Trends and disparities in receipt of pharmacotherapy among pregnant women in publically funded treatment programs for opioid use disorder in the United States

Short, Vanessa L.; Hand, Dennis J.; MacAfee, Lauren K.; Abatemarco, Diane J.; Terplan, Mishka

doi:10.1016/j.jsat.2018.04.003

Cited by 79 publications

(66 citation statements)

References 18 publications

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“…In Vermont and West Virginia, for instance, OUD is present in more than 30 in 1000 women who give birth, whereas in the District of Columbia the same is true for less than 1 in 1000 women . White women are significantly more likely than women of other racial and ethnic groups to have OUD and are more likely to receive treatment than women of other racial and ethnic groups who have OUD . Medication‐assisted therapy (also referred to as opioid maintenance therapy in this article), defined as the use of medications in addition to counseling and behavioral therapies, is the recommended treatment for pregnant women with OUD…”

Section: Introductionmentioning

confidence: 99%

Breastfeeding in Women on Opioid Maintenance Therapy: A Review of Policy and Practice

Clark

2019

J Midwife Womens Health

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Introduction:Opioid use is epidemic in the United States. Opioid use disorder (OUD) in pregnancy, as well as neonatal abstinence syndrome, has quadrupled in the last decade, and opioid maintenance therapy is recommended for pregnant women with OUD. Breastfeeding is an important means of improving outcomes for these vulnerable women and newborns. The purpose of this study was to review current policy on breastfeeding and opioid maintenance therapy, the rates of breastfeeding among women in this population, and facilitators and barriers to implementing policy recommendations.Methods: CINAHL, PubMed, the Cochrane Database of Systematic Reviews, Embase, and Web of Science were searched. Inclusion criteria included publication between 2013 and 2018, English language, human only, and original data (except for policy statements). Studies were excluded if they did not report original data and did not examine breastfeeding for women on opioid maintenance therapy.Results: Eight policy statements and 17 original research studies were identified that met the search criteria. All the policy statements support breastfeeding for women who are stable on opioid maintenance therapy and do not have HIV. Despite this, rates of breastfeeding among women receiving opioid maintenance therapy remain low compared with women in the general population. Results of qualitative research indicates that women on opioid maintenance therapy face numerous barriers to breastfeeding, including misinformation from health care professionals. Quantitative research has only begun to identify interventions to improve breastfeeding outcomes in this population. Research was conducted primarily with white women receiving care at urban health care centers. Discussion:Practice lags behind policy in terms of supporting breastfeeding in women receiving opioid maintenance therapy. There is a need for more research that includes African American and rural women on opioid maintenance therapy, as well as quantitative research that uses findings from qualitative research to identify the best possible interventions for improving breastfeeding outcomes for women on opioid maintenance therapy and their newborns. One significant need is for health care provider education regarding these policies as well as best practices for providing breastfeeding education and support to this population. 545 RESULTSA total of 558 results were found, 154 duplicates were removed, and 404 titles and abstracts were screened. Of the 404 articles, 344 were excluded for failing to meet inclusion 546

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Section: Introductionmentioning

confidence: 99%

Breastfeeding in Women on Opioid Maintenance Therapy: A Review of Policy and Practice

Clark

2019

J Midwife Womens Health

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“…2 Despite the established benefit of MAT, most pregnant women with OUD receive no treatment at all. [4][5][6] Addiction is a chronic condition, and the postpartum period is associated with increased vulnerabilities, especially for pharmacotherapy discontinuation, addiction recurrence, and overdose death. [7][8][9] The impact of opioid use on the developing fetus and child is a subject of ongoing debate.…”

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confidence: 99%

Cognitive and Behavioral Impact on Children Exposed to Opioids During Pregnancy

et al. 2019

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The developmental impact of opioid use during pregnancy is a subject of ongoing debate. Short-term neonatal outcomes, such as lower birth weight and neonatal abstinence syndrome, are the most well-recognized outcomes. However, knowledge gaps exist regarding longer-term neurocognitive and mental health outcomes. In this article, we summarize an expert panel discussion that was held in April 2018 by the Substance Abuse and Mental Health Services Administration and attended by national experts in the field of perinatal opioid exposure and its impact on child development. Despite the challenges with research in this area, there is emerging literature revealing an association between neonates exposed to opioids in utero and longer-term adverse neurocognitive, behavioral, and developmental outcomes. Although adverse sequalae may not be apparent in the neonatal period, they may become more salient as children develop and reach preschool and school age. Multiple variables (genetic, environmental, and biological) result in a highly complex picture. The next steps and strategies to support families impacted by opioid use disorder are explored. Model programs are also considered, including integrated care for the child and mother, parenting supports, and augmentations to home visiting.

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“…1 Although medication-assisted treatment (MAT) with methadone or buprenorphine during pregnancy significantly reduces the risk of adverse maternal and neonatal outcomes, many pregnant women do not receive MAT, and many opioid treatment providers do not provide MAT services for pregnant women, particularly in rural areas. 2,3 Buprenorphine's officebased availability and enhanced safety profile have resulted in federal, state, and local efforts to rapidly expand the number of buprenorphine-waivered physicians to meet increased demands for substance use treatment. 4 Obstetric providers could play a critical role in filling the opioid treatment gap during pregnancy, but the number of obstetric providers prescribing buprenorphine to pregnant women remains unknown.…”

Section: Objectivementioning

confidence: 99%

Medical specialty of buprenorphine prescribers for pregnant women with opioid use disorder

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Jarlenski

Donohue

et al. 2019

American Journal of Obstetrics and Gynecology

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Trends and disparities in receipt of pharmacotherapy among pregnant women in publically funded treatment programs for opioid use disorder in the United States

Cited by 79 publications

References 18 publications

Breastfeeding in Women on Opioid Maintenance Therapy: A Review of Policy and Practice

Breastfeeding in Women on Opioid Maintenance Therapy: A Review of Policy and Practice

Cognitive and Behavioral Impact on Children Exposed to Opioids During Pregnancy

Medical specialty of buprenorphine prescribers for pregnant women with opioid use disorder

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