Abstract
Inadequate treatment of opioid use disorder (OUD) in pregnant women increases the risk of life-threatening consequences on maternal and fetal outcomes. Untreated OUD during pregnancy is associated with higher rates of adverse outcomes among newborns. To examine the variation in the prevalence of OUD and the use of medication-assisted treatment among commercially insured pregnant women according to region and state legislature. Cohort study in which the patient cohort used was derived from a 10% random sample of enrollees within the IQVIA PharMetrics Plus adjudicated claims and enrollment database from 2007 to 2015. The database consists of a 10% random sample of private health insurance recipients in the United States and contains claims and enrollment data that are representative of the commercially insured US population. The cohort comprised women (n = 110 285) between 18 and 45 years of age with a code indicating a delivery and continuous insurance enrollment 9 months before and 12 months after delivery. Data analysis was performed from December 2017 to May 2018. Based on their state of residence, the women were classified into 4 different regions: South, Midwest, West, and Northeast. Those residing in states with statutes that imposed civil or criminal penalties for OUD diagnosis during pregnancy were placed in a separate population from those residing in states without these statutes. Diagnosis of OUD in the 9 months before delivery and the receipt of medication-assisted treatment in the 9 months before or 12 months after delivery. The 110 285 pregnant women included in the analysis had a mean (SD) age of 30.26 (5.59) years, with most (67 771 [61.5%]) falling within the 26- to 35-year age range. Of this cohort, 277 women (0.25%) had a diagnosis of OUD and 312 (0.28%) received treatment. Among the 277 women with OUD, 127 (45.9%) received treatment. The prevalence of an OUD diagnosis and receipt of treatment within regions was statistically significant (OUD diagnosis by region: Midwest, 0.05%; North, 0.09%; South, 0.06%; West, 0.06%; χ23 = 45.1148 [P < .001]; OUD treatment by region: Midwest, 0.05%; North, 0.08%; South, 0.10%; West, 0.05%; χ23 = 26.5654 [P < .001]). The prevalence of OUD diagnosis was also statistically significant when comparing women residing in states with statutes with those in states without statutes (OUD diagnosis by criminal statutes: criminalization, 0.07%; no criminalization, 0.18%; χ21 = 14.6456 [P < .001]; OUD treatment by criminal statutes: criminalization, 0.12%; no criminalization, 0.17%; χ21 = 0.0895); the receipt of treatment was not statistically significant (P = .76). These results appeared to show significant variations in the patterns of OUD diagnosis and receipt of medication-assisted treatment among pregnant women, suggesting the need to further explore the source of these variations.
Highlights
In the United States, opioid misuse is a growing and prevalent concern to the care and well-being of pregnant women as it can lead to adverse maternal and neonatal outcomes
Criminal Statutes for Opioid Use Disorder and Treatment Among Pregnant Women. These results appeared to show significant variations in the patterns of opioid use disorder (OUD) diagnosis and receipt of medication-assisted treatment among pregnant women, suggesting the need to further explore the source of these variations
Opioid use among pregnant women was approximately 5.6 per 1000 live births in 2012.3,4 In a previous study of the Optum commercially insured population, an opioid was dispensed to 14.4% (1 in every 7) of pregnant women and 2.2% were given an opioid 3 or more times during pregnancy, with some variation by region and state between 2005 and 2011.5 With the rising opioid use in this population comes a concurrent increase in opioid use disorder (OUD)
Summary
In the United States, opioid misuse is a growing and prevalent concern to the care and well-being of pregnant women as it can lead to adverse maternal and neonatal outcomes. Opioid use among women of childbearing age (15-44 years) has reached epidemic proportions, and a substantial increase in opioid use among pregnant women has been reported.[1,2] Opioid use among pregnant women was approximately 5.6 per 1000 live births in 2012.3,4 In a previous study of the Optum commercially insured population, an opioid was dispensed to 14.4% (1 in every 7) of pregnant women and 2.2% were given an opioid 3 or more times during pregnancy, with some variation by region and state between 2005 and 2011.5 With the rising opioid use in this population comes a concurrent increase in opioid use disorder (OUD). Opioid withdrawal is associated with decreased neonatal birth weight; illicit drug use; relapse; and resumption of high-risk behaviors such as intravenous drug use, prostitution, and criminal activity.[6,9] Medication-assisted treatment, methadone hydrochloride or buprenorphine hydrochloride, in combination with behavioral and psychosocial counseling is the standard practice for treating pregnant and postpartum women with OUD. Such barriers are associated with a substantially decreased use of medication-assisted treatment
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