Public Health/Global Health
Poster Session 2
Allison Gurney-McMaster, MD (she/her/hers)
Fellow
University of Texas Southwestern Medical Center
Dallas, TX, United States
Emily J. Gregory, MD
University of Cincinnati Medical Center
Cincinnati, OH, United States
Christine Wilder, MD
University of Cincinnati Medical Center
Cincinnati, OH, United States
The primary outcome was to assess the differences in custody outcomes between patients compliant with medication-assisted therapy and those with illicit substance use at delivery at an urban safety net hospital.
Study Design:
This was a retrospective cohort study at a single center of all patients admitted for delivery between 1/1/2016 to 6/1/2021. De-identified data was collected from the medical record of these patients and linked to the delivered infants. All patients admitted for delivery had urine toxicology collected with voluntary opt-out. Patients were grouped based on confirmatory opioid toxicology with sub-groups of patients on medication-assisted therapy versus illicit use. Categorical data were compared using chi-squared or Fisher’s exact tests and numerical data compared using Wilcoxon rank-sum or Student’s t-tests. A logistic regression analysis was conducted based on the pre-defined outcome of custody.
Results:
Although urine toxicology testing is voluntary, no patients were identified without results. Of the 16,827 births, 790 had positive urine toxicology screens for opioids (4.7%). A total of 202 patients had a prescription for buprenorphine and 159 for methadone. Of these, 149 were positive for buprenorphine only and 78 for methadone only, 14 were negative for all opioids. The logistic regression showed that non-Hispanic white patients had significantly higher odds than individuals of all other races to receive full custody (OR= 3.5 [2.20-5.88]). Unemployed individuals had significantly lower odds of receiving full custody (OR=0.28 [0.16-0.50]). There was no statistical difference between the odds of receiving custody based on age, use of medication-assisted therapy, or being in the delivery hospital’s perinatal addiction clinic.
Conclusion:
This study showcases ongoing ethnic/racial disparities regarding custody outcomes and the possible negative effects of universal toxicology testing. The data suggests a lack of improved custody outcomes despite compliance with treatment. This indicates the need for further awareness and interventions to help decrease these inequities.