Understanding Underutilization: The Barriers and Next Steps to Treating Pregnant Women with Opioid Dependence

Abstract

Although the prevalence of opioid use disorder (OUD) has decreased in recent years, the prevalence of maternal opioid use and ensuing neonatal abstinence syndrome (NAS) has continued to rise. At the same time, the percentage of pregnant women with opioid dependence receiving the recommended therapy – medication-assisted treatment (MAT) – has decreased. MAT utilization is especially low in the South, where less than 31 percent of women receive MAT despite increasing rates of maternal opioid use. As a result, this research strives to understand under what conditions MAT is utilized or not in the treatment plans for pregnant women using opioids. Furthermore, what makes the South exceptional and what distinct circumstances do women in the South face? This study took a qualitative descriptive approach to examine policies and practices in the East South Central census division, which has the highest incidence of NAS and greatest increases in opioid use disorder among pregnant women. I conducted phone interviews with care providers and representatives from state departments of health, county public health organizations, and substance abuse recovery programs. I used a semi-structured interview guide to lead conversations on a range of issues, including the standards of care for OUD, screening for OUD, reporting requirements and law enforcement, insurance eligibility and coverage, MAT program accessibility and availability, and effective initiatives and barriers to MAT accessibility. I grouped and analyzed the data based on six themes: 1) standards of care, 2) screening practices and laws, 3) insurance eligibility and coverage, 4) MAT program availability, 5) MAT accessibility, and 6) next steps. Through these results, I argue that while there are several factors which do not make the South inconsistent with the rest of the country, there are a number of findings which differentiate the South from the rest of the country. Standards of care, screening practices, and the use of pregnancy-dependent Medicaid are consistent with national standards and guidelines. However, women in the South face punitive laws which criminalize substance use during pregnancy, a divide between rural and urban treatment access, restricted substance abuse treatment periods due to Medicaid programs that have not been expanded, and the influences of faith-based and abstinence-only treatment programs, which lead to MAT underutilization. Based on these results, I contend that states should improve treatment access by expanding Medicaid and increasing the number of treatment providers and programs, especially in rural areas. States should eliminate punitive laws, improve transportation, and increase education initiatives to battle stigmatization against addiction and MAT. Through this research, I hope that policymakers will be able to more deeply understand and break down the barriers to MAT utilization for pregnant women using opioids, thereby improving the health of women and infants in the opioid epidemic.