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Pregnant women face barriers to opioid use disorder diagnosis, treatment
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Researchers found notable regional variations in diagnosis and treatment of opioid use disorder among pregnant women in the United States.
Although the variations in diagnosis appeared associated with the presence of state criminal or civil statues targeting pregnant women with opioid use disorder, variations in the receipt of treatment did not, according to the cohort study published in JAMA Network Open.
Pregnant women face many barriers to medication-assisted treatment (MAT), such as accessibility, insurance coverage and state laws allowing charges against pregnant women with opioid use disorders, Laura E. Gressler, MS, of the University of Maryland School of Pharmacy, and colleagues wrote.
“Pregnant women with [opioid use disorders] face not only medical consequences, such as an increased risk [for] obstetric morbidity and mortality, but also a predisposition to the potential loss of child custody and even criminalization in some states,” they wrote. “Overall, 18 states since 2012 have required health professionals to report substance use disorder in pregnant women and have established civil or criminal laws that consider substance use to be child abuse.”
Researchers evaluated the prevalence of opioid use disorder and use of MAT according to region and state statues among 110,285 commercially insured pregnant women aged 18 to 45 years who were enrolled within the IQVIA PharMetrics Plus adjudicated claims and enrollment database from 2007 to 2015. Specifically, they measured diagnosis of opioid use disorder in the 9 months prior to delivery date and the receipt of MAT in the 9 months prior to or 12 months after delivery.
Gressler and colleagues grouped women into four regions based on the state in which they lived (South, Midwest, West and Northeast), then separated women residing in states with statutes that imposed civil or criminal penalties for opioid use disorder diagnosis during pregnancy from those residing in states without these statutes.
Overall, the investigators found that 277 women (0.25%) were diagnosed with opioid use disorder and 312 (0.28%) received treatment. Of the 277 women with opioid use disorder, less than half (n = 127) received treatment.
Analysis revealed statistically significant variations in the prevalence of an opioid use disorder diagnosis and receipt of MAT by region:
- diagnosis by region: Midwest = 0.05%; North = 0.09%; South = 0.06%; West = 0.06% (2/3 = 45.1148; P < .001);
- treatment by region: Midwest = 0.05%; North = 0.08%; South = 0.1%; West = 0.05% (2/3 = 26.5654; P < .001).
Although the prevalence of opioid use disorder diagnoses was statistically significant (diagnosis by criminal statutes: criminalization = 0.07%; no criminalization = 0.18% [ 2/1 = 14.6456; P < .001]; treatment by criminal statutes: criminalization = 0.12%; no criminalization = 0.17% [ 2/1 = 0.0895]), the prevalence of treatment receipt was not (P = .76), the researchers found.
The prevalence of diagnosed opioid use disorder and the prevalence of treatment both were higher in states without statutes imposing civil or criminal penalties than those in states with these statutes, according to the results. Of the 44,683 women living in states with these statutes, 81 (0.07%) had a diagnosed opioid use disorder and 129 (0.12%) received treatment. In contrast, of the 65,602 women living in states without these criminalization statutes, 196 (0.18%) had a diagnosed opioid use disorder and 183 (0.17%) received treatment.
“In summary, in a cohort of 110,285 commercially insured pregnant women, 25 in every 10,000 women had a recorded opioid use disorder diagnosis and 28 in every 10,000 received treatment,” Gressler and colleagues wrote.
“These findings indicate a discrepancy in the diagnosis and treatment of opioid use disorder both on a regional and a legal basis,” they continued. “This study demonstrates the need for further studies into policies that reduce stigma and discrimination and that encourage the proper identification of opioid use disorder during pregnancy as part of a national quest to address the opioid epidemic among society’s most vulnerable women.” – by Savannah Demko
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Hilary S. Connery, MD, PhD
This is an interesting study that highlights the imperative at both the state and national levels to re-examine the utility and effectiveness of state-specific civil and criminal statutes regarding substance use during pregnancy to protect the unborn child from harm. The results from this study suggest that opioid use disorder is under-diagnosed in states with more severely punitive statutes as compared with states that do not have such legal consequences.
Since untreated opioid use disorder is life-threatening for both mother and child, we should be working on all fronts to find these women and engage them as soon as possible in life-saving medical treatments for opioid use disorder, such as the provision of buprenorphine and methadone maintenance services. This translates to better screening and detection services, enhanced access to care, and elimination of social and legal barriers that discourage pregnant women from receiving comprehensive prenatal care.
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