White Individuals Are More Likely to Receive Medication for Opioid Use Disorder During and After Pregnancy Than Black and Hispanic Individuals

Administration of the medications for opioid use disorder (MOUDs) methadone and buprenorphine during pregnancy can reduce fetal risks associated with exposure to illicit opioids. MOUDs also reduce the risk of maternal overdose during and after pregnancy, when the risk is highest. The earlier in pregnancy MOUD is initiated, the more likely it is to be continued post-birth. This study used Medicaid data on pregnant persons with a diagnosis of OUD from 6 US states to investigate the receipt of MOUD and the proportion of days covered (PDC) during and after pregnancy, by race.

• White individuals were more likely to receive any MOUD in the first 90 days post-partum than Hispanic and Black individuals (61 percent, 53 percent, and 33 percent receiving MOUD, respectively).
• White individuals received MOUD earlier than Hispanic and Black individuals (MOUD receipt at 69, 72, and 91 average days’ gestation, respectively).
• White individuals were more likely to be prescribed buprenorphine, compared with the other groups.
• Black individuals were more likely to receive methadone than White or Hispanic individuals, but had substantially lower PDC for methadone compared with those other groups (0.09, 0.16, and 0.18 PDC, respectively).

Comments: This study reinforces previous studies showing disparities within the US healthcare system. In the US, methadone is highly regulated and must initially be dosed daily at a certified opioid treatment program, whereas buprenorphine can be prescribed and dispensed monthly at a pharmacy. The proportion of Black individuals receiving methadone may partially explain the reduced proportion of days covered in this population, given the pervasive barriers to accessing this medication in the US.

Corey McBrayer, DO, MPH* & Darius A. Rastegar, MD

* 2022–23 Rich Saitz Editorial Intern & Grant Medical Center Addiction Medicine Fellow, OhioHealth.

Reference: Austin AE, Durrance CP, Ahrens KA, et al. Duration of medication for opioid use disorder during pregnancy and postpartum by race/ethnicity: results from 6 state Medicaid programs. Drug Alcohol Depend. 2023;247:109868.