Pregnant women with opioid use disorder (OUD) are frequently without access to addiction treatment options in one of the hardest-hit areas in the opioid epidemic, a new study finds. The study, published in the Substance Abuse journal, was led by researchers from Monroe Carell Jr. Children’s Hospital at Vanderbilt. The group analyzed whether insurance and pregnancy status were barriers to gaining access to opioid agonist therapies (OAT) – a highly effective treatment for pregnant women with OUD.
OAT has been demonstrated to improve treatment retention, reduce relapse risk, reduce risk of overdose death, and improve birth weights, among other benefits. In November 2017, the President’s Commission on Combating Drug Addiction and the Opioid Crisis named expanding access to OAT as a chief goal.
“This study highlights many of the challenges we face in ensuring the best outcomes for women with opioid use disorder and their babies,” said William O. Cooper, M.D., a professor of pediatrics and health policy at Vanderbilt and senior author on the study. “Connecting mothers to the optimal treatment is an important priority.”
Surveying Treatment Providers
OAT providers – including opioid treatment programs (OTPs) that typically require daily outpatient visits and outpatient buprenorphine providers that usually require fewer visits—in Kentucky, North Carolina, Tennessee, and West Virginia were surveyed for the study on what insurance plans they accepted and whether they treat pregnant women.
The four Appalachian states surveyed in the study have been disproportionately impacted by opioid deaths, with West Virginia leading the nation in overdose deaths, neonatal opioid withdrawal, and pregnant women with hepatitis C virus.
The researchers found that providers regularly did not accept any insurance and frequently did not treat pregnant women. Ninety-one percent of OAT providers were accepting new patients, but only 75 percent were accepting pregnant patients. Just 53 percent of outpatient buprenorphine providers accepted pregnant patients compared to 91 percent of opioid treatment programs.
Patients who could pay with cash had the best chance of accessing treatment. All OTPs and 89 percent of outpatient buprenorphine providers accepted cash payments. Medicaid acceptance varied widely across the four states, from a high of 83.3 percent to a low of 13.6 percent in Tennessee. Private insurance acceptance rates were all slightly lower than Medicaid acceptance except for in Tennessee, where private insurance was accepted about three times as often as Medicaid. Pregnant women were 85 percent less likely to be accepted for treatment if they had insurance compared to paying in cash.
The study also found that wait times, especially at outpatient buprenorphine providers, can be up to several weeks for pregnant women paying with insurance, a dangerous delay in care for mother and child. Buprenorphine has been found to be especially helpful for neonatal withdrawal.
The study points to several steps providers and states could take to improve access to OATs for pregnant women and other patients. This includes training obstetricians to become DATA (Drug Addiction Treatment Act of 2000)-waivered, which allows providers to prescribe buprenorphine, and training current DATA-waivered providers to care for pregnant women.
States across the country treat substance use in pregnancy is vastly different ways, with 24 considering it child abuse and just 19 states having created treatment programs specifically for pregnant women. With the opioid epidemic increasing in size and complexity, the researchers advised that state policies prioritizing pregnant women to treatment rather than punishment may lead to healthier outcomes.
“We know that opioid agonist therapies work, but only a fraction of people that have opioid use disorder are actually getting them,” said Stephen Patrick, M.D., director of the Vanderbilt Center for Child Health Policy. “We are seeing record high numbers of opioid-related overdose deaths, and there is an urgent need to reduce barriers to treatment to save lives.”