Women and Addiction
By MELANIE KILGORE-HILL
Study Finds Expectant Moms Struggle to Access Treatment
Women are struggling to access addiction treatment, and expectant moms are having an even tougher time receiving care. Those findings are the results of a recent study by Vanderbilt University Medical Center published recently in JAMA Open.
According to a release from VUMC, the "secret shopper" study used trained actors attempting to get into treatment with an addiction provider in 10 U.S. states. The results, with more than 10,000 unique patients, revealed numerous challenges in scheduling a first-time appointment to receive medications for opioid use disorder, including finding a provider who takes insurance rather than cash. Overall, pregnant women were about 20 percent less likely to be accepted for treatment than nonpregnant women.
Providers in the study were randomly selected from government lists of persons providing either buprenorphine or methadone treatment for opioid addiction. A total of 10,871 unique patient profiles of pregnant vs. nonpregnant women and private vs. public insurance were randomly assigned to 6,324 clinicians or clinics. About a quarter of the time, callers tried at least five times to reach a provider without success; another 20 percent of the time they reached a provider who didn't provide addiction treatment. A large portion of the clinicians from 10 states did not accept insurance and required cash payment for an appointment.
"As a neonatologist, I've been working for nearly a decade to try to understand the impact the opioid crisis has had on infants. One thing I've learned is that if you want to help the baby, you have to help the mother first," said Stephen Patrick, MD, study author and director of the Center for Child Health Policy at Vanderbilt University School of Medicine. Patrick said results were especially alarming since women were from best-case scenarios - those actively trying to receive treatment.
Conducted in 2019, the study looked at both reproductive-aged women who were and were not pregnant, as well as insured vs. uninsured. Patrick said results are especially stark given Tennessee's Safe Harbor Act, which operates under the assumption that an expectant woman can receive treatment for addiction.
Now, he said, we need more ways to bridge the narrowing gap between obstetrics and addiction, starting with more providers willing to prescribe buprenorphine. Currently less than two percent of obstetricians nationwide are waivered to prescribe the treatment, and Patrick urges more family medicine and obstetricians to receive training or to proactively partner with OBs and clinicians already prescribing.
"Understand where to refer patients if you're not comfortable with them," he urged. In Nashville, women can receive treatment at the Vanderbilt Maternal Addiction Recovery Program, which also collaborates with local non-profit Renewal House.
VUMC also is partnering to launch the CMS Maternal Opioid Misuse Model July 2021. Now in its planning phase, the MOM Model focuses on 26 rural and urban counties to improve outcomes for women with opioid use disorder and their infants beginning in pregnancy and extending to one year postpartum.
"The take-away is that pregnant women in particular often find themselves in a place where they're cared for by an OB who's not comfortable caring for addiction or an addiction medicine physician not comfortable caring for pregnancy," Patrick said. "Right now it's hard for the most important population to get help, so we need to do a better job. Recovery is possible ... you just have to provide people with the resources to get there."