Opioid use disorder is a growing cause of maternal mortality in the United States. Between 2018 and 2021, overdose mortality rates more than tripled among pregnant and postpartum women ages 35-44 years. Although medication for opioid use disorder is the standard of care both during and after pregnancy, is safe for parent and baby, and reduces the risk of death, pregnant people with opioid use disorder face numerous challenges in accessing treatment. Our recent study, supported by a Small Business Innovation Research contract from the National Institute on Drug Abuse and published in JAMA Network Open, indicates it doesn’t need to be this way.
The results of the study reveal significant outcomes for perinatal participants
We assessed treatment outcomes among pregnant people receiving telemedicine treatment for opioid use disorder at Workit Health from 2018-2022. Our model of care, founded and designed by individuals in recovery, is low-barrier: we provide patient-centered care through app-based medical and behavioral health visits and treat co-occurring conditions when feasible. The findings were striking. The sample was comprised of 94 pregnant people across multiple states, with 79% receiving Medicaid, 22% residing in rural areas, and high rates of mental health conditions and polysubstance use. Eighty percent of pregnant patients had continuous addiction care throughout pregnancy. The vast majority, 92%, maintained telemedicine treatment throughout pregnancy, and 8% transferred their addiction treatment to their prenatal provider before delivery. Furthermore, among those who stayed with telemedicine, 94% remained in care in the six weeks following pregnancy; this is important because research has indicated that the year after pregnancy is the riskiest period for overdose and adverse events.
Why might telemedicine be so impactful for this population?
The study, while small, speaks to the promise of innovative care models and technology to expand access to treatment for opioid use disorder among this high-risk population. Pregnant people face myriad barriers in obtaining addiction care, largely driven by stigma, logistical challenges like transportation and childcare, and state policies like mandatory reporting to child protective services agencies. Together, these can prevent pregnant people from seeking addiction care altogether and, nationally, only about a third of pregnant people with opioid use disorder receive treatment. For pregnant people in jails, the situation is even worse, with many carceral settings not offering medication at all, forcing pregnant individuals to experience opioid withdrawal and increasing the risk of overdose. Yet telemedicine holds the potential to eliminate many, though not all, of these challenges. For example, patients can connect to telemedicine treatment without the need for transportation or childcare and without being subject to stigma from providers and staff in traditional healthcare settings. Additionally, telemedicine can be an avenue in otherwise resource-limited settings, such as rural areas and jails.
To be sure, much work needs to be done and not all telemedicine practices are the same. But this study offers a glimmer of hope into how we might reduce the astonishingly high rates of maternal mortality among pregnant people with opioid use disorder. As the Drug Enforcement Agency works on long-term rules for the prescribing of controlled substances in the post-pandemic era, maintaining access to low-threshold and evidence-based treatments for opioid use disorder remains critical to preventing overdose. The technology exists and the medications are effective. It’s time to leverage telemedicine to save maternal lives from opioid use disorder.
