(5) Prevalence and Predictors of MAT Among Reproductive-Aged Women

Introduction: Individuals with opioid use disorder (OUD) of reproductive age who can become pregnant are at risk of having a pregnancy exposed to opioids (1). Opioid use during pregnancy increases the risk for poor maternal outcomes as well as both short- and long-term negative consequences for the developing child (2). Medication for Addiction Treatment (MAT), including buprenorphine, methadone, and naltrexone/vivitrol, are evidence-based treatments for OUD (3), and both buprenorphine and methadone are recommended during pregnancy (1). Despite the known benefits of MAT, many individuals with OUD, including pregnant people, do not receive treatment (4,5). The prevalence of MAT among individuals of reproductive age who identify as women seeking treatment in publicly funded substance use treatment centers is unknown.

Methods: This study uses data on admissions to publicly funded substance use treatment services from the 2015-2019 Treatment Episode Data Set-Admissions (TEDS-A) to identify the demographic, behavioral health, and treatment characteristics of women of reproductive age with OUD and planned receipt of MAT (methadone, buprenorphine, or naltrexone products). The analytic sample included women aged 12—49 years with no prior treatment episodes and a primary diagnosis of OUD (N = 153,830). In addition to descriptive statistics, we conducted logistic regression to identify characteristics associated with planned receipt of MAT. Approximately fifty-one percent of the sample was 25-34 years old and 79% identified as non-Hispanic White.

Results: At admission, 32.47% of the sample were enrolled in MAT. Of those receiving MAT, 8.06% were pregnant compared to 3.67% of women not receiving MAT. A little over half of pregnant women (51.38%, n = 3,953) received MAT. When adjusting for all other clinical and demographic characteristics, pregnancy status had the strongest positive association with receiving MAT (OR = 2.43, 95% CI [2.30, 2.56]). Compared to non-Hispanic whites, all other racial/ethnic groups had slightly higher odds of receiving MAT: non-Hispanic Black (OR=1.15, 95% CI [1.10, 1.20]) and Hispanic (OR=1.26, 95% CI [1.21, 1.32]). MAT was less likely to occur in residential (OR=0.17, 95% CI [0.16, 0.18]) or detoxification settings (OR=0.12, 95% CI [0.12, 0.13]) relative to ambulatory settings. Finally, MAT recipients were less likely to be referred from criminal justice (OR=0.15, 95% CI [0.14, 0.15]) or community/healthcare settings (OR=0.52, 95% CI [0.50, 0.53]) relative to being self-referred.

Conclusion: The majority of women of reproductive age seeking treatment for OUD in publicly funded treatment settings do not receive MAT, although being pregnant increased the likelihood of receiving MAT. This finding is promising in that buprenorphine and methadone improve pregnancy outcomes; however, the disparities in receipt of MAT by race, service setting, and referral source need to be further explored to identify ways to overcome barriers experienced by reproductive-aged women with OUD to receiving evidence-based treatment.

References: 1. ACOG Committee Opinion No. 524: Opioid abuse, dependence, and addiction in pregnancy. Obstet Gynecol, 2012. 119(5): p. 1070-6.
2. Floyd, R.L., et al., The clinical content of preconception care: alcohol, tobacco, and illicit drug exposures. Am J Obstet Gynecol, 2008. 199(6 Suppl 2): p. S333-9.
3. Medications for Opioid Use Disorder for Healthcare and Addiction Professions, Policymakers, Patients, and Families: Treatment Improvement Protocol: TIP 63. 2021: Rockville, MD.
4. Abraham AJ, Knudsen HK, Rieckmann T, Roman PM. Disparities in access to physicians and medications for the treatment of substance use disorders between publicly and privately funded treatment programs in the United States. J Stud Alcohol Drugs. 2013 Mar;74(2):258-65. doi: 10.15288/jsad.2013.74.258. PMID: 23384373; PMCID: PMC3568164.
5. Short VL, Hand DJ, MacAfee L, Abatemarco DJ, Terplan M. Trends and disparities in receipt of pharmacotherapy among pregnant women in publically funded treatment programs for opioid use disorder in the United States. J Subst Abuse Treat. 2018 Jun;89:67-74. doi: 10.1016/j.jsat.2018.04.003. Epub 2018 Apr 6. PMID: 29706175.