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. 2020 May 1;3(5):e205734.
doi: 10.1001/jamanetworkopen.2020.5734.

Assessment of Racial and Ethnic Disparities in the Use of Medication to Treat Opioid Use Disorder Among Pregnant Women in Massachusetts

Davida M Schiff  1 , Timothy Nielsen  2 , Bettina B Hoeppner  3 , Mishka Terplan  4 , Helena Hansen  5 , Dana Bernson  6 , Hafsatou Diop  6 , Monica Bharel  6 , Elizabeth E Krans  7 , Sabrina Selk  6 , John F Kelly  5 , Timothy E Wilens  8 , Elsie M Taveras  1
Affiliations

Assessment of Racial and Ethnic Disparities in the Use of Medication to Treat Opioid Use Disorder Among Pregnant Women in Massachusetts

Davida M Schiff et al. JAMA Netw Open. .

Abstract

Importance: Racial and ethnic disparities persist across key health and substance use treatment outcomes for mothers and infants. The use of medications, such as methadone or buprenorphine, for the treatment of opioid use disorder (OUD) has been associated with improvements in the outcomes of mothers and infants; however, only half of all pregnant women with OUD receive these medications. The extent to which maternal race or ethnicity is associated with the use of medication to treat OUD, the duration of the use of medication to treat OUD, and the type of medication used to treat OUD during pregnancy are unknown.

Objective: To examine the extent to which maternal race and ethnicity is associated with the use of medications for the treatment of OUD in the year before delivery among pregnant women with OUD.

Design, setting, and participants: This retrospective cohort study used a linked population-level statewide data set of pregnant women with OUD who delivered a live infant in Massachusetts between October 1, 2011, and December 31, 2015. Of 274 234 total deliveries identified, 5247 deliveries among women with indicators of having OUD were included in the analysis. Maternal race and ethnicity were defined as white non-Hispanic, black non-Hispanic, or Hispanic based on self-reported data on birth certificates.

Main outcomes and measures: Main outcomes were the receipt of any medication for OUD, the consistency of the use of medication (at least 6 continuous months of use before delivery, inconsistent use, or no use) for the treatment of OUD, and the type of medication (methadone or buprenorphine) used to treat OUD. Multivariable models were adjusted for maternal sociodemographic characteristics, comorbidities, and any significant interactions between the covariates and race and ethnicity.

Results: The sample included 5247 pregnant women with OUD who delivered a live infant in Massachusetts during the study period. The mean (SD) maternal age at delivery was 28.7 (5.0) years; 4551 women (86.7%) were white non-Hispanic, 462 women (8.8%) were Hispanic, and 234 women (4.5%) were black non-Hispanic. A total of 3181 white non-Hispanic women (69.9%) received any type of medication for the treatment of OUD in the year before delivery compared with 228 Hispanic women (49.4%) and 108 black non-Hispanic women (46.2%). Compared with white non-Hispanic women, black non-Hispanic and Hispanic women had a substantially lower likelihood (adjusted odds ratio [aOR], 0.37; 95% CI, 0.28-0.49 and aOR, 0.42; 95% CI, 0.35-0.52, respectively) of receiving any medication for the treatment of OUD. Stratification by maternal age identified greater disparities among younger women. Black non-Hispanic and Hispanic women also had a lower likelihood (aOR, 0.24; 95% CI, 0.17-0.35 and aOR, 0.34; 95% CI, 0.27-0.44, respectively) of consistent use of medication for the treatment of OUD compared with white non-Hispanic women. With respect to the type of medication used to treat OUD, black non-Hispanic and Hispanic women had a lower likelihood (aOR, 0.60; 95% CI, 0.40-0.90 and aOR, 0.77; 95% CI, 0.58-1.01, respectively) than white non-Hispanic women of receiving buprenorphine treatment compared with methadone treatment.

Conclusions and relevance: This study found racial and ethnic disparities in the use of medications to treat OUD during pregnancy, with black non-Hispanic and Hispanic women significantly less likely to use medications consistently or at all compared with white non-Hispanic women. Further investigation of patient, clinician, treatment program, and system-level factors associated with these findings is warranted.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Nielsen reported receiving grants from the Centers for Disease Control and Prevention during the conduct of the study. Dr Krans reported receiving grants from Gilead Sciences, Merck, and the National Institutes of Health outside the submitted work. Dr Wilens reported receiving grants from the National Institute on Drug Abuse, National Institutes of Health; other from Cambridge University Press, Guilford Press, Ironshore, KemPharm, Otsuka Pharmaceutical, and Vallon Pharmaceuticals; personal fees from Bay Cove Human Services, the Gavin Foundation, US Major League Baseball, US Minor League Baseball, and the US National Football League outside the submitted work; and receiving royalties as a co-owner (with Ironshore) of the patent for the Before School Functioning Questionnaire, a copyrighted diagnostic questionnaire. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Flowchart
NAS indicates neonatal abstinence syndrome, and OUD, opioid use disorder.
Figure 2.
Figure 2.. Adjusted Odds Ratios for Extent of Medication Use and Type of Medication Used for Treatment of OUD in Pregnant Women
A, Extent of medication use. Adjusted for age, educational level, rural residence, enrollment in Medicaid (MassHealth) during the month of delivery, depression/anxiety diagnosis, emergency department use, and opioid prescription. B, Type of medication used. Adjusted for age, educational level, rural residence, enrollment in Medicaid (MassHealth) during the month of delivery, depression/anxiety diagnosis, emergency department use, and opioid prescription. aOR indicates adjusted odds ratio, and OUD, opioid use disorder.
See this image and copyright information in PMC

References

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