1. This study found minorities are diagnosed with opioid use disorder on average 37 days later than non-Hispanic white women during pregnancy.
2. Other factors contributing to disparities in receipt of medications for opioid use disorder may include healthcare access and quality, as well as community factors.
Evidence Rating Level: 2 (Good)
Opioid use disorder (OUD) can have adverse effects on both material and fetal well-being. Current guidelines suggest that medications for opioid use disorder (MOUD) such as methadone and buprenorphine should be given both during pregnancy and the postpartum period. Previous research has suggested that Black and Hispanic women are less likely to receive MOUD as compared to non-Hispanic white women. However, it is currently unknown what factors contribute to this concerning disparity.
This retrospective cohort study examined individual, healthcare quality and access, and community factors amongst Medicaid-enrolled women from Pennsylvania Medicaid. Only women who had a live birth from October 1, 2011 to September 30, 2017 and had a diagnosis of OUD were included (n=11,521 women with 13,320 total deliveries). Patients were excluded for any missing data or lack of follow-up at 12 weeks. Primary outcomes assessed: 1) any MOUD during pregnancy and 2) any MOUD received 12 weeks postpartum. Other secondary outcomes included various individual-level factors, healthcare access and quality factors, and community factors (such as unemployment rates).
The results show that among Medicaid-enrolled women with OUD during pregnancy, non-White/Hispanic women had significantly lower usage of MOUD, both during pregnancy and postpartum. The study also finds that healthcare access and community factors explain a larger percentage of this disparity than individual factors. The timing of diagnosis of OUD was also significantly earlier for white women. This suggests the importance of early screening. This study did have several limitations, including its sample population being limited to the state of Pennsylvania, United States and lack of extensive comorbidity data in these women. Despite these limitations, this study suggests that universal substance use screening in pregnant women and improving healthcare access may close the racial-ethic gap in MOUD use.
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