Yale School of Medicine, New Haven, Connecticut; the Department of Emergency Medicine, Center for Emergency Care and Policy Research, and the Urban Health Lab, University of Pennsylvania Perelman School of Medicine, and the Leonard Davis Institute of Health Economics, Wharton School of the University of Pennsylvania, Philadelphia, Pennsylvania; the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut; and the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV and HIV New York, New York.
Obstet Gynecol. 2021 Apr 1;137(4):687-694. doi: 10.1097/AOG.0000000000004307.
To describe trends and factors associated with medication administration for opioid use disorder (OUD) and retention in treatment among pregnant women with OUD.
This is a retrospective, nationwide, cross-sectional analysis of treatment episodes for primary OUD among pregnant women from 2013 to 2017. The primary outcome was initiation of methadone, buprenorphine, or naltrexone. Secondary outcomes were retention in treatment defined as length of treatment episode lasting six months or greater, and completion of treatment. Descriptive statistics and logistic regression were applied to describe trends in, and identify factors associated with the outcomes.
There were 42,239 treatment episodes for primary OUD among pregnant women who reported using heroin (65.0%, 27,459), synthetic opioid (33.2%, 14,034), or nonprescribed methadone (1.8%, 746) between 2013 and 2017. Medications for OUD were administered in 47.4% (20,013) of episodes. Retention in treatment occurred in 16.6% of episodes without medications for OUD, and 37.8% of episodes with medications for OUD (P=.01). The rate of medication administration for OUD increased from 41.0% in 2013 to 52.0% in 2017; however, retention rates declined from 39.0% to 33.0% among treatment episodes with medication for OUD. History of at least one prior treatment episode was associated with both administration of medications for OUD and retention in treatment.
In spite of current guidelines, most treatment episodes for OUD during pregnancy did not involve administration of medications for OUD. Although administration of medications for OUD has improved over time, retention in treatment is lagging. These findings highlight gaps in the U.S. addiction care system.
描述患有阿片类药物使用障碍（OUD）的孕妇接受药物治疗以治疗 OUD 以及维持治疗的趋势和相关因素。
这是一项对 2013 年至 2017 年期间患有原发性 OUD 的孕妇进行的治疗期回顾性、全国性、横断面分析。主要结局是开始使用美沙酮、丁丙诺啡或纳曲酮。次要结局是维持治疗，定义为治疗期持续六个月或更长时间，以及完成治疗。采用描述性统计和逻辑回归来描述趋势，并确定与结果相关的因素。
在 2013 年至 2017 年间，报告使用海洛因（65.0%，27459 例）、合成阿片类药物（33.2%，14034 例）或非处方美沙酮（1.8%，746 例）的患有原发性 OUD 的孕妇中，有 42239 例治疗期接受了 OUD 治疗。在没有 OUD 治疗药物的治疗期中，有 16.6%的治疗期维持治疗，而有 OUD 治疗药物的治疗期中，有 37.8%的治疗期维持治疗（P=.01）。尽管 2013 年 OUD 治疗药物的使用率为 41.0%，但到 2017 年已上升至 52.0%；然而，有 OUD 治疗药物的治疗期中，保留率从 39.0%下降到 33.0%。至少有一次既往治疗期的病史与 OUD 治疗药物的使用和维持治疗均相关。
尽管有当前的指南，但在妊娠期间治疗 OUD 的大多数治疗期并未涉及 OUD 治疗药物的使用。尽管 OUD 治疗药物的使用随着时间的推移有所改善，但保留治疗的情况仍在滞后。这些发现突显了美国成瘾治疗系统中的差距。
