Opioid use disorder (OUD) has been declared a public health crisis in the northern New England states for years, and one population requires particular care: pregnant patients. In 2018, only about half of pregnant persons were receiving consistent treatment, while another quarter had inconsistent treatment. Increasing these numbers would be essential to supporting pregnant patients with OUD, and Drs. Katherine Ahrens of USM and Marjorie Meyer of UVM aim to do just that.
Opioid use disorder (OUD) has been declared a public health crisis in the northern New England states for years, and one population requires particular care: pregnant patients. Drs. Katherine Ahrens of the University of Southern Maine and Marjorie Meyer of the University of Vermont recently published their paper, “Medication for Addiction Treatment and Postpartum Health Care Utilization Among Pregnant Persons with Opioid Use Disorder,” aimed at estimating the postpartum effects of treating persons during pregnancy for their OUD.
“I was surprised to see that about 20-25% of women did not appear to be using medication for addiction treatment during pregnancy.” - Dr. Katherine Ahrens
Indeed, in 2018, only about half of pregnant persons were receiving consistent treatment, while another quarter had inconsistent treatment. Increasing these numbers would be essential to supporting pregnant patients with OUD, as according to Katherine, “other evidence suggests medication for addiction treatment during pregnancy is the best option for treatment of OUD.” So what is medication for addiction treatment, and how does it help?
Medication for addiction treatment is the use of FDA-approved medications to treat addiction and has been particularly effective for the treatment of OUD. These medications are often used in combination with counseling or other behavioral therapy. Katherine and Marjorie found that pregnant patients consistently engaged in this type of treatment had lower rates of hospitalization or emergency department visits in their first year postpartum.
“Medication for addiction treatment use during pregnancy, particularly consistent use, also appears to lower the risk of acute care encounters in the first year postpartum. This suggests that women using this treatment have fewer events requiring this level of emergency care, indicating more stable health.” - Dr. Katherine Ahrens
In Maine, consistent use of this treatment was associated with up to 46% lower rates of emergency department visits, while there was a 30% decrease in rates for patients in Vermont. These findings highlight substantial and long-term health benefits for pregnant OUD patients. However, clinicians are still struggling to engage these patients in consistent treatment programs. In addition to only approximately half of pregnant patients with OUD in Maine and Vermont consistently engaging in medication for addiction treatment, many end up leaving within the first year postpartum.
“They stay in treatment through pregnancy, so just treatment is not the issue. Do they choose to leave, or are the demands of treatment—counseling, visits, compliance—too challenging for new moms and we need to rethink that?” - Dr. Marjorie Meyer
Beyond the demands of parenting, other factors may be influencing patients’ desire to remain in treatment. For example, over the course of this study, Vermont began to increase use of methadone in treatment as opposed to buprenorphine, while Maine did the opposite. Medication options and changes may influence whether an individual would want to partake in treatment, but researchers are still in the beginning of exploring the factors surrounding medication for addiction treatment during pregnancy.
“I have a lot of questions I could not really pursue without these data outlining that there is an issue with retention after delivery and we have to look carefully at treatment programming and options.” - Dr. Marjorie Meyer
Now, they have many new directions and projects to pursue. “We have so much more information with both states here than either state alone,” says Marjorie. Katherine also agrees that they are far from finished, and many more projects and initiatives are in the works. Katherine also highlighted that “the skills I gained from the NNE-CTR pilot project have certainly helped me acquire funding and build my analytic abilities.” The NNE-CTR provided financial support to collect and analyze the data reported in this paper and hopes to continue supporting research addressing addiction and maternal health in our region, with Katherine and Marjorie’s work as one integral piece of this larger goal.
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Read the Paper: Ahrens, KA, McBride, CA, O'Connor, A, & Meyer, MC (2021). Medication for Addiction Treatment and Postpartum HealthCare Utilization Among Pregnant Persons With Opioid Use Disorder. Journal of Addiction Medicine.