Opiate Use Disorder Medication Based on Race, Age, Insurance | Image credit: © Kimberly Boyles – © Kimberly Boyles – stock.adobe.com.
Medication disparities for opioid use disorder (MOUD) have been observed based on race, age and insurance status, according to data recently released by the CDC.
In the United States, the incidence rate of opioid use disorder (OUD) among pregnant women increased from 1.5 per 1,000 birth hospitalizations in 1999 to 6.5 per 1,000 birth hospitalizations in 2014. MOUD as Buprenorphine and methadone are often given to pregnant women with OUD, but knowledge of the risks and benefits is still lacking.
Although other treatment options are not often seen as first-line treatment, patients may receive non-pharmacological options, switch between different types of MOUD, or have active substance use during pregnancy. These complexities have led to the need to collect comprehensive data on MOUD administration.
In the CDC report, data on individuals with OUD during pregnancy were evaluated by a collaboration between the CDC and the Institute for Public Health Informatics.
Data collection was performed through a surveillance network known as the Maternal and Infant Network for Understanding Medication-Related Outcomes for Opioid Use Disorder in Pregnancy (MAT-LINK). “Maternal” is defined as anyone who is pregnant or has given birth.
MAT-LINK collected data from clinical sites and medical records, such as public health reports, electronic health records (EHR), laboratory records, pharmaceutical product management systems, and state surveillance data. Data extraction varies between clinical sites, along with the use and transformation of EHR data. This prevented the use of a predefined data extraction algorithm.
Data quality was reviewed by automated and manual checks by the clinical centers. This process included double-entry checking for 10% of abstract dyads and comparisons between the data and expectations from clinical experience. Detected errors were checked on site and corrected using graphics reviews. Additional quality checks were performed by the CDC.
The study cohort included individuals with OUD during pregnancy who acquired MOUD. MOUD was defined as methadone, naltrexone, and buprenorphine with or without naloxone. Although buprenorphine-based pain management medications are not included as MOUDs, they are considered potential co-exposures with other medications.
Clinical sites provided data on all OUD diagnoses during pregnancy to allow the non-MOUD population to constitute a control group. Longitudinal data on pregnant individuals up to 1 year postpartum and diagnosis codes up to 6 years postpartum were also collected. Maternal history includes demographic and pregnancy-related data.
MOUD data include patterns of initiation, duration, and dosing. Data comparison is based on time points during pregnancy. Short-term and long-term outcomes for children were collected through hospitalizations, urgent care visits, and routine follow-up visits.
Pregnancy and delivery variables were also collected, including newborn measurement, type of delivery, pain management, infection data, newborn care, discharge and readmission data, neonatal abstinence syndrome, neonatal opioid withdrawal syndrome, and both neonatal abstinence syndrome and neonatal opioid withdrawal syndrome.
Postpartum data were collected on depression, anxiety, contraception, substance exposure laboratory results, substance use screening, inpatient or residential stays, and MOUD.
There were 5541 pregnancies reported, 79.1% of which used MOUD and 20.9% of which did not use MOUD. The mean maternal age was 29.7 years, and 86.3% of participants were White, 5.8% Black, 4.7% other race, 25.4% Hispanic, 2.6% American Indian or Native American. Alaska and less than 1% Asian, Native Hawaiian, or other Pacific Islander.
Public insurance was observed in 81.6% of patients, private in 15.9%, none in 2.3% and other in less than 1%. Apart from ethnicity and urban affiliation, all demographic characteristics had a significant impact on MOUD administration. Patients are more likely to develop MOUD if they are white, older, and have public insurance.
These results are consistent with those found in other populations, providing information to support the care of pregnant individuals with OUD. With further data analysis and collaboration, the MAT-LINK system will be able to provide lessons for caring for substance users during pregnancy.
reference
Miele K, Kim SY, Jones R, et al. Medication for Opioid Use Disorder in Pregnancy—Mother and Baby Network for Understanding Outcomes Related to Medication Use for Opioid Use Disorder in Pregnancy (MAT-LINK), 2014–2021 Mr. MMWR Survey Summ. 2023; 72 (3): 1-14. doi:10.15585/mmwr.ss7203a1.