COVID-19, health systems and vulnerable populations: Policies affecting maternal opioid use during pregnancy

Abstract: The current COVID-19 pandemic creates many challenges for individuals and health care systems in the United States. To make matters worse, the pandemic is occurring in the midst of a public health crisis of opioid use disorder and overdose during pregnancy. Between 2010 and 2017, the incidence of maternal opioid-related diagnoses increased from 3.5 to 8.2 per 1000 hospital live births per year. Maternal opioid use during pregnancy is associated with increased risks of prolonged hospital stay, placental abruption, poor fetal growth, preterm labor, premature delivery, stillbirth, neonatal abstinence syndrome, and maternal death. State responses regarding maternal opioid use during pregnancy prior to the COVID-19 pandemic have varied widely and included: 1) creation of funded drug-treatment programs specifically for pregnant women, 2) priority access to state-funded treatment programs, 3) mandated reporting and drug screening by healthcare professionals, and 4) criminalization of opioid use during pregnancy or grounds for commitment. However, these policies are unlikely to remain static, especially during the current COVID-19 pandemic. The need for social distancing has led to policy changes related to treatment of opioid use disorder more generally, such as easing methadone dispensing rules and making it easier for patients to initiate buprenorphine treatment from an opioid treatment center. These changes are not mandatory, however, and system-level gains in access to medication assisted treatment (MAT) may be eliminated as the pandemic subsides. In addition, little is known about the extent to which policies related to maternal opioid use during pregnancy are changing during the COVID-19 pandemic, or the extent to which such changes affect maternal and child healthcare treatment, outcomes and costs. Thus, the aims of this study are to 1) examine how state policies related to maternal opioid use during pregnancy have changed in response to the COVID-19 pandemic, and 2) examine the effects of COVID-19-related changes in state policies regarding maternal opioid use on patterns of healthcare service use, maternal and child outcomes, and healthcare costs. By thoroughly examining the policy responses to the COVID-19 pandemic and linking these data to detailed claims data describing healthcare service use of women who use opioids during pregnancy and their newborns, we will be able to provide critical data to providers, insurers, health systems, and policymakers as they design treatment processes and policies to provide adequate pregnancy and substance use care to this vulnerable population to mitigate these two public health crises.