Estimating the impact on initiating medications for opioid use disorder of state policies expanding Medicaid and prohibiting substance use during pregnancy. (1st December 2021)

• Record Type: Journal Article
• Authors: Choi, Sugy; Stein, Michael D.; Raifman, Julia; Rosenbloom, David; Clark, Jack A.
• Is Part Of: Drug and alcohol dependence. Volume 229:Part A(2021)
• Publication Date: 2021-12-01
• Subjects: Pregnancy -- Health policy -- Medication-assisted treatment -- Punitive -- Women's rights; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2021.109162
• Languages: English
• ISSNs: 0376-8716

Abstract

Abstract: Background: Medicaid expansion increased access to addiction treatment services for pregnant women. However, states' imposition of civil or criminal child abuse sanctions for drug use during pregnancy could inhibit access to treatment. We estimated the effects of Medicaid expansion on pregnant women's medications for opioid use disorder (MOUD) use, and its interaction with statutes that prohibit substance use during pregnancy. Methods: Using the Treatment Episode Dataset for Discharge (2010–2018), we identified the initial treatment episode of pregnant women with opioid use disorder (OUD). We described changes in MOUD use and estimated adjusted difference-in-differences and event study models to evaluate differences in changes in MOUD between states that prohibit substance use during pregnancy and states that do not. Findings: Among a total of 16, 070 treatment episodes for pregnant women with OUD from 2010 to 2018, most (74%) were in states that expanded Medicaid. By one year post-expansion, the proportion of episodes receiving MOUD in states not prohibit substance use during pregnancy increased by 8.7% points (95% CI: 2.7, 14.7) from the pre-expansion period compared to a 5.6% point increase in states prohibiting substance use during pregnancy (95% CI: − 3.3, 14.8). In adjusted event study analysis, the expansion was associated with an increase in MOUD use by 15.3% by year 2 in states not prohibiting versus 1.5% percentage points in states prohibiting substance use during pregnancy, respectively. Conclusions: State policies prohibiting substance use during pregnancy may limit the salutary effects of Medicaid expansion for pregnant women who could benefit from MOUD treatment. Highlights: The prohibition of drug use has been increasing for pregnant women. Punitive policies can prevent Medicaid expansion effects for pregnant women. More research is needed to fathom the complexity of state policy interactions.