(1166) Statewide Patterns of Opioid Use Disorder Diagnosis and Treatment in Nulliparous, Term, Singleton, Vertex Pregnancies

To assess regional variation in rates of identified opioid use disorder (OUD) and treatment for OUD with medication for OUD (MOUD) in birthing people across Michigan.

Study Design:

We performed a retrospective cohort study of 90,217 birthing people with a nulliparous, term, singleton, vertex (NTSV) pregnancy. Eligible individuals had a vaginal or cesarean birth at one of 62 Michigan birthing hospitals between 1/1/2020 and 1/31/2023. Birthing people were categorized by status of OUD, treatment with MOUD, and MOUD type. Individuals with a postpartum length of stay > 7 days were excluded. We used basic descriptive statistics and tests of comparison between groups based on OUD diagnosis and type of MOUD. We created geocoded heat maps of OUD diagnosis and receipt of MOUD by region. 

Results:

The rate of OUD was 0.33% (300/90,217). Patients with OUD were older, more likely to have Medicaid insurance, and use other substances (alcohol, tobacco and marijuana) compared to the general population (p < 0.01). Among patients with OUD, 69% (207/300) received MOUD. The most common MOUD was buprenorphine (62%, 129/207), followed by methadone (36%, 75/207) and naltrexone (1.5%, 3/207). The proportion of patients with diagnosed OUD ranged from 0.35-1.36%. The proportion of patients with OUD receiving MOUD ranged from 58.6-95.5%. The region with the highest number of birthing patients with OUD (n=128/300) had one of the lowest rates of MOUD (n= 75/207, 58.6%).

Conclusion:

There is a mismatch between regions with the highest burden of OUD and utilization of MOUD. Though the majority of NTSV patients with OUD received MOUD, almost one-third of patients did not. Future work is needed to understand the individual and system-level factors that influence patients’ access to MOUD.