Curran, Laura and Manuel, Jennifer (2024) The receipt of medications for opioid use disorder among pregnant individuals in the USA: a multilevel analysis. Drugs, Habits and Social Policy, 25, (1), pp. 51-66. https://doi.org/10.1108/DHS-08-2023-0030.
External website: https://www.emerald.com/insight/content/doi/10.110...
Purpose: This study aims to examine the relationship between medication for opioid use disorder (MOUD) among pregnant individuals, referral source, mental health, political affiliation and substance use policies in all 50 states in the USA.
Design/methodology/approach: This study describes MOUD receipt among pregnant people with an opioid use disorder (OUD) in 2018. The authors explored sociodemographic differences in MOUD receipt, referrals and co-occurring mental health disorders. The authors included a comparison of MOUD receipt among states that have varying substance use policies and examined the impact of these policies and the political affiliation on MOUD. The authors used multilevel binary logistic regression to examine effects of individual and state-level characteristics on MOUD.
Findings: Among 8,790 pregnant admissions with OUD, the majority who received MOUD occurred in the Northeast region (71.52%), and 14.99% were referred by the criminal justice system (n = 1,318). Of those who were self-referred, 66.39% received MOUD, while only 30.8% of referrals from the criminal justice system received MOUD. Those referred from the criminal justice system or who had a co-occurring mental health disorder were least likely to receive MOUD. The multilevel model showed that while policies were not a significant predictor, a state’s political affiliation was a significant predictor of MOUD.
Research limitations/implications: The study has some methodological limitations; a state-level analysis, even when considering the individual factors, may not provide sufficient description of community-level or other social factors that may influence MOUD receipt. This study adds to the growing literature on the ineffectiveness of prenatal substance use policies designed specifically to increase the use of MOUD. If such policies are consistently assessed as not contributing to substantial increase in MOUD among pregnant women over time, it is imperative to investigate potential mechanisms in these policies that may not facilitate MOUD access the way they are intended to.
Practical implications: Findings from this study aid in understanding the impact that a political affiliation may have on treatment access; states that leaned more Democratic were more likely to have higher rates of MOUD, and this finding can lead to research that focuses on how and why this contributes to greater treatment utilization. This study provides estimates of underutilization at a state level and the mechanisms that act as barriers, which is a stronger assessment of how state-specific policies and practices are performing in addressing prenatal substance use and a necessary step in implementing changes that can improve the links between pregnant women and MOUD.
B Substances > Opioids (opiates) > Opioid product > Buprenorphine / Suboxone
B Substances > Opioids (opiates) > Opioid product > Methadone
E Concepts in biomedical areas > Pregnancy
HJ Treatment or recovery method > Substance disorder treatment method > Substance replacement method (substitution) > Opioid agonist treatment (methadone maintenance / buprenorphine)
T Demographic characteristics > Pregnant woman
VA Geographic area > United States
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