The effects of state policies on opioid use disorders in pregnant women: prevalence, treatment and outcomes

The COVID-19 pandemic has fundamentally changed the way healthcare is delivered in the United States. The need for social distancing has led to fewer in-person interactions between providers and patients. While some of these changes in the way care is delivered have been documented, such as the easing of methad one dispensing rules, little is known about how the care of pregnant women with an opioid use disorder has been affected. The goal of this competitive revision supplement application is to conduct a qualitative analysis of how care of pregnant women with an opioid use disorder is changing in response to the COVID-19 pandemic, and whether these changes are affected or attenuated by existing state policies. The aims of the funded parent R01 project are to: 1) examine the effects of state policies related to the treatment of pregnant women with an opioid use disorder on the prevalence of opioid use disorders in pregnant women; 2) examine the effects of state policies on patterns of healthcare treatment and costs, both for prenatal care and opioid-related treatment; and 3) examine the effects of state policies on maternal and child outcomes for pregnant women with an opioid use disorder. We are currently gathering information on current and historical state policies, and will then link these data to Medicaid and private insurance claims data to explore the associations ofpolicy characteristics with healthcare treatment, maternal and child outcomes, and costs. However, because currently available claims data are at least a few years old, the parent R01 is limited to studying the effects of pre-COVID-19 policies. The analyses proposed in this competitive revision supplement will focus on more contemporary COVID-related changes in these policies and how they affect the treatment of pregnant women with an opioid use disorder. The proposed qualitative study, while being well within the scope of the parent R01, will extend and inform ongoing analyses related to the effects of state policies on the treatment of pregnant women with an opioid use disorder by providing a more detailed picture of how policies affect treatment than is available in claims data. In particular, observing how treatment changes in response to COVID-19 vary across states with more restrictive versus more supportive pre-COVID-19 policies related to the treatment of pregnant women with an opioid use disorder will provide valuable information about the effects of these policies, significantly enhancing the parent R01. Such information will be critical for policy makers in their search for the most effective ways to engage this vulnerable population in treatment and improve the well-being of women with opioid use disorders and their children.