Barriers prevent pregnant women from accessing treatment for opioid overdose

SAN DIEGO — Medication-assisted treatment for opioid overdose remains largely inaccessible for pregnant women, according to research presented at the ACOG Annual Clinical and Scientific Meeting.

However, access would improve if more OB/GYNs secured an X-waiver license to prescribe medications like methadone and buprenorphine, Molly Tuller, MD, a third-year resident in the department of OB/GYN at the University of Louisville School of Medicine, told Healio.

“There is a huge opioid epidemic in the U.S. and we don't have a lot of OBs that have X licenses to prescribe medication-assisted treatment (MAT) therapy,” she said. “And those who do are usually centered in urban areas. Patients in rural areas, which really are the ones that can struggle the most, have to travel far to get their MAT therapy and pregnancy care.”

Tuller and colleagues surveyed obstetric care professionals over the phone in areas highly affected by the opioid epidemic. These areas included West Virginia, Kentucky, Tennessee and Ohio. The researchers asked the clinicians if they prescribed methadone or buprenorphine, managed patients who obtained the medications from other prescribers or had a preferred provider they were referring to patients.

Overall, the survey results indicated that pregnant women experienced limited access and significant barriers to obtaining medication-assisted treatment for an opioid overdose compared with nonpregnant patients. The burden of management has fallen disproportionately on academic centers and non-obstetric providers, which has limited access to treatment, Tuller and colleagues wrote.

An overwhelming majority of counties in the four states analyzed had no OB/GYN with the ability to prescribe medication-assisted treatment for opioid overdose. Also, less than 15% of counties in each of the four states had any in-office prescriber of medication-assisted treatment.

“That means our patients have to go to an OB provider to get their OB care, and then they have to go elsewhere to get their MAT prescription; that is a huge barrier,” Tuller said.

Other barriers to access may be due insurance status, cultural and provider beliefs, health workforce shortages, patient access to transportation and information, according to the researchers.

“I think there needs to be better training and education for X licenses,” Tuller said. “In our program, for example, we actually don't have anyone that has an X license, and we don't really learn about it, and we're not really encouraged to pursue getting one, and that's just how it is really across the Appalachian region.”