Drug treatment utilization before, during and after pregnancy

Wolfe, Ellen; Guydish, Joseph; Santos, Ann; Delucchi, Kevin; Gleghorn, Alice

doi:10.1080/14659890600823826

Cited by 11 publications

(5 citation statements)

References 21 publications

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“…Previous research has found that >50% of pregnant women who need SUD treatment receive it only during the postpartum period. 57 This finding highlights the need for programs that can provide ongoing services to ensure that parents achieve long-term recovery, which is pivotal for early childhood development.…”

Section: Role Of Parental Treatmentmentioning

confidence: 97%

The Impact of the Opioid Epidemic on Children and Adolescents

Winstanley

Stover

2019

Clinical Therapeutics

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Although an epidemic of opioid-related overdose deaths has continued to increase in the United States for 2 decades, the impact of opioid use disorders (OUDs) on children and families receives minimal attention. The purpose of this commentary was to provide an overview of the impact of the opioid epidemic on children and adolescents, as well as to summarize challenges to improving outcomes for children. Children and adolescents who grow up in households with opioid misuse and OUDs may experience a myriad of adverse consequences, including: increased risk of mental health problems and drug use; accidental opioid poisoning; increased risk of developing a substance use disorder; and family dissolution that results from parents' incarceration, foster care placement, or loss of parent to an opioid overdose. Parental drug use may result in child neglect or deficits in parentechild attachment, and parents with an OUD may be less likely to be reunified with their children. OUD treatment is effective at reducing parental opioid use and improving child outcomes; however, stigma and cross-system collaboration may limit access to treatment and timely reunification of families. Children are the most vulnerable witnesses of the opioid epidemic, and further research is urgently needed to expand prevention interventions.

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Section: Role Of Parental Treatmentmentioning

confidence: 97%

The Impact of the Opioid Epidemic on Children and Adolescents

Winstanley

Stover

2019

Clinical Therapeutics

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“…[2][3][4] The use of medications for the treatment of OUD has been associated with improvements in prenatal care adherence and pregnancy outcomes, including lower rates of preterm birth and low birth weight and reductions in maternal relapse and overdose. 2,[5][6][7] Although pregnancy provides a motivational opportunity for women with OUD to initiate treatment with medication to engage in care and increase their engagement with health care services, 8 only 50% to 60% of pregnant women with OUD use any medication for the treatment of OUD. [9][10][11] The underuse of medication for the treatment of OUD in the general population has been attributed to a shortage of treatment programs and clinicians offering medications for OUD, insufficient insurance coverage of services, and persistent stigma and misunderstanding about the use of medications for the treatment of OUD.…”

Section: Introductionmentioning

confidence: 99%

“…The use of medications for the treatment of OUD has been associated with improvements in prenatal care adherence and pregnancy outcomes, including lower rates of preterm birth and low birth weight and reductions in maternal relapse and overdose . Although pregnancy provides a motivational opportunity for women with OUD to initiate treatment with medication to engage in care and increase their engagement with health care services, only 50% to 60% of pregnant women with OUD use any medication for the treatment of OUD …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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...

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“…Research suggests that substance abuse treatment is effective in decreasing substance use and improving birth outcomes for pregnant women who attend treatment (McMurtrie et al 1999). Rates of drug treatment entry increase during pregnancy (Wolfe et al, 2007) but retaining pregnant women in treatment can be difficult (Haller et al, 1997) and therefore increasing treatment utilization has been identified as an important goal for programs treating pregnant substance users (Howard and Beckwith, 1996). Even small increases in compliance with drug treatment have been associated with improved maternal and infant outcomes (Jones, et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

Incentives for retention of pregnant substance users: A secondary analysis

Brigham

Winhusen

Lewis

et al. 2010

Journal of Substance Abuse Treatment

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Retention of pregnant substance users in treatment is challenging. In a multi-site clinical trial, 200 pregnant substance users entering outpatient treatment at 1 of 4 programs were randomized to either 3 individual sessions of Motivational Enhancement Therapy for Pregnant Substance users (MET-PS) or 3 individual sessions normally provided. Retail scrip from $25 to $30 was provided for attendance of research visits but not treatment visits. A post-hoc analysis of the non-methadone maintained participants (N=175) evaluated the hypotheses that monetary reinforcement for attendance would result in more consecutive, and overall, weeks of attendance of research versus non-incentivized treatment visits. Findings indicate participants were nearly three times as likely to attend 4 consecutive weeks of research visits versus treatment sessions. There was no effect for income while fewer dependents were associated with more consecutive weeks of attendance. Incentives in the $25 to $30 range may serve to significantly increase attendance and retention.

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Drug treatment utilization before, during and after pregnancy

Cited by 11 publications

References 21 publications

The Impact of the Opioid Epidemic on Children and Adolescents

The Impact of the Opioid Epidemic on Children and Adolescents

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

Incentives for retention of pregnant substance users: A secondary analysis

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