Naloxone Use During Pregnancy-Data From 26 US Jurisdictions, 2019-2020

Abstract

Objectives: We aimed to determine the prevalence of self-reported naloxone use during pregnancy among people in the United States with a recent live birth. A secondary objective was to characterize people at increased risk of overdose who did and did not use naloxone.

Methods: We analyzed data from the Pregnancy Risk Assessment Monitoring System from 26 US jurisdictions that conducted an opioid supplement survey from 2019 to 2020. Respondents with increased risk of experiencing an opioid overdose were identified based on self-reported use of illicit amphetamines, heroin, cocaine, or receiving medication for opioid use disorder (MOUD) during pregnancy. Weighted prevalence estimates and 95% confidence intervals were calculated for reported naloxone use at any point during pregnancy among people with an increased risk of overdose.

Results: Naloxone use during pregnancy was reported by <1% of the overall study population (unweighted N = 88/34,528). Prevalence of naloxone use was 5.0% (95% CI: 0.0-10.6) among respondents who reported illicit amphetamine use, 15.2% (1.8-28.6) among those who reported heroin use, and 17.6% (0.0-38.1) among those who reported cocaine use. Naloxone use was 14.5% (8.4-20.6) among those who reported taking MOUD. Among people with increased risk of overdose, no significant differences in naloxone use were observed by age, race/ethnicity, education level, residential metropolitan status, or insurance status.

Conclusions: Prevalence of naloxone use among people with an increased risk of overdose during pregnancy ranged from 5.0% to 17.6%. Access to naloxone, overdose prevention education, and treatment for substance use disorders may help reduce morbidity and mortality.

Figure:. Prevalence estimates and 95% confidence intervals of naloxone use during pregnancy among individuals at increased risk of overdose – 26 U.S. jurisdictions^a, 2019-2020^b

^a U.S. jurisdictions included in 2019 only: Colorado, Connecticut, Florida, Georgia, Iowa, Illinois, Kentucky, Louisiana, Missouri, New Hampshire, Oregon, Pennsylvania, Puerto Rico, Rhode Island, Tennessee, Utah. U.S. jurisdictions included in both 2019 and 2020: Alabama, District of Columbia, Kansas, Massachusetts, Maryland, North Dakota, South Dakota, Vermont, Washington, Wyoming. ^b Prevalence estimates were calculated based on the number of people reporting the use of naloxone out of all people in the sample who reported the use of each substance or medication (medications for opioid use disorder [MOUD], heroin, illicit amphetamines [including methamphetamine], or cocaine) during pregnancy. Use of any of these substances was not mutually exclusive.