Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA 02118, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA.
Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA 02118, USA.
Drug Alcohol Depend. 2021 Dec 1;229(Pt A):109162. doi: 10.1016/j.drugalcdep.2021.109162. Epub 2021 Oct 29.
Medicaid expansion increased access to addiction treatment services for pregnant women. However, states' imposition of civil or criminal child abuse sanctions for drug use during pregnancy could inhibit access to treatment. We estimated the effects of Medicaid expansion on pregnant women's medications for opioid use disorder (MOUD) use, and its interaction with statutes that prohibit substance use during pregnancy.
Using the Treatment Episode Dataset for Discharge (2010-2018), we identified the initial treatment episode of pregnant women with opioid use disorder (OUD). We described changes in MOUD use and estimated adjusted difference-in-differences and event study models to evaluate differences in changes in MOUD between states that prohibit substance use during pregnancy and states that do not.
Among a total of 16,070 treatment episodes for pregnant women with OUD from 2010 to 2018, most (74%) were in states that expanded Medicaid. By one year post-expansion, the proportion of episodes receiving MOUD in states not prohibit substance use during pregnancy increased by 8.7% points (95% CI: 2.7, 14.7) from the pre-expansion period compared to a 5.6% point increase in states prohibiting substance use during pregnancy (95% CI: -3.3, 14.8). In adjusted event study analysis, the expansion was associated with an increase in MOUD use by 15.3% by year 2 in states not prohibiting versus 1.5% percentage points in states prohibiting substance use during pregnancy, respectively.
State policies prohibiting substance use during pregnancy may limit the salutary effects of Medicaid expansion for pregnant women who could benefit from MOUD treatment.
医疗补助计划的扩大增加了孕妇获得成瘾治疗服务的机会。然而，各州对孕妇怀孕期间使用药物实施民事或刑事儿童虐待制裁，可能会限制获得治疗的机会。我们评估了医疗补助计划扩大对孕妇使用阿片类药物使用障碍（MOUD）药物的影响，以及其与禁止怀孕期间使用药物的法规之间的相互作用。
使用出院治疗 episode 数据集（2010-2018 年），我们确定了患有阿片类药物使用障碍（OUD）的孕妇的初始治疗 episode。我们描述了 MOUD 使用的变化，并估计了调整后的差异差异和事件研究模型，以评估在禁止怀孕期间使用药物的州和不禁止怀孕期间使用药物的州之间 MOUD 变化的差异。
在 2010 年至 2018 年期间，共有 16070 例患有 OUD 的孕妇的治疗 episode，其中大多数（74%）来自医疗补助计划扩大的州。在扩张后的一年，在不禁止怀孕期间使用药物的州，接受 MOUD 的 episode 比例比扩张前增加了 8.7 个百分点（95%CI：2.7，14.7），而在禁止怀孕期间使用药物的州，增加了 5.6 个百分点（95%CI：-3.3，14.8）。在调整后的事件研究分析中，在不禁止怀孕期间使用药物的州，扩张与 MOUD 使用增加 15.3%相关，而在禁止怀孕期间使用药物的州，MOUD 使用增加了 1.5%个百分点。
禁止怀孕期间使用药物的州政策可能会限制医疗补助计划扩大对可能受益于 MOUD 治疗的孕妇的有益影响。
