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.
