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Dudley J, Gabrielson SMB, O'Connor AB, Ahrens KA. Trends in maternal opioid use disorder and neonatal abstinence syndrome in Maine, 2016-2022. J Perinatol 2024; 44:1104-1110. [PMID: 38267636 DOI: 10.1038/s41372-024-01882-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/21/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To estimate trends in maternal opioid use disorder (OUD) and neonatal abstinence syndrome (NAS) in Maine using the most recent data available. STUDY DESIGN We used hospital discharge data to estimate the annual prevalence of maternal OUD and NAS between 2016 and 2022. In addition, we used birth certificate-linked Medicaid data to estimate related trends among Medicaid enrollees. RESULT From 2016 to 2022, the prevalence of maternal OUD decreased from 35.3 to 18.8 per 1000 deliveries and the prevalence of NAS decreased from 33.2 to 14.0 per 1000 newborns (linear trend p values <0.01). Decreasing trends were also found among Medicaid enrollees. CONCLUSION In Maine between 2016 and 2022, there was a decrease in maternal OUD and NAS diagnoses recorded in administrative datasets. These findings should be interpreted with caution due to changes in how OUD and NAS diagnoses are recorded and COVID-related changes in healthcare utilization.
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Affiliation(s)
- Julia Dudley
- Muskie School of Public Service, University of Southern Maine, Portland, ME, USA.
| | - Sarah M B Gabrielson
- Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, USA
| | - Alane B O'Connor
- Perinatal Addiction Medicine, Maine Medical Center, Portland, ME, USA
| | - Katherine A Ahrens
- Muskie School of Public Service, University of Southern Maine, Portland, ME, USA.
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Frankeberger J, Coulter RWS, Jarlenski M, Krans EE, Mair C. Co-occurring conditions during pregnancy and hospitalizations in the first year postpartum among persons with opioid use disorder. Prev Med 2024; 185:108057. [PMID: 38942123 PMCID: PMC11421478 DOI: 10.1016/j.ypmed.2024.108057] [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: 03/12/2024] [Revised: 05/15/2024] [Accepted: 06/25/2024] [Indexed: 06/30/2024]
Abstract
INTRODUCTION Pregnant persons with opioid use disorder (OUD) face a multitude of comorbid conditions that may increase the risk of adverse drug and health outcomes. This study characterizes typologies of comorbidities among pregnant persons with OUD and assesses the associations of these typologies with hospitalizations in the first year postpartum. METHODS A cohort of pregnant persons with OUD at delivery in 2018 were identified in a Pennsylvania statewide hospital dataset (n = 2055). Latent class analysis assessed 12 comorbid conditions including substance use disorders (SUDs), mental health conditions, and infections. Multivariable logistic regressions examined the association between comorbidity classes and hospitalizations (all-cause, OUD-specific, SUD-related, mental health-related) during early (0-42 days) and late (43-365 days) postpartum. RESULTS A three-class model best fit the data. Classes included low comorbidities (56.9% of sample; low prevalence of co-occurring conditions), moderate polysubstance/depression (18.4%; some SUDs, all with depression), and high polysubstance/bipolar disorder (24.7%; highest probabilities of SUDs and bipolar disorder). Overall, 14% had at least one postpartum hospitalization. From 0 to 42 days postpartum, the moderate polysubstance/depression and high polysubstance/bipolar disorder classes had higher odds of all-cause and mental health-related hospitalization, compared to the low comorbidities class. From 43 to 365 days postpartum, the high polysubstance/bipolar disorder class had higher odds of all-cause hospitalizations, while both the high polysubstance/depression and moderate polysubstance/bipolar disorder classes had higher odds of SUD-related and mental health-related hospitalizations compared to the low comorbidities class. CONCLUSIONS Findings highlight the need for long-term, multidisciplinary healthcare delivery interventions to address comorbidities and prevent adverse postpartum outcomes.
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Affiliation(s)
- Jessica Frankeberger
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA; Department of Pediatrics, University of California San Diego, San Diego, CA, USA.
| | - Robert W S Coulter
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Marian Jarlenski
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Elizabeth E Krans
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
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Elmore AL, Boghossian NS, McLain AC, McDermott S, Salemi JL. Trends in maternal opioid use: Statewide differences by sociodemographic characteristics in Florida from 2000 to 2019. J Addict Dis 2024:1-11. [PMID: 38369773 PMCID: PMC11330537 DOI: 10.1080/10550887.2024.2302285] [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] [Indexed: 02/20/2024]
Abstract
BACKGROUND Maternal opioid use (MOU) remains a public health concern. Studies have demonstrated significant increases in MOU, but estimates using ICD-10-CM or stratified by sociodemographic variables are limited. OBJECTIVES Using a statewide, population-based dataset of Florida resident deliveries from 2000 to 2019, we examined the trend of MOU by age, race/ethnicity, education level, and insurance. METHODS Florida administrative data was used to conduct a retrospective cohort study. MOU was identified using opioid-related hospital discharge diagnoses documented prenatally or at delivery. Maternal sociodemographic variables were obtained from Florida vital statistics. Joinpoint regression was used to identify statistically significant changes in the trends overall and stratified by sociodemographic variables. Results are presented as annual percentage changes (APC) and 95% confidence intervals. RESULTS Our sample included over 3.6 million Florida resident mothers; of which, MOU was identified in 1% (n = 22,828) of the sample. From 2000 to 2019, MOU increased over ten-fold from 8.7 to 94.7 per 10,000 live birth deliveries. MOU increased significantly from 2000 to 2011 (APC: 32.8; 95% CI: 29.4, 36.2), remained stable from 2011 to 2016, and decreased significantly from 2016 to 2019 (APC: 3.9; 95% CI: -6.6, -1.0). However, from 2016 to 2019, MOU increased among non-Hispanic Black mothers (APC: 9.2; 95% CI: 7.5, 11.0), and those ages 30-34 (APC: 2.9; 95% CI: 1.2, 4.6) and 35-39 (APC: 6.4; 95% CI: 4.3, 8.4). CONCLUSIONS Accurate prevalence estimates of MOU by sociodemographic factors are necessary to fully understand prevalence trends, describe the burden among sub-populations, and develop targeted interventions.
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Affiliation(s)
- Amanda L. Elmore
- University of South Florida, College of Public Health, 13201 Bruce B. Downs Blvd, MDC56, Tampa, FL 33612-3805
- University of South Carolina, Department of Biostatistics and Epidemiology, 915 Greene St, Columbia, SC 29208
| | - Nansi S. Boghossian
- University of South Carolina, Department of Biostatistics and Epidemiology, 915 Greene St, Columbia, SC 29208
| | - Alexander C. McLain
- University of South Carolina, Department of Biostatistics and Epidemiology, 915 Greene St, Columbia, SC 29208
| | - Suzanne McDermott
- University of South Carolina, Department of Biostatistics and Epidemiology, 915 Greene St, Columbia, SC 29208
- City University of New York’s Graduate School of Public Health and Health Policy, 55 W 125 St, New York, NY 10027
| | - Jason L. Salemi
- University of South Florida, College of Public Health, 13201 Bruce B. Downs Blvd, MDC56, Tampa, FL 33612-3805
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Malhotra T, Sheyn D, Arora KS. Opioid use disorder at delivery hospitalization in the United States: 2012-2016. Am J Addict 2023; 32:442-449. [PMID: 36959714 PMCID: PMC10517065 DOI: 10.1111/ajad.13417] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/19/2023] [Accepted: 03/22/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The objective of this paper is to evaluate national trends, socioeconomic risk factors, and maternal and obstetric outcomes for patients with and without opioid use disorder (OUD) at delivery hospitalization. METHODS This is a retrospective cohort using the National Inpatient Sample 2012-2016 of 3,554,477 deliveries to analyze trends in OUD in patients at delivery hospitalization. We conducted univariable and multivariable logistic regression to compare clinical, demographic, hospital, and geographic associations for patients with OUD during delivery hospitalization. RESULTS The incidence of OUD at delivery hospitalization increased from 4.48 per 1000 deliveries in 2012 to 7.67 in 2016. The highest rate of OUD was in the Northeast and the lowest in the West (9.29 vs. 4.13 per 1000, respectively, p < .001). After adjusting for confounders, history of concurrent cocaine use (adjusted odds ratio [aOR] = 5.95, 95% confidence interval [CI]: 5.38-6.59), sedative use (aOR = 17.28, 95% CI: 14.71-20.31), and amphetamine use (aOR = 4.05, 95% CI: 3.71-4.43), were strongly associated with OUD. Additionally, hepatitis C infection, (aOR = 21.98, 95% CI: 20.89-23.11), white race (aOR = 3.12, 95% CI: 3.00-3.24), and public insurance (aOR = 3.92, 95% CI: 3.77-4.08) were also associated with OUD. DISCUSSION AND CONCLUSION The continued increase in rates of OUD at delivery hospitalization and its association with adverse perinatal outcomes highlights the need for universal screening and resource allocation for programs directed toward pregnant people. SCIENTIFIC SIGNIFICANCE Our study builds upon the prior literature that reports trends in OUD at delivery hospitalization from 1998 to 2011 as well as presents a more in-depth look at risk factors and adverse pregnancy outcomes than previously reported.
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Affiliation(s)
- Tani Malhotra
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center Cleveland, Ohio
| | - David Sheyn
- Urology Institute, Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC
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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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Pfeiffer M, Gelsinger C, Palmsten K, Lipkind HS, Ackerman-Banks C, Ahrens KA. Rural-urban residence and sequelae of hypertensive disorders of pregnancy in the first year postpartum, 2007 - 2019. Pregnancy Hypertens 2023; 32:10-17. [PMID: 36822069 PMCID: PMC10219842 DOI: 10.1016/j.preghy.2023.02.002] [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] [Received: 06/02/2022] [Revised: 01/21/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES To estimate the association between rural residence and sequelae of hypertensive disorders of pregnancy (HDP) in the first year postpartum. STUDY DESIGN We used the Maine Health Data Organization's All Payer Claims Data to identify women with HDP who delivered during 2007-2019 and did not have chronic hypertension or pre-pregnancy cardiac conditions (n = 8882). We used Cox proportional hazards modeling to estimate rural-urban hazard ratios (HR) and 95% confidence intervals (CI), adjusting for HDP subtype, age, insurance, nulliparity, and co-morbidities. Results were stratified by HDP subtype and timing of acute care visits. MAIN OUTCOME MEASURES Risk of at least one emergency room or inpatient visit related to hypertension or cardiovascular conditions in the first year postpartum and receipt of outpatient antihypertensive medications from 4 days to 1 year postpartum, separately. RESULTS Overall, risk of at least one acute care visit in the first year postpartum was not different between rural vs urban women (4.2% vs 4.2%; adjusted HR 0.98; 95% CI 0.79,1.21), and outpatient receipt of antihypertensive medication was not different (12.9% vs 12.8%; adjusted HR 0.99; 95% CI 0.87, 1.12). However, stratified analyses suggested some differences (e.g. preeclampsia with severe features: acute care visit adjusted HR 1.54; 95% CI 0.95, 2.49). CONCLUSIONS Rural and urban women do not differ in the risks of these common HDP sequelae, though rural women may have increased risk by HDP subtype or timing of acute care visit. Future research should investigate postpartum interventions for reducing HDP sequelae in rural and urban women.
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Affiliation(s)
- Mariah Pfeiffer
- Muskie School of Public Service, University of Southern Maine, Portland, ME, United States
| | - Catherine Gelsinger
- Muskie School of Public Service, University of Southern Maine, Portland, ME, United States
| | - Kristin Palmsten
- Pregnancy and Child Health Research Center, HealthPartners Institute, Minneapolis, MN, United States
| | - Heather S Lipkind
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, United States
| | | | - Katherine A Ahrens
- Muskie School of Public Service, University of Southern Maine, Portland, ME, United States.
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Gelsinger C, Palmsten K, Lipkind HS, Pfeiffer M, Ackerman-Banks C, Hutcheon JA, Ahrens KA. Provision of Postpartum Contraception Before and After the Start of the COVID-19 Pandemic in Maine. Public Health Rep 2023:333549231170198. [PMID: 37129355 DOI: 10.1177/00333549231170198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
OBJECTIVE Preliminary findings from selected health systems revealed interruptions in reproductive health care services due to the COVID-19 pandemic. We estimated changes in postpartum contraceptive provision associated with the start of the COVID-19 pandemic in Maine. METHODS We used the Maine Health Data Organization's All Payer Claims Database for deliveries from October 2015 through March 2021 (n = 45 916). Using an interrupted time-series analysis design, we estimated changes in provision rates of long-acting reversible contraception (LARC), permanent contraception, and moderately effective contraception within 3 and 60 days of delivery after the start of the COVID-19 pandemic. We performed 6- and 12-month analyses (April 2020-September 2020, April 2020-March 2021) as compared with the reference period (October 2015-March 2020). We used Poisson regression models to calculate level-change rate ratios (RRs) and 95% CIs. RESULTS The 6-month analysis found that provision of LARC (RR = 1.89; 95% CI, 1.76-2.02) and moderately effective contraception (RR = 1.51; 95% CI, 1.33-1.72) within 3 days of delivery increased at the start of the COVID-19 pandemic, while provision of LARC (RR = 0.95; 95% CI, 0.93-0.97) and moderately effective contraception (RR = 1.08; 95% CI, 1.05-1.11) within 60 days of delivery was stable. Rates of provision of permanent contraception within 3 days (RR = 0.70; 95% CI, 0.63-0.78) and 60 days (RR = 0.71; 95% CI, 0.63-0.80) decreased. RRs from the 12-month analysis were generally attenuated. CONCLUSION Disruptions in postpartum provision of permanent contraception occurred at the beginning of the COVID-19 pandemic in Maine. Public health policies should include guidance for contraceptive provision during public health emergencies and consider designating permanent contraception as a nonelective procedure.
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Affiliation(s)
- Catherine Gelsinger
- Muskie School of Public Service, University of Southern Maine, Portland, ME, USA
| | - Kristin Palmsten
- Pregnancy and Child Health Research Center, HealthPartners Institute, Minneapolis, MN, USA
| | - Heather S Lipkind
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Mariah Pfeiffer
- Muskie School of Public Service, University of Southern Maine, Portland, ME, USA
| | | | - Jennifer A Hutcheon
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, BC, Canada
| | - Katherine A Ahrens
- Muskie School of Public Service, University of Southern Maine, Portland, ME, USA
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Elmore AL, Patrick SW, McNeer E, Fryer K, Reid CN, Sappenfield WM, Mehra S, Salemi JL, Marshall J. Treatment access for opioid use disorder among women with medicaid in Florida. Drug Alcohol Depend 2023; 246:109854. [PMID: 37001322 PMCID: PMC10121896 DOI: 10.1016/j.drugalcdep.2023.109854] [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: 11/21/2022] [Revised: 03/15/2023] [Accepted: 03/19/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION Opioid use disorder (OUD) remains prevalent. Medications for OUD (MOUD) are standard care for pregnant and non-pregnant women. Previous research has identified barriers to MOUD for women with Medicaid but did not account for the type of MOUD (methadone vs. buprenorphine) or pregnancy status. We examined access to MOUD by treatment type for pregnant and non-pregnant women with Medicaid in Florida. METHODS A secondary analysis of Florida "secret-shopper" data was conducted. Calls were made to clinicians from the 2018 Substance Abuse and Mental Health Services Administration provider list by women posing as either a pregnant or non-pregnant woman with OUD and Medicaid. We examined 546 calls to buprenorphine-waivered providers (BWP) and 139 to opioid treatment programs (OTP). Counts and percentages were used to describe caller success by type of treatment and pregnancy status. Chi-square tests were used to identify statistical differences. RESULTS Only 42 % of calls reached a treatment provider in Florida. Pregnant and non-pregnant women were less likely to obtain an appointment with Medicaid coverage by a BWP than an OTP (p < 0.01). Nearly 40 % of OTPs offered appointments to callers with Medicaid compared to only 17 % of BWPs. Both types of providers denied appointments more often for pregnant women. Thirty-eight percent of BWP's and 12 % of OTP's denied appointments to pregnant women using cash or Medicaid payment. CONCLUSIONS Our study demonstrates logistical and financial barriers to treatment for OUD among pregnant and non-pregnant women with Medicaid in Florida and highlights the need for improved systems of care.
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Affiliation(s)
- Amanda L Elmore
- College of Public Health, University of South Florida, Tampa, FL, United States.
| | - Stephen W Patrick
- Vanderbilt Center for Child Health Policy & Departments of Pediatrics and Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Elizabeth McNeer
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kimberly Fryer
- Department of Obstetrics & Gynecology, University of South Florida, Tampa, FL, United States
| | - Chinyere N Reid
- College of Public Health, University of South Florida, Tampa, FL, United States
| | | | - Saloni Mehra
- College of Public Health, University of South Florida, Tampa, FL, United States
| | - Jason L Salemi
- College of Public Health, University of South Florida, Tampa, FL, United States
| | - Jennifer Marshall
- College of Public Health, University of South Florida, Tampa, FL, United States
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Disparities in opioid use disorder-related hospital use among postpartum Virginia Medicaid members. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 145:208935. [PMID: 36880911 DOI: 10.1016/j.josat.2022.208935] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/09/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The overdose crisis is increasingly revealing disparities in opioid use disorder (OUD) outcomes by race and ethnicity. Virginia, like other states, has witnessed drastic increases in overdose deaths. However, research has not described how the overdose crisis has impacted pregnant and postpartum Virginians. We report the prevalence of OUD-related hospital use during the first year postpartum among Virginia Medicaid members in the years preceding the COVID-19 pandemic. We secondarily assess how prenatal OUD treatment is associated with postpartum OUD-related hospital use. METHODS This population-level retrospective cohort study used Virginia Medicaid claims data for live infant deliveries between July 2016 and June 2019. The primary outcome of OUD-related hospital use included overdose events, emergency department visits, and acute inpatient stays. Independent variables of interest were prenatal receipt of medication for OUD (MOUD) and receipt of non-MOUD treatment components in line with a comprehensive care approach (e.g., case management, behavioral health). Both descriptive and multivariate analyses were performed for all deliveries and stratified by White and Black non-Hispanic individuals to bring attention to the devastating impacts of the overdose crisis within communities of color. RESULTS The study sample included 96,649 deliveries. Over a third were by Black birthing individuals (n = 34,283). Prenatally, 2.5 % had evidence of OUD, which occurred more often among White (4 %) than Black (0.8 %) non-Hispanic birthing individuals. Postpartum OUD-related hospital use occurred in 10.7 % of deliveries with OUD, more commonly after deliveries by Black, non-Hispanic birthing individuals with OUD (16.5 %) than their White, non-Hispanic counterparts (9.7 %), and this disparity persisted in the multivariable analysis (Black AOR 1.64, 95 % CI 1.14-2.36). Postpartum OUD-related hospital events were less frequent for individuals receiving versus not receiving postpartum MOUD within 30 days prior to the event. Prenatal OUD treatment, including MOUD, was not associated with decreased odds of postpartum OUD-related hospital use in the race-stratified models. CONCLUSION Postpartum individuals with OUD are at high risk for mortality and morbidity, especially Black individuals not receiving MOUD after delivery. An urgent need remains to effectively address the systemic and structural drivers of racial disparities in transitions of OUD care through the one-year postpartum period.
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Bright V, Riddle J, Kerver J. Stigma Experienced by Rural Pregnant Women with Substance Use Disorder: A Scoping Review and Qualitative Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192215065. [PMID: 36429782 PMCID: PMC9690597 DOI: 10.3390/ijerph192215065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 06/13/2023]
Abstract
Identification and recognition of experiences of rural pregnant women with substance use disorder is needed to inform public policy and medical training. This paper reviews and qualitatively synthesizes literature exploring the experiences of this population. Embase, PubMed, and Web of Science were used to identify literature through August 2022 using the search terms, such as pregnancy, substance use or abuse, stigma, and rural. Cited and citing research were also considered. Exclusion criteria included articles that failed to consider rural pregnant women's perspectives on stigma experienced, included potential confounds, occurred outside of the United States or Canada, and were published before January 2000. Nine articles met the inclusion criteria. Data were synthesized by the listed authors and assessed for common themes. A review of the articles revealed three common themes: stigma occurs in community settings, stigma occurs in healthcare settings, and comprehensive care is important to ensure appropriate support to this population. Stigma as a barrier seems to improve when women have strong social support and access to comprehensive care networks. Addressing this stigma through programs, such as peer social guidance and comprehensive health centers, may provide appropriate support to pregnant, rural women with SUD to further navigate their health needs.
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Affiliation(s)
- Victoria Bright
- Division of Public Health, College of Human Medicine, Michigan State University, Traverse City, MI 49684, USA
| | - Julia Riddle
- Department of Family Medicine, Michigan State University, Traverse City, MI 49684, USA
| | - Jean Kerver
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, Traverse City, MI 49684, USA
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Hepatitis C Virus Cascade of Care Among Perinatal Patients in Maine Diagnosed With Opioid Use Disorder, 2015-2020. J Addict Med 2022:01271255-990000000-00108. [PMID: 36598484 DOI: 10.1097/adm.0000000000001098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This is a quality improvement project to determine the best process to identify and address gaps in care for perinatal patients in receiving appropriate hepatitis C virus (HCV) testing and treatment across the largest health system in Maine. STUDY DESIGN We reviewed electronic medical record data between October 1, 2015, and February 1, 2020, to investigate rates of HCV testing and treatment among 916 perinatal patients with opioid use disorder across 8 hospitals using a "cascade of care" framework, a model used previously to identify gaps in care and treatment of chronic diseases. MAIN OUTCOME MEASURE We examined HCV testing and treatment rates along the cascade of care and patient characteristics associated with HCV antibody testing and treatment, separately, using log binomial regression models. Models were adjusted for age, residential distance to medical center, psychiatric diagnosis, and opioid agonist therapy at delivery. RESULTS Of pregnant patients eligible for screening, 64% (582/916) received HCV antibody testing. Of 136 patients with active HCV infection, 32% (n = 43) received a referral for treatment, 21% (n = 28) were treated, and 13% (n = 18) achieved sustained virologic response. In the adjusted regression models, only opioid agonist therapy was associated with HCV antibody testing (adjusted risk ratio, 1.31; 95% confidence interval, 1.18-1.46), and no factors were significantly associated with receipt of treatment among HCV viremic patients. CONCLUSION Low referral and treatment rates signify the need for quality improvement interventions to improve coordination of care between multiple disciplines and practice settings to increase access to HCV treatment.
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Ahrens KA, McBride CA, O’Connor A, Meyer MC. Medication for Addiction Treatment and Postpartum Health Care Utilization Among Pregnant Persons With Opioid Use Disorder. J Addict Med 2022; 16:56-64. [PMID: 33675606 PMCID: PMC8417138 DOI: 10.1097/adm.0000000000000827] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To estimate treatment and postpartum health care utilization among pregnant persons with opioid use disorder (OUD) in Vermont and Maine. METHODS Vermont's and Maine's All Payer Claims Databases were used to identify deliveries 2010 to 2018 that were paid for, in part, by Medicaid. OUD was identified among pregnant persons if they had any claim with an OUD-diagnosis code (ICD-9/10) or medication for addiction treatment (MAT) code during the 5 months before delivery event. Consistent and inconsistent MAT were compared to no MAT on the rate of hospitalizations and emergency department (ED) visits in the first 12 months' postpartum using negative binomial regression. RESULTS From 2010 through 2018, 27,652 deliveries in Vermont and 43,480 deliveries in Maine were among persons insured by Medicaid. The prevalence of OUD among pregnant persons increased from 6.7% to 11.6% in Vermont and from 7.4% to 11.0% in Maine. Among pregnant persons with OUD in 2018, 57% had consistent MAT in Vermont and 50% had consistent MAT in Maine; approximately 32% and 27% were not in treatment in Vermont and Maine, respectively. In Maine, consistent MAT was associated with a 47% lower rate of hospitalization and 37% to 46% lower rates of ED visits when compared to those without MAT; in Vermont, those with consistent buprenorphine treatment had a 30% lower rate of ED visits. CONCLUSIONS Medicaid data from Vermont and Maine suggests that medication for addiction treatment for opioid use disorder during pregnancy reduces emergency health care utilization in the first year postpartum.
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Affiliation(s)
- Katherine A. Ahrens
- Muskie School of Public Service, University of Southern Maine, Portland, ME
- Maine Rural Health Research Center, University of Southern Maine, Portland, ME
| | - Carole A. McBride
- Department of Obstetrics and Gynecology, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Alane O’Connor
- Clinical Lead, Maine Maternal Opioid Misuse (MaineMOM) Initiative and MaineHealth MaineMOM, Portland, ME. Perinatal IMAT Director Maine Medical Center, Portland, ME
| | - Marjorie C. Meyer
- Department of Obstetrics and Gynecology, Larner College of Medicine, University of Vermont, Burlington, VT
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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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Elmore AL, Omofuma OO, Sevoyan M, Richard C, Liu J. Prescription opioid use among women of reproductive age in the United States: NHANES, 2003-2018. Prev Med 2021; 153:106846. [PMID: 34653502 PMCID: PMC8595805 DOI: 10.1016/j.ypmed.2021.106846] [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: 02/05/2021] [Revised: 10/04/2021] [Accepted: 10/10/2021] [Indexed: 11/24/2022]
Abstract
Women are prescribed opioids more often than men. Prescription opioid use among women of reproductive age is a public health concern because opioid use during pregnancy is associated with decreased prenatal care and increased risk of adverse perinatal and maternal outcomes. Recent prevalence estimates and correlates of prescription opioid use and long-term use among women of reproductive age are limited. Using the 2003-2018 National Health and Nutrition Examination Survey (NHANES), we estimated the national prevalence, trend, and correlates of prescription opioid use, long-term use (≥ 90 days of use), and use of medications for opioid use disorder (MOUD) among women aged 15-44 (n = 13,558). Prescription opioid use within the last 30 days and prescription duration were collected through interviews and identified using prescription codes. Trend analysis was conducted using the National Cancer Institute Joinpoint Trend Analysis Software. The prevalence of prescription opioid use significantly decreased from 5.2% in 2003-2004 to 3.0% in 2017-2018 (p < .05). MOUD use increased significantly from 0.1% in 2005-2006 to 0.4% in 2011-2012. Long-term opioid use did not significantly change over time. Correlates of prescription opioid use and long-term use included ages 35-44, non-Hispanic White, public insurance, and women with poor or fair health status. As policy makers and clinicians strive to reduce the negative impacts of the opioid epidemic, they should consider the demographic groups most likely to use prescription opioids long-term. Additionally, reductions in opioid prescribing should be balanced with increased availability of nonopioid therapies and monitoring for opioid use disorder.
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Affiliation(s)
- Amanda L Elmore
- University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, Columbia, SC, United States.
| | - Omonefe O Omofuma
- University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, Columbia, SC, United States
| | - Maria Sevoyan
- University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, Columbia, SC, United States
| | - Chelsea Richard
- University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, Columbia, SC, United States
| | - Jihong Liu
- University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, Columbia, SC, United States
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Martin CE, Parlier-Ahmad AB. Addiction treatment in the postpartum period: an opportunity for evidence-based personalized medicine. Int Rev Psychiatry 2021; 33:579-590. [PMID: 34238101 PMCID: PMC8490333 DOI: 10.1080/09540261.2021.1898349] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Substance use disorders (SUD) are becoming rapidly more prevalent in women and a leading cause of pregnancy associated deaths, with most deaths occurring during the 12 months after pregnancy. The postpartum period can be quite intense, especially for women seeking addiction recovery. There is a call to reconceptualize the obstetrical postpartum care model into one that extends specialised care and is tailored to an individual's specific needs. Although SUD treatment improves maternal and infant outcomes as well as decreases overdose risk, many women do not receive consistent SUD treatment during the postpartum period. Thus, SUD treatments should consider following the same guidance as obstetrics to reconceptualize how SUD treatment is delivered postpartum. Clinically, this translates into substantially modifying traditional siloed SUD treatment structures to meet the unique needs of this vulnerable patient population. At the same time, more research is urgently needed to inform these advancements in clinical care to ensure they are evidence-based and effective. In this article, we review the existing evidence as well as highlight opportunities for both clinicians and researchers to advance the integration of tailored approaches for postpartum women into personalised SUD medical and behavioural treatments.
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Affiliation(s)
- Caitlin E. Martin
- Department of Obstetrics and Gynecology, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
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Ahrens KA, Rossen LM, Burgess AR, Palmsten KK, Ziller EC. Rural-Urban Residence and Maternal Hepatitis C Infection, U.S.: 2010-2018. Am J Prev Med 2021; 60:820-830. [PMID: 33640230 PMCID: PMC8154677 DOI: 10.1016/j.amepre.2020.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The prevalence of hepatitis C virus infection among women delivering live births in the U.S. may be higher in rural areas where county-level estimates may be unreliable. The aim of this study is to model county-level maternal hepatitis C virus infection among deliveries in the U.S. METHODS In 2020, U.S. natality files (2010-2018) with county-level maternal residence information were used from states that had adopted the 2003 revised U.S. birth certificate, which included a field for hepatitis C virus infection present during pregnancy. Hierarchical Bayesian spatial models with spatiotemporal random effects were applied to produce stable annual county-level estimates of maternal hepatitis C virus infection for years when all states had adopted the revised birth certificate (2016-2018). Models included a 6-Level Urban-Rural County Classification Scheme along with the birth year and county-specific covariates to improve posterior predictions. RESULTS Among approximately 32 million live births, the overall prevalence of maternal hepatitis C virus infection was 3.5 per 1,000 births (increased from 2.0 in 2010 to 5.0 in 2018). During 2016-2018, posterior predicted median county-level maternal hepatitis C virus infection rates showed that nonurban counties had 3.5-3.8 times higher rates of hepatitis C virus than large central metropolitan counties. The counties in the top 10th percentile for maternal hepatitis C virus rates in 2018 were generally located in Appalachia, in Northern New England, along the northern border in the Upper Midwest, and in New Mexico. CONCLUSIONS Further implementation of community-level interventions that are effective in reducing maternal hepatitis C virus infection and its subsequent morbidity may help to reduce geographic and rural disparities.
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Affiliation(s)
- Katherine A Ahrens
- Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, Maine.
| | - Lauren M Rossen
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Amanda R Burgess
- Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, Maine
| | | | - Erika C Ziller
- Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, Maine
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Thompson TA, Ahrens KA, Coplon L. Virtually possible: using telehealth to bring reproductive health care to women with opioid use disorder in rural Maine. Mhealth 2020; 6:41. [PMID: 33437837 PMCID: PMC7793013 DOI: 10.21037/mhealth-19-237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/15/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Maternal opioid use disorder (OUD) has increased more sharply in recent years among rural residents in the United States than among urban residents. In 2018, the prevalence of maternal OUD accounted for 3.5% of all hospital deliveries in Maine. Opioid use during pregnancy is associated with negative health effects for both the woman and infant. While many women with OUD use contraception, few report using a highly reliable method. METHODS A family planning clinic in Maine piloted a program to increase reproductive health access for women with OUD through the use of telehealth. In this model, a community outreach educator travelled to a community organization that serves this population to provide reproductive health information and an opportunity to connect with a nurse practitioner via telehealth to receive the following reproductive health services: HIV counseling and testing, contraception, or pregnancy testing and counseling. We assessed the feasibility of this program through the following outcome measures: number of women who engaged with the community outreach educator, number of women who used telehealth services, and number of women who received services at a referred clinic during the six-month pilot. RESULTS During the pilot program, the community outreach educator held eighteen educational sessions and engaged fifty-one women; providing condoms and/or answers to various reproductive health questions. Fifteen women used telehealth services. The majority used the service to receive testing for sexually transmitted infections (STI) such as HIV. Four women used telehealth for contraceptive services and received either birth control or the Depo-Provera injectable on-site. A third of the women received more than one reproductive health service via telehealth. Of the women who were referred to a family planning clinic for additional services, only 2 attended their appointment. No challenges with hearing or seeing the practitioner through the video platform were recorded. CONCLUSIONS Improving women's access to effective contraceptive methods and preventive reproductive health services is critical to ensuring women with OUD are able to seek effective treatment and to ensure the health of future pregnancies. Findings from this pilot program suggest that innovative health care models such as on-site provision of reproductive health care through telehealth have the potential to increase access to reproductive care for this hard-to-reach population.
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Affiliation(s)
| | - Katherine A. Ahrens
- University of Southern Maine, Muskie School of Public Service, Portland, ME, USA
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