Medicaid coverage for methadone improves treatment for opioid use disorder in pregnancy

November 14, 2017, Wolters Kluwer Health

Pregnant women with opioid use disorder (OUD) are more likely to receive evidence-based treatment with an "opioid agonist"—usually methadone—in states where those medications are covered by Medicaid, reports a study in the December issue of Medical Care.

"Our findings suggest that Medicaid coverage of maintenance should be considered a key policy strategy to support , their families, and enable their providers to deliver effective care," comments lead author Marcus A. Bachhuber, MD, of Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, N.Y.

"If we want to help children of women with addiction get the best possible start in life, we must give their mothers access to evidence-based medications during pregnancy," adds Laura J. Faherty, MD, of the RAND Corporation, Boston.

Medicaid Policy Affects Methadone Treatment Rate for OUD in Pregnancy

Opioid agonist therapy (OAT) is regarded as the standard of care for pregnant women with OUD. In addition to reducing illicit opioid use and relapse risk, OAT leads to better health outcomes for both the mother and baby. Yet studies suggest that OAT is used in less than half of pregnant women with OUD in the publicly funded treatment system.

Although a drug called buprenorphine is increasingly used, methadone is by far the most common form of OAT for pregnant women in the treatment facilities examined in the study. Opioid agonist treatment is given along with counseling and supportive services.

Using a Substance Abuse and Mental Health Services Administration database, Dr. Bachhuber and colleagues analyzed planned use of OAT in nearly 3,400 pregnant women starting publicly funded treatment for OUD in 2013-14. Rates of planned OAT use were compared for approximately 2,500 women in 18 states that covered methadone maintenance therapy versus 900 women in states that did not cover methadone. "State Medicaid programs have the power to add coverage of methadone maintenance in their benefit package," notes Brendan Saloner, PhD, of Johns Hopkins Bloomberg School of Public Health.

Seventy-one percent of pregnant women starting OUD treatment were 18 to 29 years old; 85 percent were non-Hispanic white and 56 percent used heroin. Overall, the treatment plan included opioid agonists for 53 percent of patients.

After adjustment for other factors, the rate of planned OAT use was about 61 percent for women in states with Medicaid coverage for methadone versus 28 percent in states that did not cover methadone: a difference of 33 percentage points.

Medicaid coverage of methadone was associated with higher rates of planned OAT in both intensive and non-intensive outpatient treatment settings, though not in residential settings. The researchers note that "several other patient, provider, and policy factors" likely also affected decisions about OAT.

The findings provide evidence that Medicaid coverage of methadone maintenance therapy leads to a higher rate of planned OAT in pregnant women—as previously shown in the general population of patients with OUD. The authors note some limitations of their study, including the lack of data from treatment centers that do not receive public funding.

As a matter of state and federal policy, expanding access to opioid agonists for pregnant women with OUD in the publicly funded system could be an important tool for dealing with the ongoing opioid crisis, Dr. Bachhuber and coauthors believe. They conclude, "While other barriers to OAT use persist, our findings suggest that including Medicaid coverage for methadone maintenance could significantly improve outcomes for pregnant women with OUD. "

Pooja K. Mehta, MD, of Boston University School of Medicine, adds: "Having affordable and reliable medical options for who seek recovery during pregnancy empowers providers and institutions to do the right thing during this critical and challenging moment for families."

Explore further: Opioid use disorder in pregnancy—Medication treatment improves outcomes for mothers and infants

More information: Marcus A. Bachhuber et al. Medicaid Coverage of Methadone Maintenance and the Use of Opioid Agonist Therapy Among Pregnant Women in Specialty Treatment, Medical Care (2017). DOI: 10.1097/MLR.0000000000000803

Related Stories

Opioid use disorder in pregnancy—Medication treatment improves outcomes for mothers and infants

April 14, 2017
Medication for addiction treatment (MAT) with buprenorphine or methadone is an appropriate and accepted treatment for pregnant women with opioid use disorder (OUD), according to a research review and update in the Journal ...

New study reveals some women with prenatal opioid dependence are not being treated

April 5, 2017
A new study by Queen's University researcher Susan Brogly (Surgery) has revealed that 25 per cent of women suffering from a prenatal opioid dependence were not being treated for their addiction. Using data from the Institute ...

Cannabis use may predict opioid use in women undergoing addictions treatment, study says

March 29, 2017
A new study suggests that the use of cannabis may impact treatment in women undergoing methadone treatment therapy.

ACOG: Opioid agonist Rx first choice in affected pregnancies

July 28, 2017
(HealthDay)—While opioid agonist pharmacotherapy continues to be the recommended therapy for pregnant women with an opioid use disorder, medically supervised withdrawal can be considered under the care of a physician experienced ...

Medicaid patients continue high prescription opioid use after overdose

August 22, 2017
Despite receiving medical attention for an overdose, patients in Pennsylvania Medicaid continued to have persistently high prescription opioid use, with only slight increases in use of medication-assisted treatment, according ...

More access to opioid treatment programs needed in Southeast, says study

March 30, 2017
In 2015, more than 30,000 Americans died from overdosing on opioids, and a new study led by the University of Georgia shows that one of the hardest hit populations-low-income Americans on Medicaid-isn't getting the help it ...

Recommended for you

Complex inhalers prevent patients from taking medicine

February 23, 2018
Respiratory disease patients with arthritis could struggle to manage their conditions because their inhalers are too fiddly for them to use, University of Bath research has found.

Opioid abuse leads to heroin use and a hepatitis C epidemic, researcher says

February 22, 2018
Heroin is worse than other drugs because people inject it much sooner, potentially resulting in increased risk of injection-related epidemics such as hepatitis C and HIV, a Keck School of Medicine of USC study shows.

Opioid addiction treatment behind bars reduced post-incarceration overdose deaths in RI

February 14, 2018
A treatment program for opioid addiction launched by the Rhode Island Department of Corrections was associated with a significant drop in post-incarceration drug overdose deaths and contributed to an overall drop in overdose ...

Heroin vaccine blocks lethal overdose

February 14, 2018
Scientists at The Scripps Research Institute (TSRI) have achieved a major milestone toward designing a safe and effective vaccine to both treat heroin addiction and block lethal overdose of the drug. Their research, published ...

Study shows NIH spent >$100 billion on basic science for new medicines

February 12, 2018
Federally funded research contributed to the science underlying all new medicines approved by the FDA over the past six years, according to a new study by Bentley University.

Opioid use increases risk of serious infections

February 12, 2018
Opioid users have a significantly increased risk of infections severe enough to require treatment at the hospital, such as pneumonia and meningitis, as compared to people who don't use opioids.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.