Medication for opioid use disorder based on race, age, insurance

Medication for opioid use disorder based on race, age, insurance | Image Credit: © Kimberly Boyles - © Kimberly Boyles - stock.adobe.com.

Disparities in medication for opioid use disorder (MOUD) have been observed based on race, age, and insurance status, according to data recently published by the CDC.

In the United States, an increased rate in cases of opioid use disorder (OUD) has been observedamong pregnant women, from 1.5 per 1000 delivery hospitalizations in 1999 to 6.5 per 1000 delivery hospitalizations in 2014. MOUD such as buprenorphine and methadone are often given to pregnant women with OUD, but knowledge on risks and benefits remains lacking.

Though other treatment options are not often observed as first-line treatment, patients may receive nonpharmacologic options, switch between different types of MOUD, or have active substance use during pregnancy. These complexities have brought about the need to collect comprehensive data on MOUD administration.

In the CDC’s report, data on individuals with OUD during pregnancy was evaluated from a collaboration between the CDC and the Public Health Informatics Institute.

Data collection was accomplished through a surveillance network known as the Maternal and Infant Network to Understand Outcomes Associated with Medication for Opioid Use Disorder During Pregnancy (MAT-LINK). “Maternal” was defined as anyone who is pregnant or postpartum.

MAT-LINK collected data from clinical sites and medical records such as public health reports, electric health records (EHRs), laboratory records,pharmaceutical management systems, and state surveillance data. Data abstraction varied between clinical sites, along with use and transformation of EHR data. This prevented the use of a preset algorithm for data extraction.

Data quality was reviewed through automatic and manual checks by the clinical sites. This process included dual entry verification for 10% of abstracted dyads and comparisons between the data and expectations from clinical experiences. Errors found were spot checked and fixed using chart reviews. Further quality checks were conducted by the CDC.

The study cohort included individuals with OUD during pregnancy who received MOUD. MOUD was defined as methadone, naltrexone, and buprenorphine with or without naloxone. While buprenorphine-based medications for pain management were not included as MOUD, they were considered as potential co-exposure with other medications. 

Clinical sites provided data on all diagnoses of OUD during pregnancy to allow a non-MOUD population to comprise a control group.Longitudinal data on pregnant individuals through 1 year postpartum and diagnosis codes up to 6 years postpartum were also collected. Maternal history included demographic and pregnancy-related data.

MOUD data included initiation, duration, and dosing patterns. Data comparison was based on timepoints during pregnancy.Short- and long-term child outcomes were collected through hospitalizations, acute care visits, and routine follow-up visits.

Pregnancy and delivery variables were also collected, including newborn measurement, delivery type, 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.

In the postpartum period, data was 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 races, 25.4% Hispanic, 2.6% American Indian or Alaska Native, and less than 1% Asian, Native Hawaiian, orother Pacific Islander.

Public insurance was seen in 81.6% of patients, private in 15.9%, none in 2.3%, and other in under 1%. Besides ethnicity and urbanicity, all demographic characteristics had significant impacts on MOUD administration. Patients were more likely to receive MOUD if they were White, older, and had public insurance. 

These results were consistent with those found in other populations, providing information to support care for pregnant individuals with OUD. With further data analysis and collaboration, the MAT-LINK system will be able to provide lessons for care in individuals with substance use during pregnancy.

Reference

Miele K, Kim SY, Jones R, et al. Medication for opioid use disorder during pregnancy — maternal and infant network to understand outcomes associated with use of medication for opioid use disorder during pregnancy (MAT-LINK), 2014–2021. MMWR Surveill Summ. 2023;72(3):1-14. doi:10.15585/mmwr.ss7203a1.