There are significant geographic variations in the patterns of opioid use disorder (OUD) diagnosis and treatment in pregnant women, according to cohort study data published in JAMA Network Open.

Investigators conducted a retrospective observational study of a cohort derived from a 10% sample of enrollees in the IQVIA PharMetrics Plus adjudicated claims and enrollment database from 2007 to 2015 (n=12,416,600). The database consists information gathered from health plans and self-insured employer groups in the United States and is thus representative of the commercially insured national population. The final analytical cohort comprised women (n=110,285) between age 18 and 45 with a diagnostic code indicating a delivery and continuous insurance enrollment 9 months before and 12 months after delivery. Women were classified into 4 different regions based on state of residence: South, Midwest, West, or Northeast. As primary outcome measures, investigators captured diagnosis of OUD in the 9 months before delivery and the receipt of medication-assisted treatments in the 9 months before or 12 months after delivery.

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The study cohort had a mean (SD) age of 30.26 (5.59), with most women (n=67,771; 61.5%) within the 26- to 35-year age range. Of 110,285 participants, 277 (0.25%) had a diagnosis of OUD and 312 (0.28%) received medication-assisted treatment. Of the 277 women with OUD, 127 (45.9%) received treatment. The prevalence of an OUD diagnosis varied significantly by region (Midwest, 0.05%; Northeast, 0.09%; South, 0.06%; West, 0.06%; P <.001). The prevalence of treatment receipt within regions was also statistically significant (Midwest, 0.05%; Northeast, 0.08%; South, 0.10%; West, 0.05%; P <.001). The prevalence of OUD diagnosis also differed significantly between states with statues that imposed civil or criminal penalties for OUD diagnosis during pregnancy (0.07%) compared with states that did not (0.18%) (P <.001). OUD treatment prevalence also varied by criminal statutes, although the difference was not statistically significant (P =.76).

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Given that these data only represent women with private insurance, results must be extrapolated with care. Even so, significant variations in treatment availability by region merit further investigation. Efforts to reduce stigma and increase OUD identification during pregnancy are necessary to combat the opioid epidemic.


Gressler LE, Shah S, Shaya FT. Association of criminal statutes for opioid use disorder with prevalence and treatment among pregnant women with commercial insurance in the United States. JAMA Netw Open. 2019;2(3):e190338.