Assessment of Racial and Ethnic Disparities in the Use of Medication to Treat Opioid Use Disorder Among Pregnant Women in Massachusetts

Abstract

IMPORTANCE Racial and ethnic disparities persist across key health and substance use treatment outcomes for mothers and infants. The use of medications, such as methadone or buprenorphine, for the treatment of opioid use disorder (OUD) has been associated with improvements in the outcomes of mothers and infants; however, only half of all pregnant women with OUD receive these medications. The extent to which maternal race or ethnicity is associated with the use of medication to treat OUD, the duration of the use of medication to treat OUD, and the type of medication used to treat OUD during pregnancy are unknown.OBJECTIVE To examine the extent to which maternal race and ethnicity is associated with the use of medications for the treatment of OUD in the year before delivery among pregnant women with OUD. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study used a linked populationlevel statewide data set of pregnant women with OUD who delivered a live infant in Massachusetts between October 1, 2011, and December 31, 2015. Of 274 234 total deliveries identified, 5247 deliveries among women with indicators of having OUD were included in the analysis. Maternal race and ethnicity were defined as white non-Hispanic, black non-Hispanic, or Hispanic based on selfreported data on birth certificates. MAIN OUTCOMES AND MEASURESMain outcomes were the receipt of any medication for OUD, the consistency of the use of medication (at least 6 continuous months of use before delivery, inconsistent use, or no use) for the treatment of OUD, and the type of medication (methadone or buprenorphine) used to treat OUD. Multivariable models were adjusted for maternal sociodemographic characteristics, comorbidities, and any significant interactions between the covariates and race and ethnicity. RESULTSThe sample included 5247 pregnant women with OUD who delivered a live infant in Massachusetts during the study period. The mean (SD) maternal age at delivery was 28.7 (5.0) years; 4551 women (86.7%) were white non-Hispanic, 462 women (8.8%) were Hispanic, and 234 women (4.5%) were black non-Hispanic. A total of 3181 white non-Hispanic women (69.9%) received any type of medication for the treatment of OUD in the year before delivery compared with 228 Hispanic women (49.4%) and 108 black non-Hispanic women (46.2%). Compared with white non-Hispanic women, black non-Hispanic and Hispanic women had a substantially lower likelihood (adjusted odds ratio [aOR], 0.37; 95% CI, 0.28-0.49 and aOR, 0.42; 95% CI, 0.35-0.52, respectively) of receiving any medication for the treatment of OUD. Stratification by maternal age identified greater disparities among younger women. Black non-Hispanic and Hispanic women also had a lower likelihood (aOR, 0.24; 95% CI, 0.17-0.35 and aOR, 0.34; 95% CI, 0.27-0.44, respectively) of consistent use of medication for the treatment of OUD compared with white non-Hispanic women. With respect to (continued) Key Points Question Do differences by maternal race and ethnicity exist in the use of methadone or buprenorphine...

Updates from the Literature, November/December 2020

“…The authors note that there is a need to understand why one‐third of the women received no medication treatment for OUD. They do speculate as to underlying reasons for these disparities which include punitive policies that target women of color and racial discrimination by providers, among others 10 …”

“…Race and ethnicity explained only 2.7% to 3% of the total variance in the models, which means that, statistically, race and ethnicity did not explain much of the difference in receiving treatment for OUD as the model was conceptualized. The authors note that this means that there are potentially many factors not in their models that are associated with OUD treatment in pregnancy 10 . (p 10) In terms of method, the authors used statistical model building criteria, a process that is open to criticism because statistical significance is arbitrary and may be influenced by the number of observations.…”

“…A stronger approach would have been to use a combination of theory, prior research findings, and clinical expertise. The way pregnant women with OUD were identified also raises concerns because Black and Hispanic women were more likely to be identified as having OUD by NAS diagnosis alone 10 . (p 5) The authors note that Black and Hispanic women aged less than 25 years were the least likely to receive OUD treatment 10 .…”

“…The way pregnant women with OUD were identified also raises concerns because Black and Hispanic women were more likely to be identified as having OUD by NAS diagnosis alone 10 . (p 5) The authors note that Black and Hispanic women aged less than 25 years were the least likely to receive OUD treatment 10 . (p 7) The description of the aOR for Black and Hispanic women aged less than 25 years to receive any medication treatment for OUD, compared with white women of the same age, is incorrect.…”

Commentary on Jin et al. (2020): Regulatory and allocative policies inform access to opioid agonist therapy

“…In addition to differences in access by OAT type, racial disparities in OAT access persist. Compared with White women, Black and Hispanic women are significantly less likely to receive any medication for OUD treatment [12]. Similarly, Black veterans receiving care in the Veterans Health Administration have lower odds of starting buprenorphine compared to White patients [13].…”