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

国家政策对孕妇阿片类药物使用障碍的影响：患病率、治疗和结果

• 批准号: 9797769
• 负责人: DOUGLAS L. LESLIE
• 金额: $ 40万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9797769
• 关键词: effects; state; policies; opioid; use

Abstract The current opioid crisis has resulted in increases in opioid use and abuse during pregnancy that parallel national trends of substance use. Between 2000 and 2012, the incidence of maternal opioid use during pregnancy increased from 1.19 to 5.77 per 1000 hospital live births per year. Maternal opioid use during pregnancy is associated with increased risks of prolonged hospital stay, maternal death, placental abruption, poor fetal growth, preterm labor, premature delivery, and stillbirth. Maternal opioid use can also result in neonatal abstinence syndrome (NAS), an opioid withdrawal condition occurring in 55-94% of infants whose mothers used opioids in pregnancy, the incidence of which has increased over the past decade. Opioid prescribing practices, rates of opioid use in pregnancy, and incidence of NAS vary substantially between states, suggesting that state policies may affect maternal, fetal, and neonatal outcomes. Indeed, state responses regarding treatment of opioid use disorders in pregnancy have varied widely and included creation of funded drug-treatment programs specifically for pregnant women, priority access to state-funded treatment programs, mandated reporting and drug screening by healthcare professionals, and criminalization of the behavior with grounds for commitment. While a public health response to the opioid epidemic has been proposed in favor of punitive action, evidenced-based data about what specific public health strategies result in the best outcomes for opioid-using mothers and their infants are limited. We propose to use two large, national databases to better understand the effects of these state policies on the prevalence of OUD in pregnant women, as well as patterns of prenatal and OUD care utilization, pregnancy complications and adverse outcomes, and costs. By using data from the MarketScan® Commercial Claims and Encounters and the Medicaid Analytic eXtract (MAX) files, this study will provide a comprehensive assessment of the effects of these policies on maternal and neonatal outcomes in pregnant women with OUD. This proposal, responsive to AHRQ’s Special Emphasis Notice (NOT-HS-18-015) calling for research to evaluate “state, local, and health system policy efforts to address the opioids crisis,” will address the following aims: 1) Examine the effects of state policies governing the treatment of pregnant women with OUD on the prevalence of OUD in pregnant women; 2) Examine the effects of state policies on patterns of treatment and costs, both for prenatal care and OUD treatment, for pregnant women with OUD; and 3) Examine the effects of state policies on maternal and child outcomes and costs for pregnant women with OUD. This study will take advantage of a unique set of databases that will allow for a comprehensive examination of the effects of state policies on treatment patterns and maternal and neonatal outcomes for pregnant women with OUD. The information generated from the study will be crucial to providers, insurers and policymakers as they design treatment processes and policies to provide adequate pregnancy and OUD care to this vulnerable population.

抽象的 当前的阿片类药物危机导致怀孕期间阿片类药物使用和滥用的增加 平行的国家使用物质趋势。在2000年至2012年之间，孕产妇阿片类药物的使用事件 妊娠每年从1.19增加到每1000例医院活产。孕产妇阿片类药物在 怀孕与长期住院，生物死亡，plape骨出现的风险增加有关， 胎儿的生长不良，早产，早产和死产。母亲阿片类药物的使用也可能导致 新生儿禁欲综合征（NAS），这是55-94％的婴儿的阿片类药物戒断疾病 母亲在怀孕中使用了阿片类药物，在过去的十年中，这一事件有所增加。 处方习惯，怀孕的阿片类药物使用率和事件NA之间的差异很大 国家表明，国家政策可能会影响母校，胎儿和新生儿结局。确实，国家回应 有关妊娠中阿片类药物使用障碍的关注治疗差异很大，包括创建资助 专门针对孕妇的药物治疗计划，优先获得国家资助的治疗 计划，医疗保健专业人员的规定报告和药物筛查以及将 行为与承诺的理由。虽然对阿片类药物流行的公共卫生反应 提议采​​取惩罚性行动，基于惩罚性行动，以了解哪些特定公共卫生策略 对于使用阿片类药物的母亲及其婴儿的最佳结果受到限制。我们建议使用两个大型 国家数据库，以更好地了解这些国家政策对怀孕中OUD普遍存在的影响 妇女以及产前和OUD护理利用，妊娠并发症和不良的模式 成果和成本。通过使用MarketScan®商业索赔和相遇的数据以及 医疗补助分析提取（MAX）文件，本研究将对 这些关于OUD孕妇的母亲和新生儿结局的政策。该提议，响应 AHRQ的特别重点通知（NOT-HS-18-015）呼吁进行研究以评估“州，地方和健康 系统政策努力解决阿片类药物危机，”将解决以下目的：1）检查 政策管理孕妇对孕妇的待遇 女性; 2）检查国家政策对产前护理和成本模式的影响 OUD治疗，适用于Oud的孕妇； 3）检查国家政策对孕产妇和 OUD孕妇的儿童结果和费用。这项研究将利用一套独特的 数据库将允许对国家政策对治疗方式的影响进行全面检查 OUD孕妇的母亲和新生儿结局。从 研究对提供者，确保和政策制定者设计治疗过程和政策至关重要 为这一脆弱人群提供足够的怀孕并照顾。