Impact of Prenatal Substance Use Policies on Commercially Insured Pregnant People with Opioid Use Disorder
Table of Contents
Table of Contents
Report Publish Date: September 2022
This research article describes a study investigating the impact of prenatal substance use policies on pregnant women’s access to treatment for opioid use disorder.
Primary Takeaways
The researchers found that policies that criminalized prenatal substance use or defined it as child maltreatment led to a 12% reduction in psychotherapy and 30% reduction in methadone services for pregnant women with opioid use disorder.
States that criminalized prenatal substance use had a 45% increase in opioid overdoses.
Policies that funded substance use disorder treatment for pregnant women led to an 11% increase in opioid use disorder medication and a 45% decrease in opioid overdoses.
Policies that gave pregnant women priority treatment for substance use disorder did not have a statistically significant impact on outcomes.
Overview and Objectives
States have responded to the rise in prenatal opioid use with a mix of policies. Some state policies take a punitive approach by criminalizing prenatal substance use or defining it as child maltreatment. Other policies are supportive, either by giving pregnant women priority in substance use disorder programs or funding substance use disorder treatment targeted at pregnant women. The authors wanted to know how these state policies affect access to substance abuse treatment for women with opioid use disorder who have commercial health insurance.
Hypothesis or Approach
The authors analyzed data from the 2006–2019 MarketScan Commercial Claims and Encounters database. They studied 15- to 45-year-old women who had at least one diagnosis of opioid use disorder. They collected information on state policies from Guttmacher Institute, the Administration for Children and Families, and other sources.
How This Influences Change
“Our findings support the recommendations made by leading medical organizations who oppose punitive policies and emphasize efforts that focus on rehabilitation and treatment to minimize adverse health outcomes associated with substance use disorder,” the authors write.
Research: Go Deeper
States' approaches to addressing prenatal substance use are widely heterogeneous, ranging from supportive policies that enhance access to substance use disorder (SUD) treatment to punitive policies that criminalize prenatal substance use. We studied the effect of these prenatal substance use policies (PSUPs) on medications for opioid use disorder (OUD) treatment, including buprenorphine, naltrexone, and methadone, psychosocial services for SUD treatment, opioid prescriptions, and opioid overdoses among commercially insured pregnant females with OUD. We evaluated: (1) punitive PSUPs criminalizing prenatal substance use or defining it as child maltreatment; (2) supportive PSUPs granting pregnant females priority access to SUD treatment; and (3) supportive PSUPs funding targeted SUD treatment programs for pregnant females.
Our analytical sample comprised 2,438,875 person-quarters from 164,538 unique females, of which 13% were pregnant at least once during the study period. We found that following the implementation of PSUPs funding targeted SUD treatment programs, the proportion of opioid overdoses decreased 45% and of any OUD medication increased 11%, with buprenorphine driving this increase (13%). The implementation of SUD treatment priority PSUPs was not associated with significant changes in outcomes. Following punitive PSUP implementation, the proportion receiving psychosocial services for SUD (12%) and methadone (30%) services decreased. In specifications that estimated the impact of criminalizing policies only, the strongest type of punitive PSUP, opioid overdoses increased 45%.
Our findings suggest that supportive approaches that enhance access to SUD treatment may effectively reduce adverse maternal outcomes associated with prenatal opioid use. In contrast, punitive approaches may have harmful effects. These findings support leading medical organizations' stance on PSUPs, which advocate for supportive policies that are centered on increased access to SUD treatment and safeguard against discrimination and stigmatization. Our findings also oppose punitive policies, as they may intensify marginalization of pregnant females with OUD seeking treatment.
JSAT, September 2022. DOI: 10.1016/j.jsat.2022.108800
Research Team
This study and report was conducted and created by the following people.
- Tabatabaeepoura N
- Morgan JR
- Jalali A
- Kapadiaa SN
- Meinhofer A
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