Trends in Medication-Based Treatment for Pregnant Women Experiencing Opioid Use Disorder

Background and Purpose. Opioid use among pregnant women in the U.S. has been on the rise in the past few decades, and poses significant health risks for both women and families. Despite the effectiveness of evidenced-based interventions like medication for opioid use disorder (MOUD), rates of treatment utilization remain low, and access to treatment varies by state. This study estimated the annual rates of MOUD among pregnant admissions into treatment programs across all 50 states, identifying temporal trends in MOUD use. The study also examined the referral pathways through which pregnant individuals enter treatment, and identified differences in MOUD utilization with regard to their referral source to treatment.

Methods. Data from the Treatment Episode Dataset- Admissions (TEDS-A) dataset were used to estimate measures of MOUD utilization from 2010 to 2018. The sample consisted of admissions of pregnant individuals with an opioid use disorder to a treatment program across 9 years, for a total of n= 84,492. MOUD utilization rate estimates were identified in four US regions (Northeast, Midwest, South, and West), and for all 50 states. Data on referral sources included seven types of referrals to treatment: self-referrals, healthcare providers, other substance use care providers, employers, schools, criminal justice or legal referrals, or other community agency referrals.

Results. In 2010, 51.7% (n= 4,140) of individuals who were pregnant received MOUD to treat OUD. By the end of the study years, the rate of MOUD use among pregnant people had increased to 55.35%. Among pregnant admissions to treatment for OUD nationwide, the proportion of those receiving MOUD as part of their treatment plan was an average of 50.8%. Rates of MOUD were consistently the lowest in the South across all years, with an average rate of 34.01% of admissions receiving MOUD. The region with consistently the highest rate of MOUD use was in the Northeast, with an average rate of 63.42% across years. Maine had the highest average rate of MOUD use, for an average of 81.99% across all years. Eight out of the 12 states in the highest quartile range of MOUD rates were located in the Northeast, and six states from the lowest quartile range of MOUD rates were located in the South and the West.

Individuals who were self-referred comprised the largest proportion of admissions leading to MOUD use, with a mean of 62.1%. The referral source leading to the lowest MOUD use rate was among those referred by criminal justice or legal referrals, including DUI’s and court-mandated treatment, with a mean of only 23.6% of those admissions leading to MOUD use.

Conclusion and Implications. Findings highlight how different referral pathways can impact whether a pregnant person receives MOUD as a part of their treatment. Namely, being self-referred and living in a state in the Northeast are associated with a higher likelihood of receiving MOUD at admission. Overall, these findings can inform the development of policies and practices designed to increase collaboration across service systems and facilitating equitable access to care such as medication for opioid use disorder.