950 Association between capacity for maternal opioid agonist therapy treatment and neonatal abstinence syndrome

Abstract

To study the association between county capacity for maternal opioid agonist therapy (MOAT) and neonatal abstinence syndrome (NAS) rates in Missouri (MO). This is a retrospective cohort study examining the association between MO county NAS rates, county-level demographics, and MOAT capacity. County MOAT capacity was determined as follows: all providers listed on the Substance Abuse and Mental Health Services Administration website in December 2018 were called, and the number who accept pregnant patients was divided by the number of county births from 2014-2018. MOAT capacity was then categorized as 1) no capacity, 2) low capacity, or 3) high capacity. No capacity indicates no providers in the county prescribe OAT to pregnant women; the remaining counties were halved. Rates of NAS and opioid overdose among women aged 15-45 were provided by the MO Department of Health. County-level demographics were derived from the Area Health Resources Files. Multivariate negative binomial regression was performed to assess for associations between county demographics and NAS rates. Analyses were stratified by opioid overdose rates as a proxy for opioid use disorder prevalence. Overdose rate was divided into tertiles (low, middle, high) for stratification. The rate of NAS was 6.5 per 1,000 live births (Table1). There was a strong correlation between NAS and overdose rates (rho=0.64, p<0.0001). For counties with the highest overdose rates, rural status and higher levels of poverty, manufacturing jobs, and unemployment were associated with increased NAS rates. High capacity MOAT was associated with reduced rates of NAS in counties with low overdose rates. However, in counties with high overdose rates, increasing MOAT capacity was not associated with decreasing NAS rates. Increasing MOAT capacity may lead to reduced NAS in counties with low overdose rates, but it remains insufficient for counties with the highest overdose rates. Study findings suggest an unresolved, critical gap for MOAT treatment in areas with high opioid use disorder prevalence.