. Shelly F. Greenfield is with the Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA. Davida M. Schiff is with the Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston
| | - Katherine Callaghan
- Mary Peeler is with the Johns Hopkins School of Medicine, Baltimore, MD. Munish Gupta and Mary Houghton are with the Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA. Patrice Melvin is with Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston. Allison S. Bryant is with the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston. Hafsatou Diop is with the Massachusetts Department of Public Health, Boston. Ronald Iverson is with the Department of Obstetrics and Gynecology, Boston Medical Center, Boston. Katherine Callaghan is with the Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worchester, MA. Elisha M. Wachman is with the Division of Neonatology, Department of Pediatrics, Boston Medical Center. Rachana Singh is with the Division of Newborn Medicine, Baystate Children's Hospital, Springfield, MA. Shelly F. Greenfield is with the Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA. Davida M. Schiff is with the Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston
| | - Elisha M Wachman
- Mary Peeler is with the Johns Hopkins School of Medicine, Baltimore, MD. Munish Gupta and Mary Houghton are with the Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA. Patrice Melvin is with Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston. Allison S. Bryant is with the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston. Hafsatou Diop is with the Massachusetts Department of Public Health, Boston. Ronald Iverson is with the Department of Obstetrics and Gynecology, Boston Medical Center, Boston. Katherine Callaghan is with the Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worchester, MA. Elisha M. Wachman is with the Division of Neonatology, Department of Pediatrics, Boston Medical Center. Rachana Singh is with the Division of Newborn Medicine, Baystate Children's Hospital, Springfield, MA. Shelly F. Greenfield is with the Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA. Davida M. Schiff is with the Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston
| | - Rachana Singh
- Mary Peeler is with the Johns Hopkins School of Medicine, Baltimore, MD. Munish Gupta and Mary Houghton are with the Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA. Patrice Melvin is with Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston. Allison S. Bryant is with the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston. Hafsatou Diop is with the Massachusetts Department of Public Health, Boston. Ronald Iverson is with the Department of Obstetrics and Gynecology, Boston Medical Center, Boston. Katherine Callaghan is with the Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worchester, MA. Elisha M. Wachman is with the Division of Neonatology, Department of Pediatrics, Boston Medical Center. Rachana Singh is with the Division of Newborn Medicine, Baystate Children's Hospital, Springfield, MA. Shelly F. Greenfield is with the Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA. Davida M. Schiff is with the Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston
| | - Mary Houghton
- Mary Peeler is with the Johns Hopkins School of Medicine, Baltimore, MD. Munish Gupta and Mary Houghton are with the Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA. Patrice Melvin is with Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston. Allison S. Bryant is with the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston. Hafsatou Diop is with the Massachusetts Department of Public Health, Boston. Ronald Iverson is with the Department of Obstetrics and Gynecology, Boston Medical Center, Boston. Katherine Callaghan is with the Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worchester, MA. Elisha M. Wachman is with the Division of Neonatology, Department of Pediatrics, Boston Medical Center. Rachana Singh is with the Division of Newborn Medicine, Baystate Children's Hospital, Springfield, MA. Shelly F. Greenfield is with the Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA. Davida M. Schiff is with the Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston
| | - Shelly F Greenfield
- Mary Peeler is with the Johns Hopkins School of Medicine, Baltimore, MD. Munish Gupta and Mary Houghton are with the Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA. Patrice Melvin is with Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston. Allison S. Bryant is with the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston. Hafsatou Diop is with the Massachusetts Department of Public Health, Boston. Ronald Iverson is with the Department of Obstetrics and Gynecology, Boston Medical Center, Boston. Katherine Callaghan is with the Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worchester, MA. Elisha M. Wachman is with the Division of Neonatology, Department of Pediatrics, Boston Medical Center. Rachana Singh is with the Division of Newborn Medicine, Baystate Children's Hospital, Springfield, MA. Shelly F. Greenfield is with the Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA. Davida M. Schiff is with the Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston
| | - Davida M Schiff
- Mary Peeler is with the Johns Hopkins School of Medicine, Baltimore, MD. Munish Gupta and Mary Houghton are with the Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA. Patrice Melvin is with Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston. Allison S. Bryant is with the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston. Hafsatou Diop is with the Massachusetts Department of Public Health, Boston. Ronald Iverson is with the Department of Obstetrics and Gynecology, Boston Medical Center, Boston. Katherine Callaghan is with the Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worchester, MA. Elisha M. Wachman is with the Division of Neonatology, Department of Pediatrics, Boston Medical Center. Rachana Singh is with the Division of Newborn Medicine, Baystate Children's Hospital, Springfield, MA. Shelly F. Greenfield is with the Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA. Davida M. Schiff is with the Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston
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Tran EL, Kim SY, England LJ, Green C, Dang EP, Broussard CS, Fehrenbach N, Hudson A, Yowe-Conley T, Gilboa SM, Meaney-Delman D. The MATernaL and Infant NetworK to Understand Outcomes Associated with Treatment of Opioid Use Disorder During Pregnancy (MAT-LINK): Surveillance Opportunity. J Womens Health (Larchmt) 2020; 29:1491-1499. [PMID: 33227221 DOI: 10.1089/jwh.2020.8848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pregnant women with opioid use disorder (OUD) are at risk of overdose, infectious diseases, and inadequate prenatal care. Additional risks include adverse pregnancy and infant outcomes, such as preterm birth and neonatal abstinence syndrome. Management and treatment of OUD during pregnancy are associated with improved maternal and infant outcomes. Professional organizations, including the American College of Obstetricians and Gynecologists, recommend offering opioid agonist pharmacotherapy (i.e., methadone or buprenorphine) combined with behavioral therapy as standard treatment for pregnant women with OUD. Other medications and herbal supplements have also been used by pregnant women for OUD. Determining which OUD treatments optimize maternal and infant outcomes is challenging given the host of potential factors that affect these outcomes. The Centers for Disease Control and Prevention initiated the MATernaL and Infant NetworK to Understand Outcomes Associated with Treatment of Opioid Use Disorder during Pregnancy (MAT-LINK) to monitor more than 2000 mothers and their infants, using data collected from geographically diverse clinical sites. Information learned from MAT-LINK will inform the future management and treatment of pregnant women with OUD.
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Affiliation(s)
- Emmy L Tran
- Eagle Global Scientific LLC, San Antonio, Texas, USA.,Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shin Y Kim
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lucinda J England
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caitlin Green
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth P Dang
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cheryl S Broussard
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nicole Fehrenbach
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy Hudson
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tineka Yowe-Conley
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suzanne M Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dana Meaney-Delman
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Clark RRS. Updates from the Literature, November/December 2020. J Midwifery Womens Health 2020; 65:825-830. [PMID: 33169923 DOI: 10.1111/jmwh.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Rebecca R S Clark
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing and the Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
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Smid MC, Schauberger CW, Terplan M, Wright TE. Early lessons from maternal mortality review committees on drug-related deaths-time for obstetrical providers to take the lead in addressing addiction. Am J Obstet Gynecol MFM 2020; 2:100177. [PMID: 33345905 PMCID: PMC7753059 DOI: 10.1016/j.ajogmf.2020.100177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 12/17/2022]
Abstract
Problem: In the United States, maternal mortality review committees (MMRC) are providing compelling data that drug-related deaths are emerging as a leading cause of pregnancy-associated death (death during pregnancy or up to a year postpartum). Recommendations from the MMRC consistently highlight screening all pregnant and postpartum women for drug use and improving access to evidence-based substance use disorder and mental health treatment. Unfortunately, many providers lack the confidence, skills and necessary resources to screen for substance use, provide basic behavioral health services or facilitate referral to high-quality services in their clinical settings. Our profession’s collective lack of response to a leading cause of maternal death represents a missed opportunity for potentially life-saving interventions. A Solution: We call on our fellow obstetrician gynecologists to incorporate the lessons learned from MMRC and integrate addiction assessment and treatment into prenatal and postpartum care. Provider level integration of behavioral health services is, however, insufficient to fully address the magnitude of drug-related maternal deaths in the US. We, therefore, ask colleagues to address the structural/systemic barriers to care identified in MMRC. By doing so, we can prevent drug-related maternal deaths.
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Affiliation(s)
- Marcela C Smid
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and the Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT.
| | - Charles W Schauberger
- Department of Obstetrics and Gynecology and Behavioral Health, Gundersen Health System, La Crosse, WI
| | | | - Tricia E Wright
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
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Barriers to accessing opioid agonist therapy in pregnancy. Am J Obstet Gynecol MFM 2020; 2:100225. [PMID: 33345932 DOI: 10.1016/j.ajogmf.2020.100225] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND The incidence of opioid use disorder during pregnancy has risen dramatically in the last couple of decades. Despite the safety and efficacy of treatment for opioid use during pregnancy, pregnant women often cannot access treatment. OBJECTIVE This study aimed to determine the availability of opioid agonist therapy to pregnant women in Missouri and Illinois and to compare different markers of treatment accessibility between opioid treatment programs and buprenorphine providers and between rural and urban practices. STUDY DESIGN Buprenorphine providers and opioid treatment programs in Missouri and Illinois were identified using the Substance Abuse and Mental Health Services Administration website. A phone audit was conducted to evaluate barriers to care, including whether clinics accepted new patients, pregnant patients, and insurance, and the time to the first appointment and appointment cost. Rural-urban commuting area codes and practice ZIP codes were used to determine whether practice location was rural or urban. Provider specialty was determined from state licensing databases. RESULTS There were 1363 buprenorphine providers and 98 opioid treatment programs listed. Clinics were clustered around metropolitan areas, and only 13% of buprenorphine providers (183 of 1363) and 5% of opioid treatment programs (5 of 98) were in rural areas. Despite 3 contact attempts for each clinic, we were unable to reach 42% of buprenorphine providers (401 of 965) and 14% of opioid treatment programs (14 of 98). Of those reached, 40% of buprenorphine providers (223 of 564) and 80% of opioid treatment programs (67 of 84) were accepting new pregnant patients (P=.01). Buprenorphine providers required more contact attempts (>2 attempts in 34% vs 15%; P<.0001) and had longer wait times for the first appointment (>7 days in 27% vs 4%; P=.002) than opioid treatment programs. Buprenorphine providers in urban areas required more attempts to reach (>2 attempts in 36% vs 24%; P=.03) and were less likely to accept Medicaid than those in rural areas (52% vs 74%; P=.008). More than 23% of buprenorphine provider listings (238 of 1038) contained incorrect information, whereas no opioid treatment program listing had incorrect information. Most buprenorphine providers were in primary care or psychiatry, whereas <5% of buprenorphine providers (43 of 1363) were obstetrician-gynecologists. CONCLUSION This is the first phone audit to evaluate access to opioid agonist therapy for pregnant women. Only a minority of buprenorphine providers offered care for this patient population, and a large proportion required multiple contact attempts and wait times of >7 days. Opioid treatment programs were more responsive and accepting of new pregnant patients but comprised a minority of clinics and were predominately located in urban areas. There is an urgent need for improved reliability of contact information for opioid agonist providers, timely intake and acceptance for treatment of pregnant patients, and overall improved access to clinics that are challenged by geographic and insurance status barriers.
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Antenatal Admissions Among Women with Opioid-Affected and Non-Opioid-Affected Deliveries. Matern Child Health J 2020; 24:1179-1188. [PMID: 32557132 DOI: 10.1007/s10995-020-02959-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES (1) To compare the prevalence of antenatal admissions and mean length of stay among women with opioid-affected and non-opioid-affected deliveries; (2) examine predictors of admission; and (3) describe the most common discharge diagnoses in each group. METHODS Using data from seven states in the State Inpatient Databases for varying years between 2009 and 2014, delivery hospitalizations among women 18 years of age and older were identified and classified as opioid-affected or non-opioid-affected. Antenatal admissions were linked to deliveries. The antenatal admission ratio and mean length of stay for each group were calculated; the percentage of deliveries in each group with no, any, one, two, or three or more antenatal admissions were compared with t-tests. Logistic regression models estimated odds of any antenatal admission, stratified by opioid-affected and non-opioid-affected deliveries. Frequencies were tabulated for the ten most common discharge diagnoses in each group. RESULTS Of 2,684,970 deliveries, 14,765 were opioid-affected. Admissions among women with opioid-affected deliveries were more prevalent (26.4 per 100 deliveries) compared to 6.7 among women with non-opioid-affected deliveries and were associated with a 1.5-day longer mean length of stay. The presence of a behavioral health condition was associated with higher odds of antenatal admission in both groups, with a particularly strong association among women with opioid-affected deliveries. Six of the ten most common diagnoses for admissions prior to opioid-affected deliveries were behavioral health-related. CONCLUSIONS FOR PRACTICE These results highlight the importance of addressing the large burden of behavioral health conditions among pregnant women, especially those with opioid dependence and abuse.
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Patrick SW, Richards MR, Dupont WD, McNeer E, Buntin MB, Martin PR, Davis MM, Davis CS, Hartmann KE, Leech AA, Lovell KS, Stein BD, Cooper WO. Association of Pregnancy and Insurance Status With Treatment Access for Opioid Use Disorder. JAMA Netw Open 2020; 3:e2013456. [PMID: 32797175 PMCID: PMC7428808 DOI: 10.1001/jamanetworkopen.2020.13456] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Medications for opioid use disorder, including buprenorphine hydrochloride and methadone hydrochloride, are highly effective at improving outcomes for individuals with the disorder. For pregnant women, use of these medications also improves pregnancy outcomes, including the risk of preterm birth. Despite the known benefits of medications for opioid use disorder, many pregnant and nonpregnant women with the disorder are not receiving them. OBJECTIVE To determine whether pregnancy and insurance status are associated with a woman's ability to obtain an appointment with an opioid use disorder treatment clinician. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study with random assignment of clinicians and simulated-patient callers (performed in "secret shopper" format), outpatient clinics that provide buprenorphine and methadone were randomly selected from publicly available treatment lists in 10 US states (selected for variability in opioid-related outcomes and policies) from March 7 to September 5, 2019. Pregnant vs nonpregnant woman and private vs public insurance assigned randomly to callers to create unique patient profiles. Simulated patients called the clinics posing as pregnant or nonpregnant women to obtain an initial appointment with a clinician. MAIN OUTCOMES AND MEASURES Appointment scheduling, wait time, and out-of-pocket costs. RESULTS A total of 10 871 unique patient profiles were assigned to 6324 clinicians. Among all women, 2312 of 3420 (67.6%) received an appointment with a clinician who prescribed buprenorphine, with lower rates among pregnant vs nonpregnant callers (1055 of 1718 [61.4%] vs 1257 of 1702 [73.9%]; relative risk, 0.83; 95% CI, 0.79-0.87). For clinicians who prescribed methadone, there was no difference in appointment access for pregnant vs nonpregnant callers (240 of 271 [88.6%] vs 237 of 265 [89.4%]; relative risk, 0.99; 95% CI, 0.93-1.05). Insurance was frequently not accepted, with 894 of 3420 buprenorphine-waivered prescribers (26.1%) and 174 of 536 opioid treatment programs (32.5%) granting appointments only when patients agreed to pay cash. Median wait times did not differ between pregnant and nonpregnant callers among buprenorphine prescribers (3 days [interquartile range, 1-7 days] vs 3 days [interquartile range, 1-7 days]; P = .43) but did differ among methadone prescribers (1 day [interquartile range, 1-4 days] vs 2 days [interquartile range, 1-6 days]; P = .049). For patients agreeing to pay cash, the median out-of-pocket costs for initial appointments were $250 (interquartile range, $155-$300) at buprenorphine prescribers and $34 (interquartile range, $15-$120) at methadone prescribers. CONCLUSIONS AND RELEVANCE In this cross-sectional study with random assignment of clinicians and simulated-patient callers, many women, especially pregnant women, faced barriers to accessing treatment. Given the high out-of-pocket costs and lack of acceptance of insurance among many clinicians, access to affordable opioid use disorder treatment is a significant concern.
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Affiliation(s)
- Stephen W. Patrick
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - William D. Dupont
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth McNeer
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melinda B. Buntin
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter R. Martin
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew M. Davis
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Katherine E. Hartmann
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ashley A. Leech
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kim S. Lovell
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bradley D. Stein
- RAND Corporation, Pittsburgh, Pennsylvania
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - William O. Cooper
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
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48
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Schiff DM, Nielsen T, Hoeppner BB, Terplan M, Hansen H, Bernson D, Diop H, Bharel M, Krans EE, Selk S, Kelly JF, Wilens TE, Taveras EM. Assessment of Racial and Ethnic Disparities in the Use of Medication to Treat Opioid Use Disorder Among Pregnant Women in Massachusetts. JAMA Netw Open 2020; 3:e205734. [PMID: 32453384 PMCID: PMC7251447 DOI: 10.1001/jamanetworkopen.2020.5734] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/28/2020] [Indexed: 12/11/2022] Open
Abstract
Importance Racial and ethnic disparities persist across key health and substance use treatment outcomes for mothers and infants. The use of medications, such as methadone or buprenorphine, for the treatment of opioid use disorder (OUD) has been associated with improvements in the outcomes of mothers and infants; however, only half of all pregnant women with OUD receive these medications. The extent to which maternal race or ethnicity is associated with the use of medication to treat OUD, the duration of the use of medication to treat OUD, and the type of medication used to treat OUD during pregnancy are unknown. Objective To examine the extent to which maternal race and ethnicity is associated with the use of medications for the treatment of OUD in the year before delivery among pregnant women with OUD. Design, Setting, and Participants This retrospective cohort study used a linked population-level statewide data set of pregnant women with OUD who delivered a live infant in Massachusetts between October 1, 2011, and December 31, 2015. Of 274 234 total deliveries identified, 5247 deliveries among women with indicators of having OUD were included in the analysis. Maternal race and ethnicity were defined as white non-Hispanic, black non-Hispanic, or Hispanic based on self-reported data on birth certificates. Main Outcomes and Measures Main outcomes were the receipt of any medication for OUD, the consistency of the use of medication (at least 6 continuous months of use before delivery, inconsistent use, or no use) for the treatment of OUD, and the type of medication (methadone or buprenorphine) used to treat OUD. Multivariable models were adjusted for maternal sociodemographic characteristics, comorbidities, and any significant interactions between the covariates and race and ethnicity. Results The sample included 5247 pregnant women with OUD who delivered a live infant in Massachusetts during the study period. The mean (SD) maternal age at delivery was 28.7 (5.0) years; 4551 women (86.7%) were white non-Hispanic, 462 women (8.8%) were Hispanic, and 234 women (4.5%) were black non-Hispanic. A total of 3181 white non-Hispanic women (69.9%) received any type of medication for the treatment of OUD in the year before delivery compared with 228 Hispanic women (49.4%) and 108 black non-Hispanic women (46.2%). Compared with white non-Hispanic women, black non-Hispanic and Hispanic women had a substantially lower likelihood (adjusted odds ratio [aOR], 0.37; 95% CI, 0.28-0.49 and aOR, 0.42; 95% CI, 0.35-0.52, respectively) of receiving any medication for the treatment of OUD. Stratification by maternal age identified greater disparities among younger women. Black non-Hispanic and Hispanic women also had a lower likelihood (aOR, 0.24; 95% CI, 0.17-0.35 and aOR, 0.34; 95% CI, 0.27-0.44, respectively) of consistent use of medication for the treatment of OUD compared with white non-Hispanic women. With respect to the type of medication used to treat OUD, black non-Hispanic and Hispanic women had a lower likelihood (aOR, 0.60; 95% CI, 0.40-0.90 and aOR, 0.77; 95% CI, 0.58-1.01, respectively) than white non-Hispanic women of receiving buprenorphine treatment compared with methadone treatment. Conclusions and Relevance This study found racial and ethnic disparities in the use of medications to treat OUD during pregnancy, with black non-Hispanic and Hispanic women significantly less likely to use medications consistently or at all compared with white non-Hispanic women. Further investigation of patient, clinician, treatment program, and system-level factors associated with these findings is warranted.
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Affiliation(s)
- Davida M. Schiff
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Timothy Nielsen
- Child Population and Translational Health Research, University of Sydney, Randwick, New South Wales, Australia
| | | | | | - Helena Hansen
- Department of Psychiatry, New York University, New York, New York
| | - Dana Bernson
- Massachusetts Department of Public Health, Boston
| | | | | | - Elizabeth E. Krans
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Women’s Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sabrina Selk
- Massachusetts Department of Public Health, Boston
| | - John F. Kelly
- Department of Psychiatry, New York University, New York, New York
| | - Timothy E. Wilens
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
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49
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Winkelman TNA, Ford BR, Shlafer RJ, McWilliams A, Admon LK, Patrick SW. Medications for opioid use disorder among pregnant women referred by criminal justice agencies before and after Medicaid expansion: A retrospective study of admissions to treatment centers in the United States. PLoS Med 2020; 17:e1003119. [PMID: 32421717 PMCID: PMC7233523 DOI: 10.1371/journal.pmed.1003119] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/22/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Criminal justice involvement is common among pregnant women with opioid use disorder (OUD). Medications for OUD improve pregnancy-related outcomes, but trends in treatment data among justice-involved pregnant women are limited. We sought to examine trends in medications for OUD among pregnant women referred to treatment by criminal justice agencies and other sources before and after the Affordable Care Act's Medicaid expansion. METHODS AND FINDINGS We conducted a serial, cross-sectional analysis using 1992-2017 data from pregnant women admitted to treatment facilities for OUD using a national survey of substance use treatment facilities in the United States (N = 131,838). We used multiple logistic regression and difference-in-differences methods to assess trends in medications for OUD by referral source. Women in the sample were predominantly aged 18-29 (63.3%), white non-Hispanic, high school graduates, and not employed. Over the study period, 26.3% (95% CI 25.7-27.0) of pregnant women referred by criminal justice agencies received medications for OUD, which was significantly less than those with individual referrals (adjusted rate ratio [ARR] 0.45, 95% CI 0.43-0.46; P < 0.001) or those referred from other sources (ARR 0.51, 95% CI 0.50-0.53; P < 0.001). Among pregnant women referred by criminal justice agencies, receipt of medications for OUD increased significantly more in states that expanded Medicaid (n = 32) compared with nonexpansion states (n = 18) (adjusted difference-in-differences: 12.0 percentage points, 95% CI 1.0-23.0; P = 0.03). Limitations of this study include encounters that are at treatment centers only and that do not encompass buprenorphine prescribed in ambulatory care settings, prisons, or jails. CONCLUSIONS Pregnant women with OUD referred by criminal justice agencies received evidence-based treatment at lower rates than women referred through other sources. Improving access to medications for OUD for pregnant women referred by criminal justice agencies could provide public health benefits to mothers, infants, and communities. Medicaid expansion is a potential mechanism for expanding access to evidence-based treatment for pregnant women in the US.
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Affiliation(s)
- Tyler N. A. Winkelman
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, United States of America
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Becky R. Ford
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States of America
| | - Rebecca J. Shlafer
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Anna McWilliams
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States of America
| | - Lindsay K. Admon
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Stephen W. Patrick
- Vanderbilt Center for Child Health Policy, Departments of Pediatrics and Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
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50
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Yang JC, Roman-Urrestarazu A, Brayne C. Responses among substance abuse treatment providers to the opioid epidemic in the USA: Variations in buprenorphine and methadone treatment by geography, operational, and payment characteristics, 2007-16. PLoS One 2020; 15:e0229787. [PMID: 32126120 PMCID: PMC7053738 DOI: 10.1371/journal.pone.0229787] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 02/14/2020] [Indexed: 01/04/2023] Open
Abstract
Objective To identify the geographic, organisational, and payment correlates of buprenorphine and methadone treatment among substance abuse treatment (SAT) providers. Methods Secondary analyses of the National Survey of Substance Abuse Treatment Services (NSSATS) from 2007–16 were conducted. We provide bivariate descriptive statistics regarding substance abuse treatment services which offered buprenorphine and methadone treatment from 2007–16. Using multiple logistic regression, we regressed geographic, organisational, and payment correlates on buprenorphine and methadone treatment. Results Buprenorphine is increasingly offered at SAT facilities though uptake remains comparatively low outside of the northeast. SAT facilities run by tribal governments or Indian Health Service which offer buprenorphine remain low compared to privately operated SAT facilities (AOR = 0.528). The odds of offering buprenorphine among facilities offering free or no charge treatment (AOR = 0.838) or a sliding fee scale (AOR = 0.464) was lower. SAT facilities accepting Medicaid payments showed higher odds of offering methadone treatment (AOR = 2.035). Conclusions Greater attention towards the disparities in provision of opioid agonist therapies is warranted, especially towards the reasons why uptake has been moderate among civilian providers. Additionally, the care needs of Native Americans facing opioid-related use disorders bears further scrutiny.
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Affiliation(s)
- Justin C. Yang
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
- Department of Epidemiology and Applied Clinical Research, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
- * E-mail:
| | | | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
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