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Tasket AL, Black MR, Brewer TL, Young ML. Educating Nurses to Improve Awareness and Use of a Human Milk Feeding Care Pathway for Opioid-Exposed Neonates. Nurs Womens Health 2024; 28:339-348. [PMID: 39153739 DOI: 10.1016/j.nwh.2024.04.004] [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: 02/06/2024] [Revised: 04/03/2024] [Accepted: 07/22/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE To increase nurses' awareness and use of a human milk feeding (HMF) and opioid use disorder (OUD) standardized care pathway to improve rates of HMF at discharge in opioid-exposed neonates (OENs). DESIGN Quality improvement project. SETTING/LOCAL PROBLEM Underutilizing an HMF and OUD standardized care pathway in an academic medical center led to declining HMF rates at discharge. PARTICIPANTS Staff nurses in the women and infants department (N = 311). INTERVENTION/MEASUREMENTS Nurses completed an asynchronous online educational module regarding awareness and use of the HMF and OUD standardized care pathway for supporting HMF in OENs. Monthly infographics were placed in each nursing unit to reinforce content. Nurses completed pre- and posteducation surveys to evaluate their knowledge and use of the pathway. After the education, rates of OENs receiving human milk at discharge were collected from the electronic health record. RESULTS A total of 240 (77.2%) nurses participated in the educational module; awareness of the pathway increased from 91.5% to 97.3%. HMF rate at discharge significantly increased from 29.8% to 59.4% (p = .03). CONCLUSION Improved awareness among nurses of a standardized HMF and OUD care pathway was associated with a doubling of HMF rates at discharge in OENs.
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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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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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Jilani SM, Davis JM, Goldstein D, Grossman M, Jansson LM, Terplan M, Jones HE. Clinically defining the opioid-exposed birthing person and infant as a dyad to support bedside care, surveillance, and research. Front Pediatr 2024; 12:1349102. [PMID: 38774300 PMCID: PMC11106404 DOI: 10.3389/fped.2024.1349102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/19/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction An increased incidence of maternal opioid use disorder (OUD) and neonatal abstinence syndrome (NAS) has prompted recommendations supporting a dyadic approach to care for birthing persons and their infants. However, there are no consensus guidelines outlining how the dyad is clinically defined. Methods To examine how the opioid-exposed birthing person-infant dyad has been defined for purposes of data collection and research, a literature review applying the RAND/UCLA Appropriateness Method was conducted. Results The search yielded 320 abstracts, with 110 articles identified as having a dyadic focus. While no articles included a specific definition for the dyad, 33 (30%) contained a descriptive reference to the birthing person-infant dyad. Thematic analysis revealed eight recurring elements characteristic of the dyad: (1) engagement, (2) communication, (3) bonding, (4) attachment, (5) mutual responsiveness, (6) reciprocity, (7) synchrony, and (8) attunement. Integrating these elements revealed the interactional relationship between the opioid-exposed birthing person and infant as the foundational principle that defines the dyad. Discussion This definition shifts the focus of the opioid-exposed dyad from two individual patient populations to an interactional relationship that has broad applicability for clinical use, public health data collection, and research considerations.
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Affiliation(s)
- Shahla M. Jilani
- Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Washington, DC, United States
| | - Jonathan M. Davis
- Division of Newborn Medicine, Tufts Medical Center, Boston, MA, United States
- The Tufts Clinical and Translational Science Institute, Boston, MA, United States
| | - David Goldstein
- Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Washington, DC, United States
| | - Matthew Grossman
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
| | - Lauren M. Jansson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Center for Addiction and Pregnancy, Baltimore, MD, United States
| | - Mishka Terplan
- Friends Research Institute, Baltimore, MD, United States
| | - Hendrée E. Jones
- Department of Obstetrics and Gynecology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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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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Bedrick BS, Cary C, O'Donnell C, Marx C, Friedman H, Carter EB, Raghuraman N, Stout MJ, Ku BS, Xu KY, Kelly JC. County-level neonatal opioid withdrawal syndrome rates and real-world access to buprenorphine during pregnancy: An audit ("secret shopper") study in Missouri. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 10:100218. [PMID: 38380272 PMCID: PMC10877162 DOI: 10.1016/j.dadr.2024.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/22/2024]
Abstract
Background Amid rising rates of neonatal opioid withdrawal syndrome (NOWS) worldwide and in many regions of the USA, we conducted an audit study ("secret shopper study") to evaluate the influence of county-level buprenorphine capacity and rurality on county-level NOWS rates. Methods In 2019, up to three phone calls were made to buprenorphine prescribers in the state of Missouri (USA). County-level buprenorphine capacity was defined as the number of clinicians (across all specialties) accepting pregnant people divided by the number of births. Multivariable negative binomial regression models estimated associations between buprenorphine capacity, rurality, and county-level NOWS rates, controlling for potential confounders (i.e., poverty, unemployment, and physician shortages) that may correspond to higher rates of NOWS and lower rates of buprenorphine prescribing. Analyses were stratified using tertiles of county-level overdose rates (top, middle, and lowest 1/3 of overdose rates). Results Of 115 Missouri counties, 81(70 %) had no buprenorphine capacity, 17(15 %) were low-capacity (<0.5-clinicians/1,000 births), and 17(15 %) were high-capacity (≥0.5/1,000 births). The mean NOWS rate was 6.5/1,000 births. In Missouri counties with both the highest and lowest opioid overdose rates, higher buprenorphine capacity did not correspond to decreases in NOWS rates (incidence rate ratio[IRR]=1.23[95 %-confidence-interval[CI]=0.65-2.32] and IRR=1.57[1.21-2.03] respectively). Rurality did not correspond to greater NOWS burden in both Missouri counties with highest and lowest opioid overdose rates. Conclusions The vast majority of counties in Missouri have no capacity for buprenorphine prescribing during pregnancy. Rurality and lower buprenorphine capacity did not significantly predict elevated rates of NOWS.
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Affiliation(s)
- Bronwyn S. Bedrick
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Caroline Cary
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
| | - Carly O'Donnell
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Christine Marx
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Hayley Friedman
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Ebony B. Carter
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Nandini Raghuraman
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
| | - Molly J. Stout
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI
| | - Benson S. Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Kevin Y Xu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Jeannie C. Kelly
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
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Scheidell JD, Pitre M, Andraka-Christou B. Racial and ethnic inequities in substance use treatment among women with opioid use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:106-116. [PMID: 38295349 DOI: 10.1080/00952990.2023.2291748] [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: 07/20/2023] [Accepted: 12/02/2023] [Indexed: 02/02/2024]
Abstract
Background: Research describes inequities in substance use treatment, but few studies focus specifically on racial and ethnic disparities in a range of aspects of substance use treatment among women with opioid use disorder (OUD).Objective: To examine whether substance use treatment (i.e. receipt, sources, barriers) differs by race and ethnicity among women with opioid use disorder (OUD) and to identify factors associated with treatment gap (i.e. needing treatment but not receiving it).Methods: We performed cross-sectional analyses using National Survey on Drug Use and Health 2015-2019 data, restricted to non-Hispanic Black, non-Hispanic White, and Hispanic women with past-year OUD (unweighted n = 1089). We estimated the prevalence of aspects of treatment among racial and ethnic groups, and used modified Poisson regression to estimate correlates of reported treatment gap.Results: Approximately 68% of White versus 87% of Black and 81% of Hispanic women with OUD had a treatment gap (p-value 0.0034). Commonly reported barriers to treatment included prioritization, affordability, and stigma. Older age was associated with lower prevalence of treatment gap among all women [prevalence ratio (PR) = 0.83, and 95% confidence interval (CI): 0.76, 0.92], while criminal legal involvement and healthcare coverage was associated with a lower prevalence of treatment gap among Hispanic and White women only (past year arrest: Hispanic women PR = 0.38, 95% CI: 0.17, 0.86; White women PR = 0.62, 95% CI: 0.47, 0.82).Conclusions: Receipt of treatment is low among women with OUD, especially Black and Hispanic women. Intersectional intervention approaches are needed to increase access and reduce inequities.
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Affiliation(s)
- Joy D Scheidell
- Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, United States
| | - Maya Pitre
- Department of Social Work, College of Health Professions and Sciences, University of Central Florida, Orlando, United States
| | - Barbara Andraka-Christou
- School of Global Health Management and Informatics, College of Community Innovation and Education, University of Central Florida, Orlando, United States
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Ellick KL, Kroelinger CD, Chang K, McGown M, McReynolds M, Velonis AJ, Bronson E, Riehle-Colarusso T, Pliska E, Akbarali S, Mueller T, Dronamraju R, Cox S, Barfield WD. Increasing access to quality care for pregnant and postpartum people with opioid use disorder: Coordination of services, provider awareness and training, extended postpartum coverage, and perinatal quality collaboratives. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 156:209208. [PMID: 37939904 PMCID: PMC10711679 DOI: 10.1016/j.josat.2023.209208] [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: 02/17/2023] [Revised: 08/02/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Fifteen states participating in the Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community (OMNI LC) developed action plan goals and activities to address the rise in opioid use disorder (OUD) among birthing persons. In a separate initiative, Perinatal Quality Collaboratives (PQCs) from 12 states participating in Centers for Disease Control and Prevention (CDC)-supported activities hosted trainings to improve the provision of OUD services and implement protocols for screening and treatment in delivery facilities. METHODS This descriptive study synthesizes qualitative data extracted from 15 OMNI LC state action plans, excerpts from qualitative interviews conducted with OMNI LC state teams, and quantitative data from quarterly project performance monitoring reports from 12 CDC-funded PQCs implementing quality improvement activities to address clinical service gaps for pregnant and postpartum people with OUD. Qualitative data were deidentified, coded as barriers or facilitators, then aggregated into emergent themes. Count data are presented for quantitative results. RESULTS The OMNI LC states identified a lack of coordinated care among providers, stigma toward people with OUD, discontinued insurance coverage, and inconsistencies in screening and treating birthing people with OUD as barriers to accessing quality care. State-identified facilitators for access to quality care included: 1) improving engagement and communication between providers and other partners to integrate medical and behavioral health services post-discharge, and facilitate improved patient care postpartum; 2) training providers to prescribe medications for OUD, and to address bias and reduce patient stigma; 3) extending Medicaid coverage up to one year postpartum to increase access to and continuity of services; and 4) implementing screening, brief intervention, and referral to treatment (SBIRT) in clinical practice. PQCs demonstrated that increased provider trainings to treat OUD, improvements in implementation of standardized protocols, and use of evidence-based tools can facilitate access to and coordination of services in delivery facilities. CONCLUSION State-identified facilitators for increasing access to care include coordinating integrated services, extending postpartum coverage, and provider trainings to improve screening and treatment. PQCs provide a platform for identifying emerging areas for quality improvement initiatives and implementing clinical best practices to provide comprehensive, quality perinatal care for birthing populations.
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Affiliation(s)
- Kecia L Ellick
- CDC Foundation (CDCF), 600 Peachtree St. NE #1000, Atlanta, GA 30308, United States of America
| | - Charlan D Kroelinger
- Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, MS S107-2, Atlanta, GA 30341, United States of America.
| | - Karen Chang
- Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, MS S107-2, Atlanta, GA 30341, United States of America
| | - Molly McGown
- University of Illinois Chicago (UIC), School of Public Health, 1603 W. Taylor St., Chicago, IL 60612, United States of America; Access Community Health Network, 600 W. Fulton St., Chicago, IL 60661, United States of America
| | - Matthew McReynolds
- University of Illinois Chicago (UIC), School of Public Health, 1603 W. Taylor St., Chicago, IL 60612, United States of America
| | - Alisa J Velonis
- University of Illinois Chicago (UIC), School of Public Health, 1603 W. Taylor St., Chicago, IL 60612, United States of America
| | - Emily Bronson
- CDC Foundation (CDCF), 600 Peachtree St. NE #1000, Atlanta, GA 30308, United States of America
| | - Tiffany Riehle-Colarusso
- Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, MS S107-2, Atlanta, GA 30341, United States of America
| | - Ellen Pliska
- Association of State and Territorial Health Officials (ASTHO), 2231 Crystal Dr. Ste. 450, Arlington, VA 22202, United States of America
| | - Sanaa Akbarali
- Association of State and Territorial Health Officials (ASTHO), 2231 Crystal Dr. Ste. 450, Arlington, VA 22202, United States of America
| | - Trish Mueller
- Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, MS S107-2, Atlanta, GA 30341, United States of America
| | - Ramya Dronamraju
- Association of State and Territorial Health Officials (ASTHO), 2231 Crystal Dr. Ste. 450, Arlington, VA 22202, United States of America
| | - Shanna Cox
- Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, MS S107-2, Atlanta, GA 30341, United States of America
| | - Wanda D Barfield
- Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, MS S107-2, Atlanta, GA 30341, United States of America
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Carroll JJ, Ostrach B, El-Sabawi T. Health Inequities Among People Who Use Drugs in a Post- Dobbs America: The Case for a Syndemic Analysis. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2023; 51:549-553. [PMID: 38088631 PMCID: PMC11262022 DOI: 10.1017/jme.2023.96] [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] [Indexed: 12/18/2023]
Abstract
Punitive policy responses to substance use and to abortion care constitute direct attacks on personal liberty and bodily autonomy. In this article, we leverage the concept of "syndemics" to anticipate how the already synergistic stigmas against people who use drugs and people who seek abortion services will be further compounded the Dobbs decision.
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Poland CA, Shadur JM, Cinader M, Felton JW. Co-Locating Obstetrics and Addiction Medicine Clinics to Improve Attendance in Services for Pregnant People with Opioid Use Disorder. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2023; 6:36-41. [PMID: 38854870 PMCID: PMC11154810 DOI: 10.1176/appi.prcp.20230033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 06/11/2024] Open
Abstract
Objective Pregnant people receiving treatment for opioid use disorders (OUD) are at significant risk of return to use during the postpartum period. Recently, practice groups and other national organizations have called for the co-location of addiction medicine and obstetric care to reduce the burden on pregnant and postpartum people with OUD associated with engaging in treatment. This paper examines the effectiveness of co-locating services in retaining pregnant people with OUD in care following childbirth. Methods A records review of pregnant people receiving medication for OUD between 2012 and 2017 in stand-alone addiction medicine clinic (n = 23) and from 2017 to 2021 following the creation of an integrated addiction medicine-obstetric care clinic (n = 67) was conducted to compared rates of attendance in both obstetric and addiction medicine services. Results Findings from this study suggest that individuals receiving services in a co-located clinic had significantly fewer missed appointments during the postpartum period relative to individuals who sought care at separate addiction medicine and obstetric care clinics. Conclusions Results from this study support the potential for co-locating clinics to reduce barriers to accessing obstetric and addiction medicine services, as well as support continued attendance in care across a vulnerable period.
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Affiliation(s)
- Cara A. Poland
- Department of Obstetrics, Gynecology and Reproductive HealthMichigan State UniversityEast LansingMichiganUSA
| | - Julia M. Shadur
- School of Integrative Studies and Human Development and Family ScienceGeorge Mason UniversityFairfaxVirginiaUSA
| | - Morgan Cinader
- Department of PsychiatryMichigan State UniversityEast LansingMichiganUSA
| | - Julia W. Felton
- Center for Health Policy & Health Services ResearchHenry Ford HealthDetroitMichiganUSA
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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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Turner S, Allen VM, Carson G, Graves L, Tanguay R, Green CR, Cook JL. Guideline No. 443b: Opioid Use Throughout Women's Lifespan: Opioid Use in Pregnancy and Breastfeeding. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102144. [PMID: 37977721 DOI: 10.1016/j.jogc.2023.05.012] [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: 11/19/2023]
Abstract
OBJECTIVE To provide health care providers the best evidence on opioid use and women's health. Areas of focus include pregnancy and postpartum care. TARGET POPULATION The target population includes all women currently using or contemplating using opioids. OUTCOMES Open, evidence-informed dialogue about opioid use will improve patient care. BENEFITS, HARMS, AND COSTS Exploring opioid use through a trauma-informed approach provides the health care provider and patient with an opportunity to build a strong, collaborative, and therapeutic alliance. This alliance empowers women to make informed choices about their own care. It also allows for the diagnosis and possible treatment of opioid use disorders. Opioid use should not be stigmatized, as stigma leads to poor "partnered care" (i.e., the partnership between the patient and care provider). Health care providers need to understand the effect opioids can have on pregnant women and support them to make knowledgeable decisions about their health. EVIDENCE A literature search was designed and carried out in PubMed and the Cochrane Library databases from August 2018 until March 2023 using following MeSH terms and keywords (and variants): opioids, opioid agonist therapy, illicit drugs, fertility, pregnancy, fetal development, neonatal abstinence syndrome, and breastfeeding. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE All health care providers who care for pregnant and/or post-partum women and their newborns. TWEETABLE ABSTRACT Opioid use during pregnancy often co-occurs with mental health issues and is associated with adverse maternal, fetal, and neonatal outcomes; treatment of opioid use disorder with agonist therapy for pregnant women can be safe during pregnancy where the risks outnumber the benefits. SUMMARY STATEMENTS RECOMMENDATIONS.
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Turner S, Allen VM, Carson G, Graves L, Tanguay R, Green CR, Cook JL. Directive clinique n o 443b : Opioïdes aux différentes étapes de la vie des femmes : Grossesse et allaitement. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102146. [PMID: 37977719 DOI: 10.1016/j.jogc.2023.05.014] [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: 11/19/2023]
Abstract
OBJECTIF Présenter aux professionnels de la santé les données probantes concernant l'utilisation des opioïdes et la santé des femmes. Les domaines d'intérêt sont la grossesse et les soins post-partum. POPULATION CIBLE Toutes les femmes qui utilisent des opioïdes. RéSULTATS: Un dialogue ouvert et éclairé sur l'utilisation des opioïdes améliorera les soins aux patientes. BéNéFICES, RISQUES ET COûTS: L'exploration de l'utilisation d'opioïdes par une approche tenant compte des traumatismes antérieurs donne au professionnel de la santé et à la patiente l'occasion de bâtir une alliance solide, collaborative et thérapeutique. Cette alliance permet aux femmes de faire des choix éclairés. Elle favorise le diagnostic et le traitement possible du trouble lié à l'utilisation d'opioïdes. L'utilisation ne doit pas être stigmatisée, puisque la stigmatisation affaiblit le partenariat (le partenariat entre patiente et professionnel de la santé). Les professionnels de la santé ceus-ci doivent comprendre l'effet potentiel des opioïdes sur la santé les femmes enceintes et les aider à prendre des décisions éclairées sur leur santé. DONNéES PROBANTES: Une recherche a été conçue puis effectuée dans les bases de données PubMed et Cochrane Library pour la période d'août 2018 à mars 2023 des termes MeSH et mots clés suivants (et variantes) : opioids, opioid agonist therapy, illicit drugs, fertility, pregnancy, fetal development, neonatal abstinence syndrome et breastfeeding. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et conditionnelles [faibles]). PROFESSIONNELS CONCERNéS: Tous les professionnels de la santé qui prodiguent des soins aux femmes et aux nouveaux-nés. RéSUMé POUR TWITTER: La consommation d'opioïdes pendant la grossesse coïncide souvent avec des problèmes de santé mentale et est associée à des conséquences néfastes pour la mère, le fœtus et le nouveau-né ; le traitement des troubles liés à la consommation d'opioïdes par agonistes peut être sûr pendant la grossesse lorsque les risques sont plus nombreux que les avantages. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.
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Miller JS, Bada H, Dunworth C, Charnigo R. Recent and lifetime maternal substance use: Rurality and economic distress. Res Nurs Health 2023; 46:502-514. [PMID: 37515582 PMCID: PMC10528337 DOI: 10.1002/nur.22330] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 07/10/2023] [Accepted: 07/15/2023] [Indexed: 07/31/2023]
Abstract
Research on opioid use disorder (OUD) in pregnancy has mainly considered women in urban areas receiving treatment, with less known about women in rural areas. We sought to describe demographics and substance use characteristics of pregnant women with OUD and to compare the women based on urbanicity, in a state (Kentucky) with unfavorable economic conditions in many rural counties; we hypothesized that pregnant women in rural areas would have greater adversity, broadly defined, related to substance use. Using data collected from a larger project between 2017 and 2020, we analyzed characteristics of 93 pregnant women (59 rural and 34 urban) with OUD; we examined data in medical, employment, substance use, legal, family history, relationship, and psychiatric health domains, both overall and within rural (population <50,000) and urban (population ≥50,000) strata. Pregnant women with OUD from rural and urban areas were similar on almost all attributes. Among the few significant differences, 30% from urban areas perceived inadequate prenatal care versus 11% from rural areas (p = 0.024); 21% of urban women used amphetamines/methamphetamines in the month before delivery versus 0% of rural women (p < 0.001); and rural women had longer most recent abstinence from substance use than their urban counterparts (medians 7.0 and 2.8 months, p = 0.049). The few significant differences that were discovered favored rural women. These findings, contrary to our hypothesis, suggest that tailoring interventions may require more than focusing on geography. The participants in this study were pregnant women being treated for OUD, and as such there is patient contribution of data.
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Affiliation(s)
- Jennifer Shearer Miller
- College of Medicine, University of Kentucky, Lexington, KY
- College of Nursing, University of Tennessee, Knoxville, TN
| | - Henrietta Bada
- College of Medicine, University of Kentucky, Lexington, KY
| | - Caitlin Dunworth
- KCH Office of Pediatric Research, Kentucky Children’s Hospital, Lexington, KY
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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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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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Smith KE, Dunn KE, Grundmann O, Garcia-Romeu A, Rogers JM, Swogger MT, Epstein DH. Social, psychological, and substance use characteristics of U.S. adults who use kratom: Initial findings from an online, crowdsourced study. Exp Clin Psychopharmacol 2022; 30:983-996. [PMID: 34735202 PMCID: PMC10726725 DOI: 10.1037/pha0000518] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Kratom, a plant that produces opioid-like effects, has gained popularity in the U.S. for self-treating symptoms of chronic pain, mood disorders, and substance-use disorders (SUDs). Most data on kratom are from surveys into which current kratom-using adults could self-select; such surveys may underrepresent people who have used kratom and chosen to stop. Available data also do not adequately assess important psychosocial factors surrounding kratom use. In this study, U.S. adults who reported past 6-month alcohol, opioid, and/or stimulant use (N = 1,670) were recruited via Amazon Mechanical Turk between September and December 2020. Of the 1,510 evaluable respondents, 202 (13.4%) reported lifetime kratom use. Kratom-using adults, relative to others, were typically younger, male, unpartnered, without children, and had lower income. They had higher rates of chronic pain (31.7% vs. 21.9%, p = .003), childhood adversity, anxiety, and depression (p < .001), and lower perceived social rank (d = .19, .02-.22) and socioeconomic status (d = .37 .16-.26). They also reported higher use rates for most substances (except alcohol); this included medically supervised and unsupervised use of prescription opioids and diverted opioid agonist therapy (OAT) medications. Most (83.2%) met diagnostic criteria for any past-year SUD. Those reporting kratom use were less likely to reside in an urban/suburban area. The strongest predictors of kratom use were use of other drugs: cannabidiol (OR = 3.73), psychedelics (OR = 3.39), and nonmedical prescription opioids (OR = 1.72). Another strong predictor was lifetime OAT utilization (OR = 2.31). Despite seemingly poorer psychosocial functioning and health among respondents reporting lifetime kratom use, use of other substances may be the strongest indicators of kratom use. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Kirsten E. Smith
- Real-world Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland, United States
| | - Kelly E. Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Oliver Grundmann
- College of Pharmacy, Department of Medicinal Chemistry, University of Florida
| | - Albert Garcia-Romeu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Jeffrey M. Rogers
- Real-world Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland, United States
| | - Marc T. Swogger
- Department of Psychiatry, University of Rochester Medical Center
| | - David H. Epstein
- Real-world Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland, United States
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Association of Medication-Assisted Therapy with New Onset of Cardiac Arrhythmia in Patients Diagnosed with Opioid Use Disorders. Am J Med 2022; 135:864-870.e3. [PMID: 35139325 PMCID: PMC9232850 DOI: 10.1016/j.amjmed.2022.01.032] [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: 01/09/2022] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND No data exist on comparative risk of cardiac arrhythmias among 3 Medication-Assisted Therapy (MAT) medications in patients with opioid use disorder. Understanding MAT medications with the least risk of arrhythmia can guide clinical decision-making. METHOD A multicenter retrospective cohort study was performed of patients 18 years or older diagnosed with opioid use disorder by the International Classification of Diseases, 10th revision, Clinical Modification without baseline arrhythmia in 2018-2019, using Clinformatics Data Mart Database (Optum, Eden Prairie, Minn). Everyone required 1 year of continuous enrollment prior to and after the diagnosis. Patients with MAT were propensity score-matched to those without MAT. Primary outcome was rate of arrhythmia across MAT (methadone, naltrexone, and buprenorphine). A multivariable logistic regression model was built to examine the outcome difference across 3 medications adjusted for patient's demographic and comorbidity. RESULT Only 14.1% of the 66,083 patients with opioid use disorder received MAT prescriptions in the 12 months after diagnosis. New-onset arrhythmia diagnoses occur more frequently among MAT vs non-MAT users (4.86% vs 3.92%), with 29% risk of incident arrhythmias among MAT users, even after adjusting relevant confounders (adjusted odds ratio [aOR] 1.29; 95% confidence interval [CI], 1.11-1.52). Incidence of arrhythmia varied by drugs: naltrexone (9.57%), methadone (5.71%), and buprenorphine (3.81%). Difference among the MAT drugs in incidence of arrhythmia remained significant even after adjusting covariates (aOR 2.44; 95% CI, 1.63-3.64 and buprenorphine aOR 0.77; 95% CI, 0.59-1.00, with methadone as reference). CONCLUSION MAT users had higher risk of cardiac arrhythmia than non-users. Naltrexone is associated with the highest risk of arrhythmia, suggesting caution with naltrexone use, especially in opioid use disorder patients with pre-existing heart conditions.
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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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Leiner C, Antono B, Ostrach B. Perinatal OUD Treatment Provider Understandings of Rural Patients' Experiences. J Addict Med 2022; 16:177-182. [PMID: 35289773 DOI: 10.1097/adm.0000000000000858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To present perspectives of substance use treatment providers offering perinatal opioid use disorder (OUD) treatment in a largely rural, Appalachian region. To demonstrate the extent to which providers sought to understand their patients' experiences accessing treatment and how this understanding informed providers' approach to offering patient-centered care. METHODS A qualitative study combining semi-structured interviews and participant-observation with perinatal substance use treatment providers, conducted within a comprehensive program. Using purposive and opportunistic sampling with key informants (n = 10), a saturation sample was achieved. Data were analyzed using modified Grounded Theory. RESULTS Perinatal substance use treatment providers had a good understanding of their patients' experiences seeking treatment for opioid use disorder, including being aware of obstacles patients encountered. This understanding allowed providers to better address patients' needs in and out of the clinic. CONCLUSIONS Participants demonstrated a good understanding of what their largely rural, Appalachian patients experienced when attempting to access perinatal OUD treatment. This understanding may enable more patient-centered care.
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Affiliation(s)
- Catherine Leiner
- UNC Health Sciences at MAHEC, Asheville, NC (CL); Family Medicine Residency Program, Mountain Area Health Education Center, Asheville, NC (BA); Medical resident in a program partially supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,656,886 with 0 percent financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov. (This statement is required by HRSA to be included in all publications on which a HRSA-funded medical resident is listed as an author.) (BA); Department of Research, UNC Health Sciences at MAHEC, Asheville, NC (BO); Boston University School of Medicine, Boston, MA (BO)
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What Obstetrician–Gynecologists Should Know About Substance Use Disorders in the Perinatal Period. Obstet Gynecol 2022; 139:317-337. [DOI: 10.1097/aog.0000000000004657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/01/2021] [Indexed: 11/26/2022]
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Sufrin C, Kramer CT, Terplan M, Fiscella K, Olson S, Voegtline K, Latkin C. Availability of Medications for the Treatment of Opioid Use Disorder Among Pregnant and Postpartum Individuals in US Jails. JAMA Netw Open 2022; 5:e2144369. [PMID: 35050354 PMCID: PMC8777564 DOI: 10.1001/jamanetworkopen.2021.44369] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/25/2021] [Indexed: 11/29/2022] Open
Abstract
Importance Thousands of pregnant people with opioid use disorder (OUD) enter US jails annually, yet their access to medications for OUD (MOUD) that meet the standard of care (methadone and/or buprenorphine) is unknown. Objective To assess the availability of MOUD for the treatment of pregnant individuals with OUD in US jails. Design, Setting, and Participants In this cross-sectional study, electronic and paper surveys were sent to all 2885 identifiable US jails verified in the National Jails Compendium between August 19 and November 7, 2019. Respondents were medical and custody leaders within the jails. Main Outcomes and Measures The primary outcome was the availability of MOUD (methadone and/or buprenorphine) for the treatment of pregnant people with OUD in US jails. Availability of MOUD was assessed based on (1) continuation of MOUD for pregnant incarcerated individuals (if the individual was receiving MOUD before incarceration), with or without initiation of MOUD; (2) both initiation and continuation of MOUD for pregnant individuals; (3) only continuation of MOUD for pregnant individuals; and (4) management of opioid withdrawal for pregnant individuals. Secondary outcomes included MOUD availability during the postpartum period and logistical factors associated with the provision of MOUD. Multivariate logistic regression analysis was used to assess factors associated with MOUD availability during pregnancy. Results Among 2885 total surveys sent, 1139 (39.5%) were returned; of those, 836 surveys (73.4%; 29.0% of all surveys sent) could be analyzed, with similar proportions from metropolitan (399 jails [47.7%]) and rural (381 jails [45.6%]) settings. Overall, 504 jails (60.3%) reported that MOUD was available for medication continuation, with or without medication initiation, during pregnancy. Of those, 267 jails (53.0%; 31.9% of surveys included in the analysis) both initiated and continued MOUD, and 237 jails (47.0%; 28.3% of surveys included in the analysis) only continued MOUD; 190 of 577 jails (32.9%; 22.7% of surveys included in the analysis) reported opioid withdrawal as the only management for pregnant people with OUD. Among the 504 medication-providing jails, only 120 (23.8%) continued to provide MOUD during the postpartum period. Methadone was more commonly available at jails that only continued MOUD (84 of 123 jails [68.3%]), whereas buprenorphine was more commonly available at jails that both initiated and continued MOUD (73 of 119 jails [61.3%]). In an adjusted model, jails with higher odds of MOUD availability were located in the Northeast (odds ratio [OR], 10.72; 95% CI, 2.43-47.36) or metropolitan areas (OR, 1.92; 95% CI, 1.31-2.83), had private health care contracts (OR, 1.49; 95% CI, 1.03-2.14) and a higher number of women (≥70) reported in the female census (OR, 1.69; 95% CI, 1.02-2.80), and provided pregnancy testing within 2 weeks of arrival at the jail (OR, 2.66; 95% CI, 1.69-4.17). Conclusions and Relevance In this cross-sectional study, a substantial proportion of US jails did not provide access to MOUD to pregnant people with OUD. Although most jails reported continuing to provide MOUD to individuals who were receiving medication before incarceration, few jails initiated MOUD, and most medication-providing jails discontinued MOUD during the postpartum period. These results suggest that many pregnant and postpartum people with OUD in US jails do not receive medication that is the standard of care and are required to endure opioid withdrawal, signaling an opportunity for intervention to improve care for pregnant people who are incarcerated.
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Affiliation(s)
- Carolyn Sufrin
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Camille T. Kramer
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Kevin Fiscella
- Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
- Center for Community Health and Prevention, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Sarah Olson
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin Voegtline
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Henkhaus LE, Buntin MB, Henderson SC, Lai P, Patrick SW. Disparities in receipt of medications for opioid use disorder among pregnant women. Subst Abus 2022; 43:508-513. [PMID: 34270396 PMCID: PMC8875287 DOI: 10.1080/08897077.2021.1949664] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Medications for opioid use disorder (MOUD) improve outcomes for pregnant women and infants. Our primary aim was to examine disparities in maternal MOUD receipt by family sociodemographic characteristics. Methods: This retrospective cohort study included mother-infant dyads with Medicaid-covered deliveries in Tennessee from 2009 to 2016. First, we examined family sociodemographic characteristics - including race/ethnicity, rurality, mother's primary language and education level, and whether paternity was recorded in birth records - and newborn outcomes by type of maternal opioid use. Second, among pregnant women with OUD, we used logistic regression to measure disparities in receipt of MOUD by family sociodemographic characteristics including interactions between characteristics. Results: Our cohort from Medicaid-covered deliveries consisted of 314,965 mother-infant dyads, and 4.2 percent were exposed to opioids through maternal use. Among dyads with maternal OUD, MOUD receipt was associated with lower rates of preterm and very preterm birth. Logistic regression adjusted for family sociodemographic characteristics showed that pregnant women with OUD in rural versus urban areas (aOR: 0.66; 95% CI: 0.60-0.72) and who were aged ≥35 years versus ≤25 years (aOR: 0.75; 95% CI: 0.64-0.89) were less likely to have received MOUD. Families in which the mother's primary language was English (aOR: 2.47; 95% CI: 1.24-4.91) and paternity was recorded on the birth certificate (aOR: 1.30; 95% CI: 1.19-1.42) were more likely to have received MOUD. Regardless of high school degree attainment, non-Hispanic Black versus non-Hispanic White race was associated with lower likelihood of MOUD receipt. Hispanic race was associated with lower likelihood of MOUD receipt among women without a high school degree. Conclusions: Among a large cohort of pregnant women, we found disparities in receipt of MOUD among non-Hispanic Black, Hispanic, and rural pregnant women. As policymakers consider strategies to improve access to MOUD, they should consider targeted approaches to address these disparities.
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Affiliation(s)
- Laura E. Henkhaus
- Data Science Institute, Vanderbilt University, Nashville, Tennessee, USA,Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA,Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melinda B. Buntin
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA,Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah Clark Henderson
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Pikki Lai
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen W. Patrick
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA,Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA,Mildred Stahlman Division of Neonatology, Vanderbilt University, Nashville, Tennessee, USA
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Sang J, Patton RA, Park I. Comparing Perceptions of Addiction Treatment between Professionals and Individuals in Recovery. Subst Use Misuse 2022; 57:983-994. [PMID: 35373710 DOI: 10.1080/10826084.2022.2058706] [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: The purpose of this qualitative study was to compare and contrast the differing perspectives of service users and professionals regarding the current substance use disorders (SUD) services provided in Summit County, Ohio. Seven focus groups were conducted with 44 participants (52.3% male, mean age 46 years), including 15 individuals in recovery, 16 direct service providers, and 13 executive directors. The participants were asked about three areas: (1) effective treatment for SUD, (2) challenges for persons with SUD, and (3) suggestions for improving SUD treatment outcomes. The data were analyzed and coded according to major themes. Results: While there were numerous emergent themes that were concordant between service use and professionals, several differing themes between the groups were also identified. First, participants disagreed on the effectiveness of medication-assisted treatment/Medications for Opioid Use Disorder. Second, professionals identified trauma, stigma, "one-size-fits-all" approach to treatment, and limitations set by managed care act as barriers to treatment, whereas individuals in recovery reported difficulty dealing with feelings, feeling of being rushed into recovery, and the lack of long-term recovery plans as the most significant barriers. Lastly, in order to improve treatment outcomes, professionals emphasized the importance of education unlike individuals in recovery who identified sober supports as the most important factor. Conclusion: This study identified challenges in SUD recovery and highlights essential areas for consideration when developing and implementing SUD treatment. The findings can be used as guidelines to provide better services to individuals with SUDs.Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2022.2058706 .
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Affiliation(s)
- Jina Sang
- School of Social Work and Family Sciences, The University of Akron, Akron, OH, USA
| | - Rikki A Patton
- School of Social Work and Family Sciences, The University of Akron, Akron, OH, USA
| | - Insun Park
- Department of Criminal Justice, The University of Akron, Akron, OH, 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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Krans EE, Kim JY, Chen Q, Rothenberger SD, James AE, Kelley D, Jarlenski MP. Outcomes associated with the use of medications for opioid use disorder during pregnancy. Addiction 2021; 116:3504-3514. [PMID: 34033170 PMCID: PMC8578145 DOI: 10.1111/add.15582] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/28/2021] [Accepted: 05/12/2021] [Indexed: 12/18/2022]
Abstract
AIM To test the effect of the duration of medication for opioid use disorder (MOUD) use during pregnancy on maternal, perinatal and neonatal outcomes. DESIGN Retrospective cohort analysis of claims, encounter and pharmacy data. SETTING Pennsylvania, USA. PARTICIPANTS We analyzed 13 320 pregnancies among 10 741 women with opioid use disorder aged 15-44 years enrolled in Pennsylvania Medicaid between 2009 and 2017. MEASUREMENTS We examined five outcomes during pregnancy and for 12 weeks postpartum: (1) overdose, (2) postpartum MOUD continuation, (3) preterm birth (< 37 weeks gestation), (4) term low birth weight (< 2500 g at ≥ 37 weeks) and (5) neonatal abstinence syndrome (NAS). Our primary exposure was the duration (count of weeks) of any MOUD use, including methadone or buprenorphine, during pregnancy. FINDINGS Among 13 320 pregnancies, 306 (2.3%) were complicated by an overdose, 1753 (13.2%) resulted in a preterm birth and 6787 (50.9%) continued MOUD postpartum. Among infants, 874 (7.6%) were low birth weight at term and 7706 (57.9%) were diagnosed with NAS. As the duration of MOUD use increased, we found a statistically significant decrease in the rate of overdose and preterm birth, a statistically significant increase in the rate of postpartum MOUD continuation and NAS and a decline in term low birth weight. Specifically, for each additional week of MOUD, the adjusted odds of overdose decreased by 2% [adjusted odds ratio (aOR) = 0.98; 95% confidence interval (CI) = 0.97, 0.99], preterm birth decreased by 1% (aOR = 0.99; 95% CI = 0.99, 1.00), postpartum MOUD continuation increased by 95% (aOR = 1.95; 95% CI = 1.87, 2.04) and NAS increased by 41% (aOR = 1.41; 95% CI = 1.35, 1.47). The odds of term low birth weight did not change (aOR = 1.00; 95% CI = 0.99, 1.00), although the rate declined with a longer duration of MOUD use during pregnancy. CONCLUSIONS Longer duration of medication for opioid use disorder use during pregnancy appears to be associated with improved maternal and perinatal outcomes.
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Affiliation(s)
- Elizabeth E. Krans
- Department of Obstetrics, Gynecology & Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joo Yeon Kim
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Qingwen Chen
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Scott D. Rothenberger
- Center for Research on Health Care Data Center, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alton Everette James
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David Kelley
- Pennsylvania Department of Human Services, Harrisburg, Pennsylvania
| | - Marian P. Jarlenski
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania
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Sanders AN, Vance DE, Dudding KM, Shorten A, Rice M. Maternal-infant bonding for the opioid exposed dyad: A rodgers' evolutionary concept analysis. Nurs Forum 2021; 57:165-170. [PMID: 34676568 DOI: 10.1111/nuf.12663] [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: 08/02/2021] [Revised: 09/15/2021] [Accepted: 10/14/2021] [Indexed: 11/28/2022]
Abstract
AIM This concept analysis aimed to offer insight into how opioid exposure affects the quality and construction of the maternal-infant bond. BACKGROUND Maternal-infant bonding can be influenced by maternal opioid use disorder and the neonatal intensive care unit environment. Many interventions for mothers with opioid use disorder focus on enhancing parental skills, but often the emotional and relational features of the maternal-infant bond have been overlooked. DATA SOURCE Literature from Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PubMed, and PsycINFO published from January 2011 to June 2021 using "attachment theory," "mother-infant attachment," "maternal-infant bonding," "neonatal opioid withdrawal syndrome," and "neonatal abstinence syndrome" as key terms. REVIEW METHODS Rodgers' method of concept analysis was used to determine the antecedents, attributes, and consequences of maternal-infant bonding. RESULTS The key attributes of bonding for the opioid-exposed mother-infant dyad are engaged mothering, recognition of risk, affection, and respectful maternity care. The antecedents are closeness, selflessness, and purposeful touch. The consequences are sobriety, custody, love, and security.
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Affiliation(s)
- Allyson N Sanders
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David E Vance
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Katherine M Dudding
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Allison Shorten
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marti Rice
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Ignaszewski MJ. The Epidemiology of Drug Abuse. J Clin Pharmacol 2021; 61 Suppl 2:S10-S17. [PMID: 34396554 DOI: 10.1002/jcph.1937] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/02/2021] [Indexed: 01/12/2023]
Abstract
Many Americans use alcohol and recreational drugs. Some will develop substance use disorders that affect a person's brain and behavior, leading to continued use despite problems caused. We review the epidemiology of addiction in the United States, including changes in use patterns over time, highlighting rates in adolescents and young adults, as well as adults. An overview of the health and societal impacts of substance use is provided alongside the importance of multimodal, evidence-based treatment comprising psychosocial interventions and medication management. The article concludes by exploring the impact of the coronavirus disease 2019 pandemic on people who use drugs and their access to treatment.
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Affiliation(s)
- Martha J Ignaszewski
- Complex Pain and Addiction Service, Vancouver General Hospital, British Columbia Children's Hospital, and Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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Predictors of Initiation of Medication for Opioid Use Disorder and Retention in Treatment Among U.S. Pregnant Women, 2013-2017. Obstet Gynecol 2021; 137:687-694. [PMID: 33706349 DOI: 10.1097/aog.0000000000004307] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/10/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe trends and factors associated with medication administration for opioid use disorder (OUD) and retention in treatment among pregnant women with OUD. METHODS This is a retrospective, nationwide, cross-sectional analysis of treatment episodes for primary OUD among pregnant women from 2013 to 2017. The primary outcome was initiation of methadone, buprenorphine, or naltrexone. Secondary outcomes were retention in treatment defined as length of treatment episode lasting six months or greater, and completion of treatment. Descriptive statistics and logistic regression were applied to describe trends in, and identify factors associated with the outcomes. RESULTS There were 42,239 treatment episodes for primary OUD among pregnant women who reported using heroin (65.0%, 27,459), synthetic opioid (33.2%, 14,034), or nonprescribed methadone (1.8%, 746) between 2013 and 2017. Medications for OUD were administered in 47.4% (20,013) of episodes. Retention in treatment occurred in 16.6% of episodes without medications for OUD, and 37.8% of episodes with medications for OUD (P=.01). The rate of medication administration for OUD increased from 41.0% in 2013 to 52.0% in 2017; however, retention rates declined from 39.0% to 33.0% among treatment episodes with medication for OUD. History of at least one prior treatment episode was associated with both administration of medications for OUD and retention in treatment. CONCLUSION In spite of current guidelines, most treatment episodes for OUD during pregnancy did not involve administration of medications for OUD. Although administration of medications for OUD has improved over time, retention in treatment is lagging. These findings highlight gaps in the U.S. addiction care system.
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Anesthetic management of the parturient with opioid addiction. Int Anesthesiol Clin 2021; 59:28-39. [PMID: 34100798 DOI: 10.1097/aia.0000000000000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Joudrey PJ, Adams ZM, Bach P, Van Buren S, Chaiton JA, Ehrenfeld L, Guerra ME, Gleeson B, Kimmel SD, Medley A, Mekideche W, Paquet M, Sung M, Wang M, You Kheang ROO, Zhang J, Wang EA, Edelman EJ. Methadone Access for Opioid Use Disorder During the COVID-19 Pandemic Within the United States and Canada. JAMA Netw Open 2021; 4:e2118223. [PMID: 34297070 PMCID: PMC8303098 DOI: 10.1001/jamanetworkopen.2021.18223] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/12/2021] [Indexed: 02/03/2023] Open
Abstract
Importance Methadone access may be uniquely vulnerable to disruption during COVID-19, and even short delays in access are associated with decreased medication initiation and increased illicit opioid use and overdose death. Relative to Canada, US methadone provision is more restricted and limited to specialized opioid treatment programs. Objective To compare timely access to methadone initiation in the US and Canada during COVID-19. Design, Setting, and Participants This cross-sectional study was conducted from May to June 2020. Participating clinics provided methadone for opioid use disorder in 14 US states and territories and 3 Canadian provinces with the highest opioid overdose death rates. Statistical analysis was performed from July 2020 to January 2021. Exposures Nation and type of health insurance (US Medicaid and US self-pay vs Canadian provincial). Main Outcomes and Measures Proportion of clinics accepting new patients and days to first appointment. Results Among 268 of 298 US clinics contacted as a patient with Medicaid (90%), 271 of 301 US clinics contacted as a self-pay patient (90%), and 237 of 288 Canadian clinics contacted as a patient with provincial insurance (82%), new patients were accepted for methadone at 231 clinics (86%) during US Medicaid contacts, 230 clinics (85%) during US self-pay contacts, and at 210 clinics (89%) during Canadian contacts. Among clinics not accepting new patients, at least 44% of 27 clinics reported that the COVID-19 pandemic was the reason. The mean wait for first appointment was greater among US Medicaid contacts (3.5 days [95% CI, 2.9-4.2 days]) and US self-pay contacts (4.1 days [95% CI, 3.4-4.8 days]) than Canadian contacts (1.9 days [95% CI, 1.7-2.1 days]) (P < .001). Open-access model (walk-in hours for new patients without an appointment) utilization was reported by 57 Medicaid (30%), 57 self-pay (30%), and 115 Canadian (59%) contacts offering an appointment. Conclusions and Relevance In this cross-sectional study of 2 nations, more than 1 in 10 methadone clinics were not accepting new patients. Canadian clinics offered more timely methadone access than US opioid treatment programs. These results suggest that the methadone access shortage was exacerbated by COVID-19 and that changes to the US opioid treatment program model are needed to improve the timeliness of access. Increased open-access model adoption may increase timely access.
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Affiliation(s)
- Paul J. Joudrey
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Zoe M. Adams
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Paxton Bach
- British Columbia Center on Substance Use, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jessica A. Chaiton
- British Columbia Center on Substance Use, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Simeon D. Kimmel
- Sections of General Internal Medicine and Infectious Diseases, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | | | | | - Maxime Paquet
- Faculty of Pharmacy, Université de Montréal, Montréal, Canada
| | - Minhee Sung
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven
| | - Melinda Wang
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Jingxian Zhang
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Emily A. Wang
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - E. Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut
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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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36
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Cavazos-Rehg P, Xu C, Krauss MJ, Min C, Winograd R, Grucza R, Bierut LJ. Understanding barriers to treatment among individuals not engaged in treatment who misuse opioids: A structural equation modeling approach. Subst Abus 2021; 42:842-850. [PMID: 33617738 DOI: 10.1080/08897077.2021.1876199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Many individuals misusing opioids do not enter into treatment. The question of who enters into treatment for their opioid abuse and under what circumstances is complex and shaped by multiple factors. The objective of the current study is to explore the risk factors for wide-ranging and numerous barriers to treatment among social media users. Method: Opioid-related forums within a popular social media platform were used to recruit non-treatment engaged individuals (≥15 years) who had misused opioids in the past month (n = 144; 66% male; median age 28). Four treatment barrier factors were identified utilizing principle component analysis: (1) stigma, (2) awareness, (3) attitudinal, and (4) denial. A structural equation model (SEM) was then created to explore the risk factors for different types of barriers to OUD treatment. Results: The most common barriers among participants not engaged in treatment for their opioid misuse were the belief that one should be able to help themselves with their condition (66%), treatment was too expensive (63%), and worries about being labeled or judged (57%). Additionally, SEM results demonstrate stigma barriers, awareness, and attitudinal barriers were associated with mental health comorbidities, opioid abuse and dependence severity, and treatment history. Denial barriers, however, were only associated with treatment history, and structural/financial barriers were only associated with opioid abuse and dependence severity. Conclusions: Our research findings are relevant for underscoring the wide-ranging and numerous barriers to treatment faced by individuals misusing opioids that are especially concentrated among those who also struggle with comorbid mental illness.
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Affiliation(s)
- Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Christine Xu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Melissa J Krauss
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Caroline Min
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Rachel Winograd
- Missouri Institute of Mental Health, University of Missouri St. Louis, St. Louis, MO, USA
| | - Richard Grucza
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Leiner C, Cody T, Mullins N, Ramage M, Ostrach BMM. "The elephant in the room;" a qualitative study of perinatal fears in opioid use disorder treatment in Southern Appalachia. BMC Pregnancy Childbirth 2021; 21:143. [PMID: 33596843 PMCID: PMC7890815 DOI: 10.1186/s12884-021-03596-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/27/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Diagnoses of perinatal opioid use disorder (OUD) continue to rise in the United States. Patients and providers report obstacles to OUD treatment access. Difficulties include legal ambiguity related to Social Services notification requirements following a birth to people using opioids or in medication-assisted treatment for OUD. METHODS Through semi-structured interviews, participant-observation, and a focus group conducted in a mostly rural, region of the Southern United States (where perinatal OUD is more prevalent), patients' and providers' perspectives about perinatal substance use treatment were initially sought for a larger study. The findings presented here are from a subset analysis of patients' experiences and perspectives. Following ethics review and exemption determination, a total of 27 patient participants were opportunistically, convenience, and/or purposively sampled and recruited to participate in interviews and/or a focus group. Data were analyzed using modified Grounded Theory. RESULTS When asked about overall experiences with and barriers to accessing perinatal substance use treatment, 11 of 27 participants reported concerns about Social Services involvement resulting from disclosure of their substance use during pregnancy. In the subset analysis, prevalent themes were Fears of Social Services Involvement, Preparation for Delivery, and Providers Addressing Fears. CONCLUSIONS Perinatal OUD patients may seek substance use treatment with existing fears of Social Services involvement. Patients appreciate providers' efforts to prepare them for this potential reality. Providers should become aware of how their own hospital systems, counties, states, and countries interpret laws governing notification requirements. By becoming aware of patients' fears, providers can be ready to discuss the implications of Social Services involvement, promote patient-centered decision-making, and increase trust.
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Affiliation(s)
- Catherine Leiner
- UNC School of Medicine, 321 S Columbia St, Chapel Hill, NC, 27516321, USA
| | - Tamara Cody
- Mountain Area Health Education Center, 119 Hendersonville Rd, Asheville, NC, 28803, USA
| | - Nathan Mullins
- Mountain Area Health Education Center, 119 Hendersonville Rd, Asheville, NC, 28803, USA
| | - Melinda Ramage
- Mountain Area Health Education Center, 119 Hendersonville Rd, Asheville, NC, 28803, USA
| | - Bayla M M Ostrach
- Department of Research, UNC Health Sciences at MAHEC, 121 Hendersonville Road, Asheville, NC, 28803, USA.
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Abstract
Before the COVID-19 pandemic, many pregnant patients experienced barriers in accessing opioid use disorder (OUD) medication. This project surveyed buprenorphine treatment clinics to determine how many accepted pregnant women before and then during the pandemic. Of those clinics accepting pregnant patients during the pandemic, respondents were asked what services were provided and what forms of payment they accepted.
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Liang OS, Chen Y, Bennett DS, Yang CC. Identifying Self-Management Support Needs for Pregnant Women With Opioid Misuse in Online Health Communities: Mixed Methods Analysis of Web Posts. J Med Internet Res 2021; 23:e18296. [PMID: 33538695 PMCID: PMC7892281 DOI: 10.2196/18296] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 12/11/2020] [Accepted: 12/20/2020] [Indexed: 12/18/2022] Open
Abstract
Background The current opioid crisis in the United States impacts broad population groups, including pregnant women. Opioid use during pregnancy can affect the health and wellness of both mothers and their infants. Understanding women’s efforts to self-manage opioid use or misuse in pregnancy is needed to identify intervention points for improving maternal outcomes. Objective This study aims to identify the characteristics of women in an online health community (OHC) with opioid use or misuse during pregnancy and the self-management support needs of these mothers. Methods A total of 200 web posts by pregnant women with opioid use participating in an OHC were double coded. Concepts and their thematic connections were identified through an inductive process until theoretical saturation was reached. Statistical tests were performed to identify patterns. Results The majority of pregnant women (150/200, 75.0%) in the OHC exhibited signs of misuse, and 62.5% (125/200) of the participants were either contemplating or pursuing dosage reduction. Self-managed withdrawal was more common (P<.001) than professional treatment among the population. A total of 5 themes of self-management support needs were identified as women sought information about the potential adverse effects of gestational opioid use, protocols for self-managed withdrawal, pain management safety during pregnancy, hospital policies and legal procedures related to child protection, and strategies for navigating offline support systems. In addition, 58.5% (117/200) of the pregnant women expressed negative emotions, of whom only 10.2% (12/117) sought to address their emotional needs with the help of the OHC. Conclusions OHCs provide vital self-management support for pregnant women with opioid use or misuse. Women pursuing self-managed dosage reduction are prone to misinformation and repeated relapses, which can result in extreme measures to avoid testing positive for drug use at labor. The study findings provide evidence for public policy considerations, including universal screening of substance use for pregnant women, emphasis on treatment rather than legal punishment, and further expansion of the Drug Addiction Treatment Act waiver training program. The improvement of web-based platforms that can organize geo-relevant information, dispense clinically validated withdrawal schedules, and offer structured peer support is envisioned for harm reduction among pregnant women who opt for self-management of opioid misuse.
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Affiliation(s)
- Ou Stella Liang
- College of Computing and Informatics, Drexel University, Philadelphia, PA, United States
| | - Yunan Chen
- Donald Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, CA, United States
| | - David S Bennett
- Department of Psychiatry, College of Medicine, Drexel University, Philadelphia, PA, United States
| | - Christopher C Yang
- College of Computing and Informatics, Drexel University, Philadelphia, PA, United States
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Beetham T, Saloner B, Gaye M, Wakeman SE, Frank RG, Barnett ML. Admission Practices And Cost Of Care For Opioid Use Disorder At Residential Addiction Treatment Programs In The US. Health Aff (Millwood) 2021; 40:317-325. [DOI: 10.1377/hlthaff.2020.00378] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Tamara Beetham
- Tamara Beetham is a PhD student in health policy and management at Yale University, in New Haven, Connecticut
| | - Brendan Saloner
- Brendan Saloner is the Bloomberg Associate Professor of American Health in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Marema Gaye
- Marema Gaye is a research project and data assistant in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - Sarah E. Wakeman
- Sarah E. Wakeman is the medical director for the Massachusetts General Hospital Substance Use Disorder Initiative, program director of the Mass General Addiction Medicine fellowship, and an associate professor of medicine at Harvard Medical School, all in Boston, Massachusetts
| | - Richard G. Frank
- Richard G. Frank is the Margaret T. Morris Professor of Health Economics in the Department of Health Care Policy at Harvard Medical School
| | - Michael Lawrence Barnett
- Michael Lawrence Barnett is an assistant professor in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, and an assistant professor of medicine at Harvard Medical School
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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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Nguemeni Tiako MJ, Culhane J, South E, Srinivas SK, Meisel ZF. Prevalence and Geographic Distribution of Obstetrician-Gynecologists Who Treat Medicaid Enrollees and Are Trained to Prescribe Buprenorphine. JAMA Netw Open 2020; 3:e2029043. [PMID: 33306115 PMCID: PMC7733157 DOI: 10.1001/jamanetworkopen.2020.29043] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE The incidence of opioid use during pregnancy is increasing, and drug overdoses are a leading cause of postpartum mortality. Most women who are pregnant do not receive medications for treatment of opioid use disorder, despite the mortality benefit that these agents confer. Furthermore, buprenorphine is associated with milder symptoms of neonatal abstinence syndrome (NAS) compared with methadone. OBJECTIVE To describe the prevalence and geographic distribution across the US of obstetrician-gynecologists who can prescribe buprenorphine (henceforth described as X-waivered) in 2019. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional, nationwide study linking physician-specific data to county- and state-level data was conducted from September 1, 2019, to March 31, 2020. Data were obtained on 31 211 obstetrician-gynecologists who accept Medicaid insurance through the Centers for Medicare & Medicaid Services Physician Compare data set and linked to the Drug Addiction Treatment Act buprenorphine-waived clinician list. EXPOSURES State-level NAS incidence and county-level uninsured rates and rurality. MAIN OUTCOMES AND MEASURES Prevalence and geographic distribution of obstetrician-gynecologists who are trained to prescribe buprenorphine. RESULTS Among the 31 211 identified obstetrician-gynecologists, 18 710 (59.9%) were women. Most had hospital privileges (23 236 [74.4%]) and worked in metropolitan counties (28 613 [91.7%]). Only 560 of the identified obstetrician-gynecologists (1.8%) were X-waivered. Obstetrician-gynecologists in counties with fewer than 5% uninsured residents had nearly twice the odds of being X-waivered (adjusted odds ratio [aOR], 1.59; 95% CI, 1.04-2.44; P = .04) compared with those in counties with greater than 15% uninsured residents. Compared with those located in metropolitan counties, obstetrician-gynecologists in suburban counties (eg, urban population of ≥20 000 and adjacent to a metropolitan area) were more likely to be X-waivered (aOR, 1.85; 95% CI, 1.26-2.71; P = .002). Compared with states with an NAS rate of 5 per 1000 births or less, obstetrician-gynecologists in states with an NAS rate of 15 per 1000 births or greater had nearly 5 times the odds of being X-waivered (aOR, 4.94; 95% CI, 3.60-6.77; P < .001). Obstetrician-gynecologists without hospital privileges were more likely to be X-waivered (aOR, 1.32; 95% CI, 1.08-1.61; P = .007). CONCLUSIONS AND RELEVANCE Fewer than 2% of obstetrician-gynecologists who accept Medicaid are able to prescribe buprenorphine, and their geographic distribution appears to be skewed in favor of suburban counties. This finding suggests that there is an opportunity for health systems and professional societies to incentivize X-waiver trainings among obstetrician-gynecologists to increase patients' access to buprenorphine, especially during pregnancy.
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Affiliation(s)
- Max Jordan Nguemeni Tiako
- Medical student, Yale School of Medicine, New Haven, Connecticut
- Center for Emergency Care and Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Urban Health Lab, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Jennifer Culhane
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Eugenia South
- Center for Emergency Care and Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Urban Health Lab, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Sindhu K. Srinivas
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Zachary F. Meisel
- Center for Emergency Care and Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV, University of Pennsylvania, Philadelphia
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43
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Abstract
The opioid crisis has grown to affect pregnant women and infants across the United States, as evidenced by rising rates of opioid use disorder among pregnant women and neonatal opioid withdrawal syndrome among infants. Across the country, pregnant women lack access to evidence-based therapies, including medications for opioid use disorder, and infants with opioid exposure frequently receive variable care. In addition, public systems, such as child welfare and early intervention, are increasingly stretched by increasing numbers of children affected by the crisis. Systematic, enduring, coordinated, and holistic approaches are needed to improve care for the mother-infant dyad. In this statement, we provide an overview of the effect of the opioid crisis on the mother-infant dyad and provide recommendations for management of the infant with opioid exposure, including clinical presentation, assessment, treatment, and discharge.
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Affiliation(s)
- Stephen W Patrick
- Division of Neonatology, Department of Pediatrics and Health Policy, School of Medicine, Vanderbilt University and Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee;
| | - Wanda D Barfield
- Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Brenda B Poindexter
- Department of Pediatrics, College of Medicine, University of Cincinnati and Cincinnati Children's Medical Hospital Center, Cincinnati, Ohio
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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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Bryan MA, Smid MC, Cheng M, Fortenberry KT, Kenney A, Muniyappa B, Pendergrass D, Gordon AJ, Cochran G. Addressing opioid use disorder among rural pregnant and postpartum women: a study protocol. Addict Sci Clin Pract 2020; 15:33. [PMID: 33129355 PMCID: PMC7603672 DOI: 10.1186/s13722-020-00206-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/23/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Opioid use disorder (OUD) among women delivering at a hospital has increased 400% from 1999-2014 in the United States. From the years 2007 to 2016, opioid-related mortality during pregnancy increased over 200%, and drug-overdose deaths made up nearly 10% of all pregnancy-associated mortality in 2016 in the US. Disproportionately higher rates of neonatal opioid withdrawal syndrome (NOWS) have been reported in rural areas of the country, suggesting that perinatal OUD is a pressing issue among these communities. There is an urgent need for comprehensive, evidence-based treatment services for pregnant women experiencing OUD. The purpose of this article is to describe a study protocol aimed at developing and evaluating a perinatal OUD curriculum, enhancing evidence-based perinatal OUD treatment in a rural setting, and evaluating the implementation of such collaborative care for perinatal OUD. METHODS This two-year study employed a one group, repeated measures, hybrid type-1 effectiveness-implementation design. This study delivered interventions at 2 levels, both targeting improvement of care for pregnant women with OUD. The first area of focus was at the community healthcare provider-level, which aimed to evaluate the acceptability and feasibility of perinatal OUD education across time and to improve provider education by increasing knowledge specific to: MOUD provision; screening, brief intervention, and referral to treatment (SBIRT) utilization; and NOWS treatment. The second area of intervention focus was at the patient-level, which assessed the preliminary effect of perinatal OUD provider education in promoting illicit opioid abstinence and treatment engagement among pregnant women with OUD. We adopted constructs from the Consolidated Framework for Implementation Research (CFIR) to assess contextual factors that may influence implementation, and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model to comprehensively evaluate implementation outcomes. DISCUSSION This article presents the protocol of an implementation study that is employing the CFIR and RE-AIM frameworks to implement and evaluate a perinatal OUD education and service coordination program in two rural counties. This protocol could serve as a model for clinicians and researchers seeking to implement improvements in perinatal care for women with OUD in other rural communities. Trial registration NCT04448015 clinicaltrials.gov.
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Affiliation(s)
- M Aryana Bryan
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA.
| | - Marcela C Smid
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA.,Department of Obstetrics and Gynecology, University of Utah School of Medicine, Division of Maternal Fetal Medicine, Salt Lake City, UT, 84132, USA
| | - Melissa Cheng
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way Ste. A, Salt Lake City, UT, 84108, USA
| | - Katherine T Fortenberry
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way Ste. A, Salt Lake City, UT, 84108, USA
| | - Amy Kenney
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
| | - Bhanu Muniyappa
- Department of Pediatrics, University of Utah School of Medicine, Division of General Pediatrics, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | | | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA.,Greater Intermountain Node (GIN), NIH NIDA Clinical Trials Network, University of Utah, Salt Lake City, UT, USA.,Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Gerald Cochran
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA.,Greater Intermountain Node (GIN), NIH NIDA Clinical Trials Network, University of Utah, Salt Lake City, UT, USA
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46
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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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Hadland SE, Jent VA, Alinsky RH, Marshall BDL, Mauro PM, Cerdá M. Opioid Use Disorder Treatment Facilities With Programs for Special Populations. Am J Prev Med 2020; 59:e125-e133. [PMID: 32448551 PMCID: PMC7484197 DOI: 10.1016/j.amepre.2020.03.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/19/2020] [Accepted: 03/16/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Special populations, including veterans, pregnant and postpartum women, and adolescents, benefit from opioid use disorder treatment tailored to their specific needs, but access to such services is poorly described. This study identifies the availability of opioid use disorder treatment facilities that use medications and have special programming and contextualizes facilities amid counties' opioid-related overdose mortality. METHODS Data were compiled on 15,945 U.S. treatment facilities using medications for opioid use disorder listed in the Behavioral Health Services Treatment Locator in 2018. Facilities with programs tailored to special populations (veterans, pregnant and postpartum women, and adolescents) were identified and geocoded. Counties with such facilities were characterized. Cold spots (county clusters with poor treatment availability) were identified using Getis-Ord Gi* statistics. Data were extracted in October 2018 and analyzed from October 2018 to May 2019. RESULTS Of all 3,142 U.S. counties, 1,889 (60.1%) had opioid use disorder treatment facilities. Facilities with tailored programs for veterans, pregnant and postpartum women, and adolescents were located in 701 (22.3%), 918 (29.2%), and 1,062 (33.8%) of the counties, respectively. Specific medications provided for opioid use disorder varied, with only a minority of facilities offering methadone (among facilities with tailored programs for veterans, 6.0%; pregnant and postpartum women, 13.2%; adolescents, 1.3%). Many counties reporting opioid-related overdose deaths lacked programs for special populations (veterans, 72.6%; pregnant and postpartum women, 54.8%; adolescents, 30.6%). Cold spots were located throughout the Midwest, U.S. Southeast, and portions of Texas. CONCLUSIONS Facilities using medications for opioid use disorder with tailored programs for veterans, pregnant and postpartum women, and adolescents are limited. There is a need for improved access to evidence-based programs that address the unique treatment needs of special populations.
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Affiliation(s)
- Scott E Hadland
- Department of Pediatrics/Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts.
| | - Victoria A Jent
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University School of Medicine, New York, New York
| | - Rachel H Alinsky
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Pia M Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University School of Medicine, New York, New York
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Smith WT. Women with a substance use disorder: Treatment completion, pregnancy, and compulsory treatment. J Subst Abuse Treat 2020; 116:108045. [DOI: 10.1016/j.jsat.2020.108045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 12/29/2022]
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Abstract
Morbidity and mortality associated from opioid use have been on the rise, exemplifying a major public health epidemic. Despite public health interventions, opioid-related morbidity and mortality have yet to plateau or decrease. One explanation for this phenomenon is the presence of barriers to evidence-based pharmacotherapies. Stigma has only recently been identified as a barrier to treatment. The purpose of this report is to evaluate language utilized to describe opioid use disorder and associated pharmacological treatment. Nurse practitioners must emerge as leaders in assuring that patient-centered and non-stigmatizing language is utilized, in order to improve patient outcomes.
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Affiliation(s)
- Brayden N Kameg
- University of Pittsburgh School of Nursing, Department of Health and Community Systems, 3500 Victoria St. Suite 415, Pittsburgh, PA 15261
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