(96) Perinatal Opioid Use Disorder: Postpartum Access to Healthcare and Opioid Use Treatment

Introduction
Current guidelines for clinical management of perinatal opioid use disorder (OUD) recommend medications for opioid use disorder (MOUD), including buprenorphine products or methadone, as part of comprehensive treatment for at least one year postpartum. However, little evidence exists on the postpartum utilization and continuation of these services. The purpose of this study was to examine postpartum healthcare utilization and identify needs among a postpartum Medicaid population of patients diagnosed with OUD during pregnancy.
Methods
We queried North Carolina Medicaid medical and pharmacy claims to identify individuals with a live delivery and evidence of opioid use disorder during pregnancy from 2015 to 2020. We examined any evidence of postpartum healthcare utilization, and evidence of MOUD during postpartum. We also determined the impact that four factors may have had on these outcomes: type of Medicaid coverage (Medicaid for Pregnant Women [MPW] as compared to other types of coverage); living in rural vs urban areas; race (white vs non-white); and the prenatal use of MOUD. Descriptive statistics, Kaplan-Meier curves with log-rank tests, and negative binomial regression were used. Data were analyzed in SAS (v9.4).
Results
In total, there were 6,186 individuals who were included in the study. Of those 84.5% were identified as white, 29.6% lived in rural areas, 35.0% had MPW coverage, and the average age was 28.
Of the sample, 77.4% sought at least some healthcare service during postpartum. The median number of healthcare visits was 5. Postpartum OUD patients that were MPW beneficiaries and were non-white had significantly lower rates of seeking healthcare. Further, postpartum patients who had no evidence of prenatal MOUD accessed postpartum services substantially less as compared to individuals with prenatal evidence (69% vs 82%). In the regression model, the largest predictors of postpartum healthcare utilization were living a rural area (effect estimate: -0.08), non-white (-0.16), having other types of Medicaid (0.26), receiving buprenorphine (0.53) or methadone (0.53) prenatally, the number of prenatal visits (0.03), and having no concurrent mental health diagnoses (-0.14).
Of the sample, merely 53.6% had evidence of MOUD utilization during postpartum. The largest disparities for MOUD utilization were between white and non-white patients (59% vs 27%) and between patients who did and did not utilize MOUD prenatally (93% vs 17%). Patients with MPW or those who lived in urban areas also had significantly lower rates of utilization.
The four factors not only played a significant role in commencing treatment, but also in continuing treatment. For those who had evidence of MOUD treatment during postpartum, we found significant differences in the continuation, as evidenced by the last available MOUD claim, by type of Medicaid coverage. Postpartum patients with MPW continue recommended MOUD at significantly lower rates as compared to patients with other forms of Medicaid (86% vs 93% at 60 days; 57% vs 78% at 180 days). In the regression models, the largest predictors of postpartum MOUD use was prenatal MOUD use.
Conclusions
Significant gaps in healthcare use remain across type of Medicaid coverage, racial, geographic setting, and prenatal access to care.

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Diversity, Equity, and Inclusion: As part of this study, we made a specific effort to identify health disparities of postpartum healthcare utilization for individuals with OUD according to racial strata, geographic location, and insurance coverage. These were among our primary exposures of interest in the study. These data will help policymakers understand the gaps in care that underserved populations experience.