1
|
Schmidt RA, Everett K, Perez-Brumer A, Strike C, Rush B, Gomes T. A population-based time-series analysis of opioid agonist treatment dispensed during pregnancy. Addiction 2024; 119:1111-1122. [PMID: 38476027 DOI: 10.1111/add.16459] [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: 07/28/2023] [Accepted: 01/25/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND AND AIMS Identifying effective opioid treatment options during pregnancy is a high priority due to the growing prevalence of opioid use disorder across North America. We assessed the temporal impact of three population-level interventions on the use of opioid agonist treatment (OAT) during pregnancy in Ontario, Canada. DESIGN This was a population-based time-series analysis to identify trends in the monthly prevalence of pregnant people dispensed methadone and buprenorphine. The impact of adding buprenorphine/naloxone to the public drug formulary, the release of pregnancy-specific guidance and the start of the COVID-19 pandemic were assessed. SETTING AND PARTICIPANTS The study was conducted in Ontario, Canada between 1 July 2013 and 31 March 2022, comprising people who delivered a live or stillbirth in any Ontario hospital during the study period. MEASUREMENTS We identified any prescription for methadone or buprenorphine dispensed between the estimated conception date and delivery date and calculated the monthly prevalence of OAT-exposed pregnancies among all pregnant people in Ontario. FINDINGS Overall, rates of OAT during pregnancy have declined since mid-2018. Methadone-exposed pregnancies decreased from 0.46% of all pregnancies in Ontario in 2015 to a low of 0.16% in 2022. In the primary analysis, none of the interventions had a statistically significant impact on overall OAT rates; however, in the stratified analyses, there was a small increase in buprenorphine after the formulary change [0.006%, 95% confidence interval (CI) = 0.0032-0.0081, P < 0.0001] and a decrease in buprenorphine after the release of the 2017 guidelines (-0.005%, 95% CI = -0.0080 to -0.0020, P = 0.001) and the start of the COVID-19 pandemic (-0.003%, 95% CI = -0.0054 to -0.0006, P = 0.015). CONCLUSION Despite changes in guidance and funding, opioid agonist treatment during pregnancy has been declining in Ontario, Canada since 2018.
Collapse
Affiliation(s)
- Rose A Schmidt
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- ICES, Toronto, Canada
| | | | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Brian Rush
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Tara Gomes
- ICES, Toronto, Canada
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Management and Evaluation at the University of Toronto, Institute of Health Policy, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Bello JK, Dell NA, Laxton AM, Conte M, Chen L. Prevalence and predictors of medication for opioid use disorder among reproductive-aged women. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 11:100239. [PMID: 38711835 PMCID: PMC11070671 DOI: 10.1016/j.dadr.2024.100239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 05/08/2024]
Abstract
Background Women of reproductive age would benefit from treatment of opioid use disorder (OUD) prior to pregnancy to improve maternal and infant outcomes. In this study, we aimed to identify the prevalence of medication for OUD (MOUD) and characterize correlates of MOUD receipt among 12-49-year-old women with OUD seeking treatment in publicly funded substance use disorder treatment programs at the time of their first treatment episode. Methods This cross-sectional study explores the demographic and clinical characteristics of women of reproductive age with OUD receiving publicly funded substance use treatment services. We used data from the concatenated 2015-2021 Treatment Episode Data Set-Admissions (TEDS-A), which documents demographic and clinical characteristics of patient admissions to publicly funded substance use treatment services in the United States. Results In the sample of females aged 12-49 with no prior treatment admissions and primary OUD (n=325,512), 40.53% received MOUD (n=131,930), including 39.40% of non-pregnant women (n=115,315) and 52.79% of pregnant women (n=8423). Pregnant women had significantly higher odds of receiving MOUD (aOR = 2.42, 95%CI: 2.30, 2.54) compared to non-pregnant women. Non-white race, treatment setting, and treatment self-referral were also associated with higher levels of MOUD. Conclusions We identified a significant unmet need among both pregnant and non-pregnant women with OUD seeking care in publicly funded treatment clinics. While women who are pregnant are significantly more likely to receive evidence-based treatment with MOUD, still 47.21% of pregnant women did not receive MOUD. All reproductive-aged women with OUD should be offered evidence-based treatment options, including MOUD.
Collapse
Affiliation(s)
- Jennifer K. Bello
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | - Aaron M. Laxton
- School of Social Work, Saint Louis University, St. Louis, MO, USA
- Assisted Recovery Centers of America, St. Louis, MO, USA
| | - Mary Conte
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Lynn Chen
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
3
|
Elmore AL, Boghossian NS, McLain AC, McDermott S, Salemi JL. Trends in maternal opioid use: Statewide differences by sociodemographic characteristics in Florida from 2000 to 2019. J Addict Dis 2024:1-11. [PMID: 38369773 DOI: 10.1080/10550887.2024.2302285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND Maternal opioid use (MOU) remains a public health concern. Studies have demonstrated significant increases in MOU, but estimates using ICD-10-CM or stratified by sociodemographic variables are limited. OBJECTIVES Using a statewide, population-based dataset of Florida resident deliveries from 2000 to 2019, we examined the trend of MOU by age, race/ethnicity, education level, and insurance. METHODS Florida administrative data was used to conduct a retrospective cohort study. MOU was identified using opioid-related hospital discharge diagnoses documented prenatally or at delivery. Maternal sociodemographic variables were obtained from Florida vital statistics. Joinpoint regression was used to identify statistically significant changes in the trends overall and stratified by sociodemographic variables. Results are presented as annual percentage changes (APC) and 95% confidence intervals. RESULTS Our sample included over 3.6 million Florida resident mothers; of which, MOU was identified in 1% (n = 22,828) of the sample. From 2000 to 2019, MOU increased over ten-fold from 8.7 to 94.7 per 10,000 live birth deliveries. MOU increased significantly from 2000 to 2011 (APC: 32.8; 95% CI: 29.4, 36.2), remained stable from 2011 to 2016, and decreased significantly from 2016 to 2019 (APC: 3.9; 95% CI: -6.6, -1.0). However, from 2016 to 2019, MOU increased among non-Hispanic Black mothers (APC: 9.2; 95% CI: 7.5, 11.0), and those ages 30-34 (APC: 2.9; 95% CI: 1.2, 4.6) and 35-39 (APC: 6.4; 95% CI: 4.3, 8.4). CONCLUSIONS Accurate prevalence estimates of MOU by sociodemographic factors are necessary to fully understand prevalence trends, describe the burden among sub-populations, and develop targeted interventions.
Collapse
Affiliation(s)
- Amanda L Elmore
- College of Public Health, University of South Florida, Tampa, FL, USA
- Department of Biostatistics and Epidemiology, University of South Carolina, Columbia, SC, USA
| | - Nansi S Boghossian
- Department of Biostatistics and Epidemiology, University of South Carolina, Columbia, SC, USA
| | - Alexander C McLain
- Department of Biostatistics and Epidemiology, University of South Carolina, Columbia, SC, USA
| | - Suzanne McDermott
- Department of Biostatistics and Epidemiology, University of South Carolina, Columbia, SC, USA
- City University of New York's Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Jason L Salemi
- College of Public Health, University of South Florida, Tampa, FL, USA
| |
Collapse
|
4
|
Green VR, Kennedy-Hendricks A, Saloner B, Bandara S. Substance use and treatment characteristics among pregnant and non-pregnant females, 2015-2019. Drug Alcohol Depend 2024; 254:111041. [PMID: 38043227 DOI: 10.1016/j.drugalcdep.2023.111041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION In the United States (US), pregnant females who use substances face increased morbidity and mortality risks compared to non-pregnant females. This study provides a national snapshot of substance use and treatment characteristics among US reproductive-aged females, including those who are pregnant. METHODS Our sample included females aged 15-44 years (n=97,830) from the 2015-2019 National Survey on Drug Use and Health (NSDUH) data. We calculated weighted percentages of past-month alcohol or drug use and past-year substance use disorder (SUD), stratified by pregnancy status. We also calculated weighted percentages of past-year treatment setting and payer. Pearson chi-square tests were conducted to determine if percentages were statistically significantly different. RESULTS Compared to non-pregnant females, pregnant females had lower prevalence of past-month illicit drug use excluding cannabis (1.6% vs. 4.3%, p<0.01), cannabis use (5.3% vs. 12.5%, p<0.01), binge drinking (4.5% vs. 29.3%, p<0.01) and past-year SUD (7.1 vs. 8.8%, p<0.01). Less than 13% of females with SUD received treatment regardless of pregnancy status, but treatment use was higher among pregnant females compared to non-pregnant females (12.8% vs. 10.5%). However, there were no statistically significant differences in past-year treatment use, setting, or treatment payer. DISCUSSION The prevalence of substance use and SUD was lower among pregnant females compared to non-pregnant females in 2015-2019. Low uptake of substance use treatment suggests that barriers exist to treatment-seeking among reproductive-aged women. Further exploration of stigma, payment, and access to treatment, and how they differ by pregnancy status, is needed.
Collapse
Affiliation(s)
- Victoria R Green
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Alene Kennedy-Hendricks
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Brendan Saloner
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Sachini Bandara
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| |
Collapse
|
5
|
Grossarth S, Osmundson SS, Wiese AD, Phillips SE, Pham A, Leech AA, Patrick SW, Spieker AJ, Grijalva CG, Adgent MA. Maternal Opioid Use Disorder and the Risk of Postneonatal Infant Mortality. JAMA Pediatr 2023; 177:675-683. [PMID: 37155175 PMCID: PMC10167598 DOI: 10.1001/jamapediatrics.2023.1047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/17/2023] [Indexed: 05/10/2023]
Abstract
Importance The risk of serious long-term outcomes for infants born to individuals with opioid use disorder (OUD) is not fully characterized, nor is it well understood whether risks are modified by infant diagnosis of neonatal opioid withdrawal syndrome (NOWS). Objective To characterize the risk of postneonatal infant mortality among infants with a NOWS diagnosis or born to individuals with OUD. Design, Setting, and Participants The study team conducted a retrospective cohort study of 390 075 infants born from 2007 through 2018 to mothers who were enrolled in Tennessee Medicaid from 183 days prior to delivery through 28 days post partum (baseline). Maternal and infant baseline characteristics were measured using administrative claims and birth certificates, and infants were followed up from day 29 post partum through day 365 or death. Deaths were identified using linked death certificates through 2019. These data were analyzed from February 10, 2022, through March 3, 2023. Exposure Infant exposures included birth to an individual with OUD or postnatal diagnosis of NOWS. The study team defined a pregnant individual's OUD status (maternal OUD) as having OUD diagnosis or a maintenance medication prescription fill during baseline; this study defined NOWS as having NOWS diagnosis up to day 28. Groups were categorized by exposures as maternal OUD with NOWS (OUD positive/NOWS positive), maternal OUD without NOWS (OUD positive/NOWS negative), no documented maternal OUD with NOWS (OUD negative/NOWS positive), and no documented maternal OUD or NOWS (OUD negative/NOWS negative, unexposed). Main Outcome and Measures The outcome was postneonatal infant death, confirmed by death certificates. Cox proportional hazards models were used, adjusting for baseline maternal and infant characteristics, to estimate adjusted hazard ratios (aHRs) and 95% CIs for the association between maternal OUD or NOWS diagnosis with postneonatal death. Results Pregnant individuals in the cohort had a mean (SD) age of 24.5 (5.2) years; 51% of infants were male. The study team observed 1317 postneonatal infant deaths and incidence rates of 3.47 (OUD negative/NOWS negative, 375 718), 8.41 (OUD positive/NOWS positive, 4922); 8.95 (OUD positive/NOWS negative, 7196), and 9.25 (OUD negative/NOWS positive, 2239) per 1000 person-years. After adjustment, the risk of postneonatal death was elevated for all groups, relative to the unexposed: OUD positive/NOWS positive (aHR, 1.54; 95% CI, 1.07-2.21), OUD positive/NOWS negative (aHR, 1.62; 95% CI, 1.21-2.17), and OUD negative/NOWS positive (aHR, 1.64; 95% CI, 1.02-2.65). Conclusions and Relevance Infants born to individuals with OUD or with a NOWS diagnosis had an increased risk of postneonatal infant mortality. Future work is necessary to create and evaluate supportive interventions for individuals with OUD during and after pregnancy to reduce adverse outcomes.
Collapse
Affiliation(s)
- Sarah Grossarth
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah S. Osmundson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew D. Wiese
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sharon E. Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amelie Pham
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ashley A. Leech
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephen W. Patrick
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Mildred Stahlman Division of Neonatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew J. Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carlos G. Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Veterans’ Health Administration Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Nashville
| | - Margaret A. Adgent
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
6
|
Banks DE, Fentem A, Li X, Paschke M, Filiatreau L, Woolfolk C, Cavazos-Rehg P. Attitudes Toward Medication for Opioid Use Disorder Among Pregnant and Postpartum Women and People Seeking Treatment. J Addict Med 2023; 17:356-359. [PMID: 37267191 PMCID: PMC10248185 DOI: 10.1097/adm.0000000000001113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Pregnant and postpartum women and people (PPWP) who use opioids experience higher rates of morbidity, preterm labor, and stillbirth than those who do not. Although medication for opioid use disorder (MOUD) is the standard of treatment, utilization among PPWP has remained low because of MOUD stigma and misconceptions. The current report examined general and pregnancy-related MOUD attitudes, norms, and self-efficacy among PPWP seeking treatment. METHODS Participants (n = 33) receiving MOUD at a Midwestern clinic reported beliefs about MOUD in general using the Attitudes toward Methadone Questionnaire (modified to include all MOUD) and during pregnancy/postpartum using an investigator-generated scale based on previous research. Participants responded using a 5-point scale from "strongly agree" to "strongly disagree" with higher scores indicating more positive attitudes. Analyses examined the bivariate association of attitudes with MOUD subjective norms and self-efficacy, also measured via investigator-generated scales. RESULTS Respondents reported positive attitudes toward MOUD use during pregnancy, with most agreeing it was safe. However, up-to-half of participants reported uncertainty regarding the appropriate dosage of MOUD and its impact on the fetus and/or neonate. Both general and pregnancy/postpartum-related MOUD attitudes were positively associated with subjective norms toward MOUD. CONCLUSIONS Pregnant and postpartum women and people reported high uncertainty about MOUD use despite currently using it, emphasizing the need for strategies that assess and mitigate MOUD-related stigma. Findings suggest that familial support and stigma impact attitudes toward MOUD and highlight the importance of accurate psychoeducation and social supports for patients and their families to improve the acceptance and utilization of MOUD among PPWP.
Collapse
Affiliation(s)
- Devin E. Banks
- Department of Psychological Sciences, University of Missouri – St. Louis, One University Blvd. 325 Stadler Hall, St. Louis, MO 63121
| | - Andrea Fentem
- Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Xiao Li
- Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Maria Paschke
- Department of Psychological Sciences, University of Missouri – St. Louis, One University Blvd. 325 Stadler Hall, St. Louis, MO 63121
| | - Lindsey Filiatreau
- Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Candice Woolfolk
- Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Patricia Cavazos-Rehg
- Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| |
Collapse
|
7
|
Elmore AL, Patrick SW, McNeer E, Fryer K, Reid CN, Sappenfield WM, Mehra S, Salemi JL, Marshall J. Treatment access for opioid use disorder among women with medicaid in Florida. Drug Alcohol Depend 2023; 246:109854. [PMID: 37001322 PMCID: PMC10121896 DOI: 10.1016/j.drugalcdep.2023.109854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/15/2023] [Accepted: 03/19/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION Opioid use disorder (OUD) remains prevalent. Medications for OUD (MOUD) are standard care for pregnant and non-pregnant women. Previous research has identified barriers to MOUD for women with Medicaid but did not account for the type of MOUD (methadone vs. buprenorphine) or pregnancy status. We examined access to MOUD by treatment type for pregnant and non-pregnant women with Medicaid in Florida. METHODS A secondary analysis of Florida "secret-shopper" data was conducted. Calls were made to clinicians from the 2018 Substance Abuse and Mental Health Services Administration provider list by women posing as either a pregnant or non-pregnant woman with OUD and Medicaid. We examined 546 calls to buprenorphine-waivered providers (BWP) and 139 to opioid treatment programs (OTP). Counts and percentages were used to describe caller success by type of treatment and pregnancy status. Chi-square tests were used to identify statistical differences. RESULTS Only 42 % of calls reached a treatment provider in Florida. Pregnant and non-pregnant women were less likely to obtain an appointment with Medicaid coverage by a BWP than an OTP (p < 0.01). Nearly 40 % of OTPs offered appointments to callers with Medicaid compared to only 17 % of BWPs. Both types of providers denied appointments more often for pregnant women. Thirty-eight percent of BWP's and 12 % of OTP's denied appointments to pregnant women using cash or Medicaid payment. CONCLUSIONS Our study demonstrates logistical and financial barriers to treatment for OUD among pregnant and non-pregnant women with Medicaid in Florida and highlights the need for improved systems of care.
Collapse
Affiliation(s)
- Amanda L Elmore
- College of Public Health, University of South Florida, Tampa, FL, United States.
| | - Stephen W Patrick
- Vanderbilt Center for Child Health Policy & Departments of Pediatrics and Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Elizabeth McNeer
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kimberly Fryer
- Department of Obstetrics & Gynecology, University of South Florida, Tampa, FL, United States
| | - Chinyere N Reid
- College of Public Health, University of South Florida, Tampa, FL, United States
| | | | - Saloni Mehra
- College of Public Health, University of South Florida, Tampa, FL, United States
| | - Jason L Salemi
- College of Public Health, University of South Florida, Tampa, FL, United States
| | - Jennifer Marshall
- College of Public Health, University of South Florida, Tampa, FL, United States
| |
Collapse
|
8
|
Kitsantas P, Aljoudi SM, Baker KM, Peppard L, Oh KM. Racial/ethnic differences in medication for addiction treatment for opioid use disorders among pregnant women in treatment facilities supported by state funds. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 148:208960. [PMID: 37102193 DOI: 10.1016/j.josat.2023.208960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/31/2022] [Accepted: 01/17/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Medication for addiction treatment (MAT) for opioid use disorder (OUD) in pregnant women is known to improve neonatal health outcomes. Despite the benefits of this evidence-based treatment for OUD, MAT has been underutilized during pregnancy among certain racial/ethnic groups of women in the United States. The purpose of this study was to examine racial/ethnic differences and factors that affect MAT administration among pregnant women with OUD seeking treatment at publicly funded facilities. METHODS We used data from the 2010-2019 Treatment Episode Data Set system. The analytic sample included 15,777 pregnant women with OUD. We built logistic regression models to examine associations between race/ethnicity and MAT and determine differences and similarities in factors that may influence the use of MAT across racial/ethnic groups of pregnant women with OUD. RESULTS Although in this sample only 31.6 % received MAT, an increasing trend of MAT receipt has been observed during 2010-2019. Approximately 44 % of the Hispanic pregnant women received MAT, and this was significantly higher than non-Hispanic Black (27.1 %) and White (31.3 %) women. Even after adjusting for potential confounders, the adjusted odds of receiving MAT during pregnancy were lower for Black (AOR = 0.57, 95 % CI 0.44, 0.75) and White (AOR = 0.75, 95 % CI 0.61, 0.91) women compared to Hispanic women. Not being in the labor force increased the odds of receiving MAT in Hispanic women relative to their employed counterparts while homelessness or dependent living decreased the odds of MAT for White women compared to those living independently. Regardless of their racial/ethnic background, pregnant women younger than 29 years old were less likely to receive MAT relative to older women; however, if they were arrested once prior to admission to treatment, they had significantly higher odds of receiving MAT than those with no arrests. Treatment of at least 7 months was associated with a higher likelihood of MAT across all racial/ethnic groups. CONCLUSIONS This study highlights the underutilization of MAT, particularly among pregnant Black and White women who seek treatment for OUD in publicly funded treatment facilities. A multi-dimensional approach to MAT intervention programs is needed to increase MAT for all pregnant women and reduce racial/ethnic inequities.
Collapse
Affiliation(s)
- Panagiota Kitsantas
- Department of Health Administration and Policy, George Mason University, 4400 University Dr., MS 1J3, Fairfax, VA 22030-4444, United States of America.
| | - Salman M Aljoudi
- Department of Health Administration and Policy, George Mason University, 4400 University Dr., MS 1J3, Fairfax, VA 22030-4444, United States of America
| | - Kelley M Baker
- Department of Health Administration and Policy, George Mason University, 4400 University Dr., MS 1J3, Fairfax, VA 22030-4444, United States of America
| | - Lora Peppard
- Washington/Baltimore HIDTA 1800 Alexander Bell Drive, Suite 300, Reston, VA 20191
| | - Kyeung Mi Oh
- School of Nursing, George Mason University, 4400 University Dr., MS 3C4, Fairfax, VA 22030-4444, United States of America
| |
Collapse
|
9
|
Worth T. Caring for people and their babies in the opioid crisis. Nature 2022; 612:S56-S58. [PMID: 36536217 DOI: 10.1038/d41586-022-04347-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
10
|
Zivin K, Allen L, Barnes AJ, Junker S, Kim JY, Tang L, Kennedy S, Ahrens KA, Burns M, Clark S, Cole E, Crane D, Idala D, Lanier P, Mohamoud S, Jarlenski M, McDuffie MJ, Talbert J, Gordon AJ, Donohue JM. Design, Implementation, and Evolution of the Medicaid Outcomes Distributed Research Network (MODRN). Med Care 2022; 60:680-690. [PMID: 35838242 PMCID: PMC9378530 DOI: 10.1097/mlr.0000000000001751] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the US, Medicaid covers over 80 million Americans. Comparing access, quality, and costs across Medicaid programs can provide policymakers with much-needed information. As each Medicaid agency collects its member data, multiple barriers prevent sharing Medicaid data between states. To address this gap, the Medicaid Outcomes Distributed Research Network (MODRN) developed a research network of states to conduct rapid multi-state analyses without sharing individual-level data across states. OBJECTIVE To describe goals, design, implementation, and evolution of MODRN to inform other research networks. METHODS MODRN implemented a distributed research network using a common data model, with each state analyzing its own data; developed standardized measure specifications and statistical software code to conduct analyses; and disseminated findings to state and federal Medicaid policymakers. Based on feedback on Medicaid agency priorities, MODRN first sought to inform Medicaid policy to improve opioid use disorder treatment, particularly medication treatment. RESULTS Since its 2017 inception, MODRN created 21 opioid use disorder quality measures in 13 states. MODRN modified its common data model over time to include additional elements. Initial barriers included harmonizing utilization data from Medicaid billing codes across states and adapting statistical methods to combine state-level results. The network demonstrated its utility and addressed barriers to conducting multi-state analyses of Medicaid administrative data. CONCLUSIONS MODRN created a new, scalable, successful model for conducting policy research while complying with federal and state regulations to protect beneficiary health information. Platforms like MODRN may prove useful for emerging health challenges to facilitate evidence-based policymaking in Medicaid programs.
Collapse
Affiliation(s)
- Kara Zivin
- Department of Veterans Affairs, University of Michigan Ann Arbor, MI
| | | | | | | | | | - Lu Tang
- University of Pittsburgh, Pittsburgh, PA
| | | | | | | | | | - Evan Cole
- University of Pittsburgh, Pittsburgh, PA
| | | | - David Idala
- The Hilltop Institute, University of Maryland Baltimore County, Baltimore, MD
| | - Paul Lanier
- University of North Carolina at Chapel Hill, Pittsboro NC
| | - Shamis Mohamoud
- The Hilltop Institute, University of Maryland Baltimore County, Baltimore, MD
| | | | | | | | - Adam J Gordon
- Department of Veterans Affairs, University of Utah Salt Lake City, UT
| | | |
Collapse
|
11
|
Jarlenski M, Chen Q, Ahrens KA, Allen L, Austin AE, Chappell C, Donohue JM, Hammerslag L, Lanier P, Joan McDuffie M, Talbert J, Tang L, Krans EE. Postpartum Follow-up Care for Pregnant Persons With Opioid Use Disorder and Hepatitis C Virus Infection. Obstet Gynecol 2022; 139:916-918. [PMID: 35576352 PMCID: PMC9170182 DOI: 10.1097/aog.0000000000004760] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/10/2022] [Indexed: 11/27/2022]
Abstract
Among Medicaid-enrolled pregnant persons with opioid use disorder, one third are diagnosed with hepatitis C virus, but only 6% receive postpartum follow-up or medication treatment.
Collapse
Affiliation(s)
- Marian Jarlenski
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA
| | - Qingwen Chen
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA
| | | | - Lindsay Allen
- Department of Health Policy, Management, and Leadership, West Virginia University School of Public Health, Morgantown, WV
| | - Anna E. Austin
- Department of Maternal and Child Health, University of North Carolina-Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC
| | - Catherine Chappell
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA
| | - Julie M. Donohue
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA
| | - Lindsay Hammerslag
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy
| | - Paul Lanier
- School of Social Work, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Mary Joan McDuffie
- Center for Community Research and Service, University of Delaware, Newark, DE
| | - Jeffrey Talbert
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy
| | - Lu Tang
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, PA
| | - Elizabeth E Krans
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|